Causes Of Challenging Behaviour Research Articles

ProVIA-Kids - outcomes of an uncontrolled study on smartphone-based behaviour analysis for challenging behaviour in children with intellectual and developmental disabilities or autism spectrum disorder.

Challenging behaviour (CB) is a common issue among children with autism spectrum disorder or intellectual and developmental disability. Mental health applications are low-threshold cost-effective tools to address the lack of resources for caregivers. This pre-post study evaluated the feasibility and preliminary effectiveness of the smartphone app ProVIA-Kids using algorithm-based behaviour analysis to identify causes of CB and provide individualized practical guidance to manage and prevent CB. A total of 18 caregivers (M = 38.9 ± 5.0) of children with a diagnosis of autism spectrum disorder (44%), intellectual and developmental disabilities (33%) or both (22%) aged 4-11 years (M = 7.6 ± 1.8) were included. Assessments were performed before and after an 8-week intervention period. The primary outcome was the change in parental stress. Caregiver stress experience due to CB was also rated daily via ecological momentary assessments within the app. Secondary outcomes included the intensity of the child's CB, dysfunctional parenting, feelings of parental competency as well as caregivers' mood (rated daily in the app) and feedback on the app collected via the Mobile Application Rating Scale. We observed increases in parental stress in terms of conscious feelings of incompetence. However, we also saw improvements in parental stress experience due to CB and overreactive parenting, and descriptive improvements in CB intensity and caregiver mood. ProVIA-Kids pioneers behaviour analysis in a digital and automated format, with participants reporting high acceptance. Pilot results highlight the potential of the ProVIA-Kids app to positively influence child behaviour and caregiver mental health over a longer intervention period. The study was registered at https://www.drks.de (ID = DRKS00029039) on May 31, 2022.

Challenging Behaviours in Primary Classrooms: Examining Causal Attributions and Strategies Used by Primary School Teachers in India

AbstractIn this study, we examined 535 primary classroom teachers’ causal attributions about challenging behaviour in West Bengal, India. The participants completed a questionnaire that collected information about their perceptions, causal attribution, and proposed strategies to address a range of challenging behaviours that were presented through five vignettes. The participants identified student-related and family-related factors as the main causes of challenging behaviour more frequently compared to teacher-related causes. They reported using proactive strategies more often than reactive strategies to address challenging behaviours in their classrooms. The findings provided insight into teachers’ causal attributions influencing their choice of classroom-management strategies, which helped to understand teaching practices and how they affect students. The implications of the study are presented to improve professional learning and practice for teachers and guide them to adopt strength-based strategies to address challenging behaviour in primary schools in West Bengal, India.

Algorithm-based pain management for people with dementia in nursing homes.

Algorithm-based pain management for people with dementia in nursing homes.

Psychiatric hospital nurses' attitudes towards trauma-informed care.

Accessible SummaryWhat is known on the subject? Research indicates many clients using mental health services have trauma histories. Consequently, mental health professionals must be aware of the impact of trauma and of how they can avoid retraumatizing service‐users. Care delivered with this awareness is known as trauma‐informed care (TIC).There is little research on attitudes towards TIC. To date, only one study explored these attitudes among MHNs exclusively. Additionally, a richer understanding of TIC attitudes using methods like in‐depth interviews is needed. It is unclear whether knowledge of TIC results in more favourable attitudes. What this paper adds to existing knowledge? MHNs in this study had little knowledge of TIC but expressed overall favourable TIC attitudes. Traumatic histories were not appreciated as causes of challenging behaviour. On rehabilitation wards, clients come to be perceived as family members and this makes it harder for MHNs to not take challenging behaviour of clients personally. MHNs face work‐related traumas which interfere with their ability to provide TIC. What are the implications for practice? Findings of this study can be used to guide plans to implement TIC in psychiatric hospitals. Policymakers are called to appreciate that ensuring MHN well‐being on the workplace will facilitate their delivery of TIC. TIC training initiatives for MHNs must stress the importance of acknowledging traumatic histories as causes of challenging behaviour and of maintaining professional boundaries with long‐term clients. This would benefit service‐users by ensuring MHNs are more trauma‐informed. More research on attitudes towards TIC among MHNs is needed. IntroductionQuantitative studies exploring trauma‐informed care (TIC) attitudes have not used samples made up exclusively of mental health nurses (MHNs). Qualitative methods were sparingly used.AimTo examine nurses' TIC attitudes at a psychiatric hospital.MethodA mixed‐method design was used. One hundred and thirty‐six MHNs completed the Attitudes Related to Trauma‐Informed Care scale. Data were analysed using inferential statistics. A focus group interview among ten MHNs ensued. Thematic analysis was used.ResultsMHNs demonstrated favourable TIC attitudes. Ambivalent attitudes for the subscale “Causes” were identified. MHNs employed for less than 5 years at the hospital and those in acute settings displayed more favourable attitudes on some subscales. Three themes “Awareness,” “Unhealthy boundaries” and “Inhibition” emerged from qualitative analysis.DiscussionChallenges uncovered in the provision of TIC include the unacknowledged impact of trauma on challenging behaviour among MHNS, the influence of blurred professional boundaries with long‐term clients on the cycle of perpetuated trauma identified by previous research and MHNs work‐related traumas.Implications for practiceIdentified challenges to TIC integration among MHNs can facilitate the implementation of TIC in hospitals. TIC educational packages for MHNs should acknowledge traumatic histories in the aetiology of challenging behaviour and stress the importance of maintaining professional boundaries with clients.

The association between challenging behaviour and symptoms of post-traumatic stress disorder in people with intellectual disabilities: a Bayesian mediation analysis approach.

BackgroundA preponderance of behavioural symptoms is assumed to be the main difference in the manifestation of symptoms of post‐traumatic stress disorder (PTSD) in people with intellectual disability (ID). However, no study so far has assessed the relationship between challenging behaviour (CB) and PTSD. The present study aims to explore this relationship by exploring whether CB is directly related to trauma exposure or whether this relationship is mediated through core symptoms of PTSD.MethodsTrauma exposure and current symptoms of PTSD were assessed in 43 adults with mild to moderate ID. Parallel versions were administered to 43 caregivers, including the Aberrant Behaviour Checklist to measure CB. Bayesian mediation analyses were conducted using self‐rated and informant‐rated data.ResultsThe self‐report data showed no associations of CB with trauma exposure or PTSD symptoms. The association between informant‐rated trauma exposure and irritability was mediated by severity and frequency of PTSD symptoms. The associations between informant‐reported trauma exposure and the Aberrant Behaviour Checklist subscales hyperactivity and inappropriate speech were mediated by PTSD symptom severity.ConclusionsThe relationship between trauma exposure and CB was mediated by PTSD symptoms. PTSD core symptoms should be considered as underlying causes of CB, highlighting the necessity to explore trauma biography and symptoms of PTSD. The improvement of self‐report assessment in people with ID is an important task for future studies.

A Tablet App- and Sensor-Based Assistive Technology Intervention for Informal Caregivers to Manage the Challenging Behavior of People With Dementia (the insideDEM Study): Protocol for a Feasibility Study.

BackgroundDespite the enormous number of assistive technologies (ATs) in dementia care, the management of challenging behavior (CB) of persons with dementia (PwD) by informal caregivers in home care is widely disregarded. The first-line strategy to manage CB is to support the understanding of the underlying causes of CB to formulate individualized nonpharmacological interventions. App- and sensor-based approaches combining multimodal sensors (actimetry and other modalities) and caregiver information are innovative ways to support the understanding of CB for family caregivers.ObjectiveThe main aim of this study is to describe the design of a feasibility study consisting of an outcome and a process evaluation of a newly developed app- and sensor-based intervention to manage CB of PwD for family caregivers at home.MethodsIn this feasibility study, we perform an outcome and a process evaluation with a pre-post descriptive design over an 8-week intervention period. The Medical Research Council framework guides the design of this feasibility study. The data on 20 dyads (primary caregiver and PwD) are gathered through standardized questionnaires, protocols, and log files as well as semistructured qualitative interviews. The outcome measures (neuropsychiatric inventory and Cohen-Mansfield agitation inventory) are analyzed by using descriptive statistics and statistical tests relevant to the individual assessments (eg, chi-square test and Wilcoxon signed-rank test). For the analysis of the process data, the Unified Theory of Acceptance and Use of Technology is used. Log files are analyzed by using descriptive statistics, protocols are analyzed by using documentary analysis, and semistructured interviews are analyzed deductively using content analysis.ResultsThe newly developed app- and sensor-based AT has been developed and was evaluated until July in 2018. The recruitment of dyads started in September 2017 and was concluded in March 2018. The data collection was completed at the end of July 2018.ConclusionsThis study presents the protocol of the first feasibility study to encompass an outcome and process evaluation to assess a complex app- and sensor-based AT combining multimodal actimetry sensors for informal caregivers to manage CB. The feasibility study will provide in-depth information about the study procedure and on how to optimize the design of the intervention and its delivery.International Registered Report Identifier (IRRID)DERR1-10.2196/11630

Emotional development, aggression regulation and challenging behavior in individuals with intellectual disbility

Analysis of the causes of challenging behavior in individuals with intellectual disability (ID). The relatedness and the impact of cognitive and emotional functioning on challenging behavior was investigated by correlation and regression analyses in 262 individuals with ID and mental disorders / challenging behavior. Despite the high correlation between ID and emotional development, cognitive-emotional developmental discrepancies were found in every second patient. The severity of challenging behavior was associated with a lower level of emotional development, especially in the area of "aggression regulation". The level of emotional development should be ascertained in the context of an assessment of challenging behavior in individuals with ID.

Exploring the need for an expertise centre for challenging behaviour

In a case study (N=1) a 78-year-old woman of Indonesian origin was referred for admission to the psychiatric hospital because there were increasing behavioural problems in the nursing home where she was staying. The challenging behaviour consisted of screaming; name calling, pinching, hitting and throwing food. The multidisciplinary team in the nursing home did not cope with the behaviour of the patient. This patient has an extensive history in psychiatry; she was diagnosed with bipolar disorder, anger management disorder and cognitive impairment. Because of cognitive impairment the patient lived in a nursing home because her husband was no longer able to care for her because of his own health problems. The medical team of the nursing home wanted her transfer to GGz centraal with the purpose to treat her provocative behaviour and to lead her to a permanent place to live in a setting appropriate to her problems. Also, the family of the patient supported this. They were very dissatisfied with the care offered in the nursing home. They indicated that they were very overburdened by the challenging behaviour of this patient in the nursing home. They also said that they felt that the nurses tried to solve the behavioural problems themselves without enlisting the help of experts in psychiatry. The patient was admitted to the geriatric psychiatry ward for a multidisciplinary evaluation of condition and challenging behaviour. Through the efforts of the team and the involvement of the family it was clear what causes the challenging behaviour and the team members were able to gradually work on the provocative behaviour of the patient. Most of the causes were related to traumatic experiences in the past. Small simple interventions led to a better quality of life for the patient and the team could discharge her to the nursing home with a clear treatment and supervision plan for the carers. The mental health care management organization came to the aforementioned case study with the question of whether the author wanted to deepen more on this subject and wanted to do research on challenging behaviour in older adults with severe mental illness and cognitive comorbidity. This subject is especially important because at the same time the government decided that the long-term beds must be decreased in psychiatry. Many elderly patients who may have lived most of their lives in the long-term psychiatric wards are being transferred to nursing homes, which lead to problems in the provision of care for these patients. The author claims an expertise centre could provide the solution. The expertise centre challenging behaviour aims to diagnose the possible causes of challenging behaviour and investigate what interventions can be effective. As a theoretical basis it uses the Neuman Systems Model. This nursing model can be used both as a theoretical framework, based on a systems thinking perspective, as well as on a methodical approach to explore nursing problems. Based on this case study an expertise centre for challenging behaviour will be developed in which a multidisciplinary team consisting of a psychiatrist, a nurse practitioner and a nurse will visit the nursing home team members and talk with the patient if possible and his or her family. This team will also focus on the interaction between the caregivers and the patient. The hypothesis of the author is that these efforts will ultimately lead to a better quality of life, fewer readmissions in a psychiatric hospital and a higher satisfaction with the family or directly involved healthcare professionals with the patient. In a next study the patient outcomes of the expertise centre will be investigated as well as the cost-benefits.

Staff attributions of the causes of challenging behaviour in children and adults with profound intellectual and multiple disabilities

A study has shown that staff do not generally perceive challenging behaviour in people with profound intellectual and multiple disabilities (PIMD) as being of serious consequence. In this study we aimed to gain a better understanding of the causal explanations that direct care and support staff give for challenging behaviour in this group. The purpose of this study was twofold: (1) to determine the way staff attribute challenging behaviour in children and adults with PIMD; and (2) to analyse whether more experienced staff attribute challenging behaviour in children and adults with PIMD differently than less experienced staff. In total, 195 direct support staff and an equal number of children and adults with PIMD participated in the study. Direct support staff filled out the Challenging behaviour Attribution Scale (five causal explanatory models of challenging behaviour) to explain challenging behaviour in one individual that they supported. The results show that direct support staff as a whole report the biomedical model as the most plausible explanation for challenging behaviour in children and adults with PIMD. However, in the present study the mean scores on all models are low. This might indicate that a large number of staff found none of the models particularly useful as possible explanations of challenging behaviour in people with PIMD. This could mean that staff have difficulties stating the cause of challenging behaviour in this group. Another possible explanation could be that there is little scientific knowledge about causing and maintaining factors of challenging behaviour in people with PIMD. It could also mean that staff have additional explanations for challenging behaviour in this target group that are not mentioned in the instrument used. Future research should address these issues. No differences were found between more experienced and less experienced direct support staff.

Predictors of challenging behaviour in adults with intellectual disability

Purpose – The purpose of this paper is to determine the extent to which mental health, physical health, communication, learned function of the behaviour(s), severity of disability, living arrangement, age, and gender, alone or in combination, predicted challenging behaviours in adults with intellectual disability. Design/methodology/approach – In total, 74 adults with intellectual disability and their paid carers were recruited into the study from adult disability services in Victoria, Australia. Paid carers provided information about participants with intellectual disability on a range of measures targeting each variable of interest. Findings – Based on principle components analyses of three challenging behaviour measures, two topographies of challenging behaviour emerged: contact and non-contact behaviours. Multiple regression analysis revealed that contact behaviours were predicted by anxiety scores and severity of disability. In addition to severity of disability and anxiety scores, non-contact behaviours were also predicted by sensory scores. Practical implications – The results of the current study indicate that contact and non-contact behaviours were determined by multiple factors. Clinicians and others who work with people who display challenging behaviour may, therefore, find it helpful to utilise the biopsychosocial model in their formulations of possible reasons that motivate a person to engage in challenging behaviour. Originality/value – These results contribute to the evidence base available to clinicians and researchers to guide future assessment for challenging behaviour. Expansion of functional assessment methods to explore factors not traditionally included, such as mental health and severity of intellectual disability, as causes of challenging behaviour, may prove helpful.

Challenging behavior in Smith-Lemli-Opitz syndrome: initial test of biobehavioral influences.

To study challenging behavior (destruction, aggression, self-injury, stereotypy) in children with Smith-Lemli-Opitz syndrome (SLOS) using a biobehavioral model that helps distinguish biological from socially mediated variables influencing the behavior. SLOS is an autosomal-recessive syndrome of multiple malformations and intellectual disability resulting from a genetic error in cholesterol synthesis in all cells and tissues, including brain. The exact cause of the challenging behavior in SLOS is unclear, but defective brain cholesterol synthesis may contribute. Because the precise genetic and biochemical etiology of SLOS is known, this disorder is a good model for studying biological causes of challenging behavior. In a preliminary application of a biobehavioral model, we studied the association between cholesterol levels (as a biochemical indicator of disease severity) and behavior subtype ("biological" vs "learned") in 13 children with SLOS. Parents completed a questionnaire that categorized challenging behavior as influenced primarily by social or nonsocial (thus, presumably biological) factors. The severity of the cholesterol synthesis defect correlated significantly with behavior subtype classification for 1 of 2 challenging behaviors. Greater severity of the cholesterol synthesis defect was associated with behavior being classified as primarily influenced by biological factors. The interplay between challenging behavior and defective cholesterol synthesis in SLOS may help explain biological influences on the behavior. Our findings have implications for research on the effectiveness of behavioral and medical treatments for behavioral difficulties in SLOS and other neurodevelopmental disorders.

Challenging behaviour: the causes (part II)

PurposeThe aim of this paper is to provide an overview of the dominant approaches used to explain causes of challenging behaviour.Design/methodology/approachThis paper is the second in a two‐part series. It presents the causes of challenging behaviour according to the three theoretical approaches that have dominated the literature: applied behaviour analysis; biological factors; and psychiatric disorders.FindingsIt is apparent that the causes of challenging behaviour are likely to be complex and involve multiple factors. The approaches that have dominated the literature focus on single causes and do not explore possible interactions between various causes. Given the shortcomings of existing approaches, a fourth approach, the biopsychosocial model, is proposed as an alternative model to explain the causes of challenging behaviour.Originality/valueThis paper is the most recent of only a few providing an overview of the various approaches that seek to explain the causes of challenging behaviour.

Adult diagnosis of pathological demand avoidance – subsequent care planning

PurposeMany patients in residential and secure settings have no formal diagnosis of Autism but may in fact be on the spectrum. This paper seeks to outline the diagnosis and subsequent treatment and intervention planning for a young woman in a low secure hospital.Design/methodology/approachThis paper summarises the literature in relation to the diagnosis of Pathological Demand Avoidance (an atypical presentation of Autism Spectrum Disorder) in children and describes how this diagnosis may present in adults. This search revealed that whilst there was a growing literature around PDA in Children, there was very little literature available about either the clinical presentation or management guidance in adults. A case study design was adopted.FindingsThe paper concludes that the lack of an appropriate diagnosis and inappropriate formulation of the underlying causes of challenging behaviour can lead to patients becoming impossible to manage. Many may benefit from diagnosis and Autism‐specific intervention.Originality/valueThis paper highlights the challenges of adult diagnosis of Autism in highly complex individuals and outlines novel approaches to treatment.

Understanding Challenging Behaviour: Perspectives of Children and Adolescents with a Moderate Intellectual Disability

Background The present study examines understanding of challenging behaviour among a sample of children and adolescents with a moderate intellectual disability, and investigates their behavioural intentions towards peers with challenging behaviour.Methods The study involved the collection of quantitative and qualitative data. In the quantitative part of the study participants (n = 39) completed a modified Friendship Activity Scale (FAS) following the presentation of vignettes depicting individuals with challenging and non‐challenging behaviour. In the qualitative part of the study, participants (n = 31) took part in a semi‐structured interview that sought their views on the causes of the challenging behaviour described in one of the vignettes.Results Analysis of the data from the FAS indicates that participants have significantly more positive intentions towards a vignette character that does not engage in challenging behaviour. Content analysis of the qualitative data indicates that participants hold a variety of beliefs about the causes of challenging behaviour. Suggestions include the possibility that it is a response to transient emotional states and to external events.Conclusions The findings are consistent with the findings of other studies on young people’s understanding of and attitudes towards peers with atypical behaviour. The theoretical and clinical implications for young people with intellectual disabilities are discussed.

Interpreting the Evidence on Interventions With Challenging Behaviour: Theoretical, Contextual and Cultural Perspectives from New Zealand

AbstractResearch on managing challenging behaviour in children and young people with disabilities is becoming increasingly complex as a guide to best practice. There continues to be an outpouring of single-case studies conducted in the traditional research methods and conceptual models of applied behaviour analysis. In contrast, there is growing recognition of the importance of context, social systems, and cultural values, not only in understanding the causes of challenging behaviour, but in the design of interventions and the evaluation of rehabilitative treatments. A ‘third wave’ of educative intervention approaches attempts to integrate these two perspectives within concepts of positive behaviour support. We offer practitioners some guidance to the extant empirical literature by bringing together the most promising themes within this rapprochement.

Care staff attributions about challenging behaviors in adults with intellectual disabilities

A number of researchers have explored the attributions that care staff make about challenging behavior. The expectation, based on behavioral and cognitive models, is that these attributions may help predict why staff inadvertently reinforce challenging behavior. Two studies of staff attributions about challenging behavior are reported. In the first, a high level of consistency in attributions across staff was found. In a second quasi-experimental study, staff made attributions about two known clients’ behavior. Analysis of these data showed that attributions varied in a manner broadly consistent with the hypothesized functions of the behaviors. The weight of the evidence suggests that staff may be sensitive to the causes of challenging behavior. The practical implications of these data are discussed.

Measuring staff perceptions of challenging behaviour: the Challenging Behaviour Attributions Scale (CHABA)

Causal attributions may interact with other variables to determine staff responses to challenging behaviour. Furthermore, staff perceptions of the causes of challenging behaviour are likely to change as a result of theoretical and practical training. However, there is no established simple method for measuring staff attributions that could facilitate research in these areas. The present paper describes the development and preliminary psychometric analysis of the Challenging Behaviour Attributions Scale (CHABA).

Staff beliefs about the challenging behaviors of children and adults with mental retardation

From both theoretical and practical perspectives, staff beliefs are likely to have a significant impact on the process of care for children and adults with mental retardation who engage in challenging behaviors. This paper reviews research addressing three domains of staff beliefs: definitions of challenging behavior, causal attributions, and beliefs about appropriate intervention. In general, staff definitions were found to be at odds with formal definitions. According to care staff, challenging behaviors are actions that are difficult to manage. Staff causal attributions appear congruent with current theory, when measured with little specificity. However, when staff are asked to suggest causes of challenging behavior with clearly described functions they often fail to make appropriate attributions. Beliefs about appropriate short-term interventions suggest responses likely to develop and/or maintain challenging behavior, but beliefs about longer-term planned intervention appear to be more closely matched to contemporary practice. Reasons for this long-term/short-term distinction, based on the demands of the immediate situation, are proposed. Suggestions for future research on staff beliefs are discussed in detail. Finally, implications for staff training, referral practice, and for analysis and intervention with challenging behavior, are outlined.

Tourette's Syndrome and Challenging Behaviour: A Case Study

Tourette's syndrome, although often undiagnosed, is one of the remediable causes of challenging behaviour in people with learning disabilities. The social consequences for the sufferer when the disorder is unrecognised can include rejection, blame and isolation. This paper describes the diagnosis of Tourette's syndrome in a man with learning disabilities, and the effectiveness of medical and social interventions.

UNDERSTANDING FACTORS THAT INFLUENCE STAFF RESPONSES TO CHALLENGING BEHAVIOURS: AN EXPLORATORY INTERVIEW STUDY

AbstractStaff beliefs about challenging behaviours, and their perception of their working environment, are important for two main reasons. Firstly, the manner in which staff define challenging behaviour affects who is labelled as a challenge, and who is referred to specialist services. Secondly, staff views of their working environment may help us to understand why staff interact with people with learning disabilities in the apparently counter‐habilitative ways outlined in previous reasearch. These issues were investigated in a systematic semi‐structured interview of 19 care staff. The interview covered staff definitions of challenging behaviour, the reasons for its occurrence, and strategies for its amelioration; their views on training and behavioural programmes; and their reported emotional responses to challenging behaviour. Content analysis of the interview transcripts revealed several patterns that may help in generating an account of staff behaviour. For example, staff's beliefs about the causes of challenging behaviour were partially congruent with those of psychological analyses, but their reported interventions for challenging behaviour could not be characterised as ‘functional’ strategies. Staff reports also revealed some of the factors in the service environment that may explain why they respond ‘inappropriately’ to challenging behaviour in the short term. These included: an emphasis in staff training on techniques for managing behaviour rather than understanding it, the (possibly resulting) belief that challenging behaviour is to be controlled, and the aversive nature of challenging behaviours. These findings, and their implications for research and practice, are discussed.