Challenging Behavior In Persons Research Articles

Using Video Feedback at Home in Dementia Care: A Feasibility Study

Video feedback at home (VFH) aims to improve the well-being of informal caregivers and persons with dementia by training the caregiver to communicate successfully. This feasibility study had 2 aims: (1) to investigate possible effects regarding VFH, caregiver self-efficacy and the burden experienced, and the frequency of challenging behavior in persons with dementia, and (2) to perform a process evaluation of barriers and facilitators regarding the use of VFH. The respondents were caregivers of home-dwelling persons with dementia participating in VHF (N = 10), a group of caregivers who declined participating in VFH (N = 18), stakeholders (N = 6), and field experts (N = 55). The assessments performed were Positive and Negative Affect Scales, Cohen-Mansfield Agitation Inventory, Sense of Competence Scale, semistructured interviews, and questionnaires. Results demonstrated that caregivers were satisfied with VFH and that various (sub)scores on questionnaires improved. Caregivers mentioned a reluctance toward being filmed and both caregivers and referrers were unfamiliar with VFH. Recommendations have been made for health-care professionals and researchers to overcome these barriers.

Comparing the percentage of non-overlapping data approach and the hierarchical linear modeling approach for synthesizing single-case studies in autism research

We examined the performance of two approaches for synthesizing single-case experimental data: the percentage of non-overlapping data (PND) approach and the hierarchical linear modeling (HLM) approach. The comparison was performed by analyzing an empirical dataset on behavioral interventions for reducing challenging behavior in persons with autism by means of the two approaches. We compared the findings of both approaches for analyzing the outcomes of the behavioral interventions as well as for identifying moderating variables. With respect to the analysis of the interventions’ outcomes, similar positive results were found based on both approaches. With respect to the moderating variables, Functional analysis/assessment and Availability of follow up data were found to be statistically significant moderators by means of the PND as well as the HLM approach. The variables Intervention type, Availability of generalization attempts, Design type, and Availability of inter-rater reliability data were also found to be statistically significant moderators by means of the PND approach. The PND approach seems overly liberal in identifying statistically significant predictors in comparison to the HLM approach.

Psychosocial interventions for reducing vocal challenging behavior in persons with autistic disorder: A multilevel meta-analysis of single-case experiments

Vocal challenging behavior (VCB) forms a common problem in individuals with autistic disorder. Since VCB is associated with negative outcomes for the individual and his or her environment, it is important to know how to manage this type of CB. To evaluate the effectiveness of several psychosocial interventions applied to decrease VCB in individuals with autistic disorder, we conducted a meta-analysis of single-case experiments (SCEs). Fifty-two SCEs, including 74 participants, were combined using a multilevel meta-analysis. The overall treatment effect was large and statistically significant. However, the effect varied significantly over the included studies and participants. Examining this variance, evidence was found for a moderator effect of VCB type and intervention type, with, on average, the largest effects for interventions used to reduce VCB including stereotypical VCB and for interventions containing both antecedent and consequence components. Age, gender, primary treatment setting, publication year, and study quality did not significantly moderate the intervention effect.

A multilevel meta-analysis of single-case and small-n research on interventions for reducing challenging behavior in persons with intellectual disabilities

The effectiveness of different interventions for challenging behavior (CB) in persons with intellectual disabilities (ID) was reviewed by means of a two-phase study. First, a systematic review of 137 meta-analyses and reviews on group-study interventions for CB in persons with ID was conducted. Based on this review, hypotheses concerning the effectiveness of divergent interventions for CB and concerning the impact of variables moderating treatment effectiveness were systematically generated. Second, these hypotheses were tested by means of a multilevel meta-analysis of single-case and small-n research. Two hundred and eighty-five studies reporting on 598 individuals were examined. The average treatment effect was large and statistically significant. However, this effect varied significantly over the included studies and participants. Compared to the meta-analyses and reviews focusing on group-studies in this research domain, the results of the present multilevel meta-analysis of single-case and small-n intervention research provided more detailed knowledge on which specific CB and intervention components moderate the interventions' effectiveness.

Melatonin decreases daytime challenging behaviour in persons with intellectual disability and chronic insomnia

Persons with intellectual disability (ID) and sleep problems exhibit more daytime challenging behaviours than persons with ID without sleep problems. Several anecdotal reports suggest that melatonin is not only effective in the treatment of insomnia, but also decreases daytime challenging behaviour. However, the effect of melatonin treatment on daytime challenging behaviour in persons with ID has not been investigated in a randomised controlled trial. We investigated the effects of melatonin on challenging behaviour using data from two randomised controlled trials on the efficacy of melatonin on sleep problems in 49 persons (25 men, 24 women; mean age 18.2 years, SD = 17.1) with ID and chronic insomnia. Participants received either melatonin 5 mg (<6 years 2.5 mg) or placebo during 4 weeks. Daytime challenging behaviour was measured by the Storend Gedragsschaal voor Zwakzinnigen - Maladaptive Behaviour Scale for the Mentally Retarded (SGZ; Kraijer & Kema, 1994) at baseline week and the end of the fourth treatment week. Salivary dim light melatonin onset (DLMO) was measured at baseline and the last day of the fourth treatment week. Sleep logs were used to gather information on sleep parameters. Melatonin treatment significantly reduced SGZ scores, sleep latency, and number and duration of night wakes, and treatment increased total sleep time and advanced DLMO. However, after 4 weeks of treatment, change in SGZ scores did not significantly correlate with change in sleep parameters, nor with change in DLMO. Relatively strong correlations were found between change in SGZ scores, change in DLMO and number of night wakes. Melatonin treatment in persons with ID and chronic insomnia decreases daytime challenging behaviour, probably by improving sleep maintenance or by improving circadian melatonin rhythmicity.

Psychotropic medication use for challenging behaviors in persons with intellectual disabilities: An overview

Challenging behaviors in persons with intellectual disabilities are primary target for treatment in mental health clinics and institutions. Furthermore, an increasing number of people are receiving psychotropic medications for the management of their challenging behaviors. Many people are often treated with high doses of multiple psychotropic medications for extended periods of time with little or no data collected to determine treatment efficacy. Similarly, data demonstrating treatment effectiveness is at best questionable at this time. It is for these reasons that controversy exists regarding the use of psychotropic medication for challenging behaviors. The purpose of this paper was to summarize past and current studies of drug related interventions for challenging behaviors for persons with intellectual disabilities. Based on the results of this review, the effectiveness of psychotropic medications in managing challenging behaviors is best described as minimal and a need exists for controlled studies of higher scientific quality in this area. Considering alternative psychologically based interventions and careful functional assessments appear to be advisable.

Aggressive challenging behaviour and intellectual disability

The aim of this article is to review reports of aggressive challenging behaviour in individuals with intellectual disability from September 2006 to March 2008. Studies continued to demonstrate the prevalence and significance of aggressive challenging behaviour in persons with intellectual disability. Over half of the population engages in some form of aggression, but only a small number is responsible for frequent or severe acts. A publication that identified aggression profiles offered a promising new approach. Aggressive behaviour in adults often has multiple functions. The most frequently studied interventions were either behavioural or somatic. Parents learned skills to effectively intervene with their aggressive preschool child. Reviews of medication efficacy studies concluded that there was insufficient evidence to recommend a single medication. Psychiatrists agreed that medication should not be the first treatment option. In one study, a class of medication was found to reduce aggression, but not aggression with self-injury, or self-injury alone. Research on aggressive challenging behaviour requires assessment instruments that address the topography and severity of aggression. Identifying aggression types may clarify mixed results of previous research and improve treatment effectiveness. Greater access to effective, nonmedication treatments is needed.

Use of noncontingent reinforcement in the treatment of challenging behavior. A review and clinical guide.

Recently, noncontingent reinforcement (NCR) has been used to reduce challenging behavior in persons with developmental disabilities. In this context, NCR involves reinforcement on a fixed-time schedule irrespective of behavior. The present article reviews studies involving NCR for the treatment of challenging behavior. Based on this review, a clinical guide for the implementation of NCR is delineated. NCR appears to depend on ensuring that reinforcement matches the function of the challenging behavior. Initially, noncontingent reinforcement should be provided on a continuous basis. The schedule can then be faded from continuous reinforcement to a more appropriate level in a number of ways. NCR can also be combined with additional educationally oriented interventions to promote skill development. Given its ease of implementation and other potential advantages, NCR would appear particularly relevant for applied settings. The clinical guide may offer some assistance to practitioners.

Suicidal threats and behavior in a person with developmental disabilities: Effective psychiatric monitoring based on a fundamental assessment

AbstractA psychiatric monitoring procedure was designed to better manage and treat suicidal behavior and threats in a person with moderate mental retardation, and psychiatric disorders. During the baseline suicidal threats and behavior were managed by assigning the person a counselor available to discuss his problems, keeping him in eyesight at all time, admission to the state school infirmary, counseling from his physician, and admission to a Multiple Disabilities Unit (MDU) located in a state hospital located 2 hr drive away from the state school in which he lived. A functional assessment indicated that these behaviors were not related to depressed mood or a depressive disorder. Rather, they were socially mediated operant behaviors in a person with poor impulse control, in which the attempts to manage the behaviors by the interdisciplinary team might have been counter‐habilitative. A psychiatric surveillance procedure was based upon this functional assessment. The procedure consisted of increasing the number of apparently pleasurable activities available on the living area, asking for a no harm agreement following suicide threats or attempts, social isolation for 12–36 hr immediately contingent upon failure to give a no harm agreement, and release from social isolation contingent upon a no harm agreement. Data showed that this procedure was completely successful in reducing admissions to the MDU over a 7 month period. The social isolation was typically used once a week for approximately 25 hours over the 7‐month period. It was noted that considerable savings were made by not using admissions to the state hospital over a 7‐month period. Functional assessment can form the basis of developing and evaluating a variety of procedures relating to challenging behavior in persons with dual diagnosis including management of suicidal threats and behavior.