Challenging Behaviour Scale Research Articles

Emotional Reactions of Professionals to Challenging Behaviors in People with Intellectual and Developmental Disability.

Professionals working with people with intellectual and developmental disability (IDD) can be exposed to challenging behaviors (CBs), which may result in professionals exhibiting emotional reactions that can impact their practices. This study examined these reactions and analyzed how they are influenced by the individual characteristics of people with IDD (gender, age, and level of IDD) and the variables related to CB (type of behavior and its frequency and behavioral function). A total of 125 professionals assessed 293 people with IDD who exhibited CBs. The professionals were asked to complete the Behavior Problems Inventory-Short Form, the Emotional Reactions to Challenging Behavior Scale, and the Questions About Behavior Function measure. It was revealed that positive emotional reactions predominated over negative ones. Significant results were found regarding the level of disability and the age of people with IDD. Emotional reactions were related to the severity of CBs, especially self-injurious and aggressive/destructive behavior, as well as certain behavioral functions. The severity of CBs and the age of people with IDD emerge as key predictors of the emotional reactions of professionals. In short, these reactions vary according to different variables, highlighting the importance of interventions that address professionals' emotional needs.

Non-pharmacological prescribing for behaviour that challenges in dementia: An evaluation of 12 months of outcome data

BackgroundNon-pharmacological interventions are recommended as a first line treatment for the management of Behaviour that Challenges in Dementia (BtC). For the past decade, The Durham and Darlington Care Home Liaison (CHL) Hub have developed Behaviour Support Plans (BSPs), providing guidance on staff approaches and recommending specific, individualised, non-pharmacological interventions. Until recently, it was left to residents’ families to pay for and provide any items recommended. Clinicians knew what interventions could help, but they could not prescribe them. The CHL Hub was awarded non-recurrent funding in 2021 to prescribe a range of non-pharmacological interventions. This evaluation presents 12 months of routine outcome data for residents receiving such interventions.MethodProxy-rated measures of behaviour that challenges (Challenging Behaviour Scale, CBS, Moniz-Cook et al., 2001) and Quality of Life in Dementia Scale (QUALID, Weiner et al., 2000) were completed as part of routine care pre and post non-pharmacological intervention. Qualitative feedback .from care home staff and families of residents receiving non-pharmacological interventions was collected via telephone interview.ResultsResults show a significant difference between pre and post intervention CBS (z=1.28, p<.01) and QUALID scores (z=1.03, p<.01), with large effect sizes (r=.82, CI [.74-.87] and r=.67, CI [.5-.81], respectively).ConclusionCare home residents showed reduced BtC and improved quality of life following the introduction of non-pharmacological interventions as part of BSPs. Recommendations are discussed.

Cross-Cultural Adaptation, Validation and Reliability of the Turkish Version of The Child’s Challenging Behaviour Scale 2

The Child’s Challenging Behaviour Scale 2 (CCBS-2) is a scale designed for mothers of school-age children with disabilities between the ages of 5 and 18, and evaluates the child's challenging behaviours. This study was carried out to conduct the Turkish cross-cultural adaptation, validity and reliability of CCBS-2. One hundred thirty-eight mothers of disabled children were included in this study. The Child’s Challenging Behaviour Scale-2 Turkish version (CCBS-2-TR) was administered to mothers twice with an interval of 7 days. Internal consistency of CCBS-2-TR was assessed with Cronbach's Alpha coefficient. In addition, test–retest reliability was analyzed using intra-class correlation coefficient (ICC). Confirmatory factor analysis was performed to evaluate the construct validity. A total of 138 mothers (38.6±6.8 years) and their children (9.8±4.7 years) were included in this study. Cronbach's Alpha value of the scale was 0.73, demonstrating that this value has good internal consistency. Test–retest reliability was found as (ICC) 0.930 (ICC 95% CI [0.903- 0.949]. As a result of the confirmatory factor analysis, CCBS-2-TR was found to be unidimensional. The Turkish version of the Child’s Challenging Behaviour Scale-2 is reliable and valid scale for mothers with children with developmental disabilities. CCBS-2-TR was found to be a brief, well-targeted, and unidimensional scale and this scale can help researchers and clinicians to follow-up maternal health.

Development and Psychometric Evaluation of the Open-Source Challenging Behavior Scale (OS-CBS).

At present, there are no brief, freely-available, informant-report measures that evaluate key challenging behaviors relevant to youth with autism spectrum disorder (ASD) or other developmental disabilities (DD). This paper describes the development, refinement, and initial psychometric evaluation of a new 18-item measure, the Open-Source Challenging Behavior Scale (OS-CBS). In a large sample (n = 2004, 169 with ASD, ages 2-17), results of psychometric analyses indicated a clear factor structure (property destruction, aggression, elopement, conduct problems, and self-injury and a general factor with high loadings from all items) based on exploratory structural equation modeling, good scale reliability (α = .66-.83 for subscales, α = .91 total scale), measurement invariance across demographics, and good construct validity. The OS-CBS is a psychometrically-sound instrument for screening and monitoring intervention progress.

Implementing Affordable Socially Assistive Pet Robots in Care Homes Before and During the COVID-19 Pandemic: Stratified Cluster Randomized Controlled Trial and Mixed Methods Study.

BackgroundRobot pets may assist in the challenges of supporting an aging population with growing dementia prevalence. Prior work has focused on the impacts of the robot seal Paro on older adult well-being, but recent studies have suggested the good acceptability and implementation feasibility of more affordable devices (Joy for All [JfA] cats and dogs).ObjectiveWe aimed to address the limited effectiveness research on JfA devices.MethodsWe conducted an 8-month, stratified, cluster randomized controlled trial in 8 care homes in Cornwall, United Kingdom. Over 4 months, 4 care homes each received 2 JfA devices (1 cat and 1 dog; intervention group), and 4 homes received care as usual (control group). Psychometrics were collected before and after the intervention to compare the change from baseline to follow-up between the groups. In the final 4 months, all 8 care homes received devices, but only qualitative data were collected owing to COVID-19 and reduced capacity. The primary outcome was neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI] Nursing Home version). Care provider burden was a secondary outcome (occupational disruptiveness NPI subscale), alongside the Challenging Behavior scale, the Holden communication scale, the Campaign to End Loneliness questionnaire, and medication use. Qualitative data were collected through care staff observation calendars and end-of-study interviews to understand use, experience, and impact. We also collected demographic data and assessed dementia severity. In total, 253 residents had robot interaction opportunities, and 83 were consented for direct data collection.ResultsThere was a significant difference in the total change from baseline to follow-up between the intervention and control groups for NPI (P<.001) and occupational disruptiveness (P=.03). Neuropsychiatric symptoms increased in the control group and decreased in the intervention group. No significant difference was seen for communication issues or challenging behavior. For NPI subdomains, there were significant differences from baseline to follow-up in delusions (P=.03), depression (P=.01), anxiety (P=.001), elation (P=.02), and apathy (P=.009), all of which decreased in the intervention group and increased slightly in the control group. The summative impact results suggested that most residents (46/54, 85%) who interacted with robots experienced a positive impact. Those who interacted had significantly higher dementia severity scores (P=.001). The qualitative results suggested good adoption, acceptability, and suitability for subjectively lonely individuals and lack of a novelty effect through sustained use, and demonstrated that the reasons for use were entertainment, anxiety, and agitation.ConclusionsAffordable robot pets hold potential for improving the well-being of care home residents and people with dementia, including reducing neuropsychiatric symptoms and occupational disruptiveness. This work suggests no novelty effect and contributes toward understanding robot pet suitability. Moreover, interactions were more common among residents with more moderate/severe dementia and those subjectively lonely.Trial RegistrationClinicalTrials.gov NCT04168463; https://www.clinicaltrials.gov/ct2/show/NCT04168463

Translation and Linguistic Validation of the German Challenging Behavior Scale for Formal Caregivers of People With Dementia in Nursing Homes.

The Challenging Behavior Scale (CBS) measures the behavior of individuals with dementia. The study aims to translate the English CBS into German (CBS-G) and test its linguistic validity. The two-panel approach was used to translate the CBS. Nursing home staff reviewed the unambiguity and familiarity of the CBS-G items and the adequateness of the examples used to describe the items. Content validity indexes (CVI) and modified kappa (k) coefficients were calculated. Most of the CBS-G items had excellent CVI and k values for both unambiguity and familiarity. All examples were viewed as adequate. A German version of the CBS that is linguistically equivalent to the original CBS is available but needs further testing of its psychometric properties.

Criterion Validity of the Child’s Challenging Behavior Scale, Version 2 (CCBS–2)

The Child's Challenging Behavior Scale, Version 2 (CCBS-2), measures maternal rating of a child's challenging behaviors that compromise maternal mental health. The CCBS-2, the Child Behavior Checklist (CBCL), and the Strengths and Difficulties Questionnaire (SDQ) were compared in a sample of typically developing young Australian children. Criterion validity was investigated by correlating the CCBS-2 with "gold standard" measures (CBCL and SDQ subscales). Data were collected in a cross-sectional survey of mothers (N = 336) of children ages 3-9 yr. Correlations with the CBCL externalizing subscales demonstrated moderate (ρ = .46) to strong (ρ = .66) correlations. Correlations with the SDQ externalizing behaviors subscales were moderate (ρ = .35) to strong (ρ = .60). The criterion validity established in this study strengthens the psychometric properties that support ongoing development of the CCBS-2 as an efficient tool that may identify children in need of further evaluation.

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Child's Challenging Behaviour Scale, Version 2 (CCBS-2): Psychometric Evaluation With Young Children.

In this article, we evaluate psychometric properties of the Child's Challenging Behaviour Scale, Version 2 (CCBS-2) with mothers of young, typically developing children. A cross-sectional mail survey with Australian mothers (N = 337) included the CCBS-2, the Depression Anxiety Stress Scales, and the Parents' Evaluation of Developmental Status scale. Internal consistency was good, and no gender differences in CCBS-2 scores were significant. Significant results included differences between CCBS-2 scores: among children grouped according to age, among children grouped according to pre- and post-school entry, among mothers grouped according to extent of any symptom type, and between this sample and a previously collected age-matched sample of children with disabilities. Of the properties tested, results support sound psychometrics. The CCBS-2 can be used to differentiate children according to age, school entry, and disability as well as to identify families for potential services in behavior management and mental health.

Nature of behaviours that challenge in residents living in aged care homes: Implications for psychosocial interventions and service development

Background/Aims: Competing theories exist regarding the causes and nature of behaviours that challenge (BC). The present study attempted to provide better insight into these behaviours and determine whether there were any underlying relationships for people living in care homes with and without dementia.Methods: Cross sectional data for 2185 residents living in 63 UK care homes using the Challenging Behaviour Scale were collected. The incidence (i.e. presence/absence) of 25 commonly reported behaviours that challenge staff were determined using dichotomous scoring. Cluster analysis and Mokken scaling were used to examine underlying relationships. Mokken is a method of analysing data to determine whether there is a ‘latent’ structure within a data set.Results: The prevalence of reported BC was 87.5 per cent. Cluster analysis revealed three main clusters: apathy, agitation with internal focus, agitation with active external focus. For seven of the 25 items a hierarchical model emerged, where behaviours at the bottom of the hierarchy tended to occur in the presence of those higher up. Behaviours at the bottom of the hierarchy (dangerous behaviour) were less frequently observed than the items at the top (lack of self-care, verbal aggression).Conclusion: Some common BC may occur in groups and themed clusters. This study has shown that a hierarchical structure of BC in residents may be present. The findings testify to the complexity in the aetiology and treatment of BC and hence the need for focused high intensity bio-psychosocial interventions to be targeted towards those with high levels of ‘unmet need’. Implications for future research and practice are discussed.

Challenging behavior, functioning difficulties, and quality of life of adults with intellectual disabilities

Objective: The current study aimed at examining the correlations between challenging behaviors, difficulties in functioning, and quality of life in institutionalized adults with intellectual disabilities.Methods: A sample of 53 people with intellectual disabilities and challenging behavior who resided in a large institutional care facility was recruited. The research questionnaire included the following instruments: (1) The challenging behavior scale; (2) The World Health Organization Disability Assessment Schedule 2.0; and (3) The Personal Well-Being Index.Results: No significant correlation was found between challenging behavior and quality of life. However, more challenging behavior found to be correlated with greater difficulties in functioning. Furthermore, a weak correlation was found between difficulties in functioning and quality of life. Participants who had greater difficulty functioning tended to exhibit lower levels of quality of life. No significant associations were found between the sample’s personal characteristics (gender, age, and the severity of intellectual disability) and challenging behavior, difficulties in functioning, and quality of life.Conclusion: Empowering personal functioning of people with intellectual disabilities is important in planning rehabilitation interventions. Such interventions are likely to promote a higher quality of life. There is the need for future research to further investigate the relationship found in this study.

Challenging behavior among institutionalized adults with intellectual disability in Israel: a comparison of measurements and definitions

Objectives: Challenging behavior (CB) is used as a diagnostic label among service providers. For persons with intellectual disability (ID) this label holds important implications such as placement in segregated housing and extreme stigmatization. Therefore, the ways through which service providers define and measure CB holds great importance. This study compared the nature and extent of differences between the way CB is measured in institutionalized adults with ID among service providers with a valid CB tool (Challenging Behavior Scale, CBS).Methods: A survey was conducted among 53 institutionalized adults with ID in Israel. Data were collected via a close ended questionnaire from key staff members.Results: We found that staff's definitions of CB did not align with CBS scores.Conclusions: Given the far reaching implications of the CB label among persons with ID, it is highly important that service providers relay on valid measurements.

Screening for Significant Behavior Problems in Diverse Young Children Living in Poverty

The development and use of first line screening instruments is an essential first step in assessing behavior disorders in very young children. The Early Childhood Behavior Screen (ECBS) is a parent-report measure for behavior disorders and is normed on young children (1–5 years old) living in poverty. The current study presents psychometric support for the discriminative validity of the ECBS’s 10-item Challenging Behavior Scale (CBS) as a first-line screener for externalizing behavior problems for preschool aged-children in poverty. The study’s sample included 673 participants (M age years = 2.81; 63.2 % male; 65.8 % African American) that all met the federal definitional standard for living in poverty. A confirmatory factor analysis was run to provide support for the ECBS factor structure. Receiver operating characteristics (ROC) curve analyses were used to test the CBS’s ability to distinguish between 428 clinic-referred children and 245 non-clinic-referred children. Results showed an acceptable fit model for the ECBS, providing further evidence of its construct validity. Optimal cut-scores by child age derived from the ROC curve analyses were provided with corresponding levels of sensitivity, specificity, and positive and negative predictive values. Sensitivity rates for cut scores ranged from 0.76 to 0.83 and specificity rates ranged from 0.88 to 0.95. Acceptable test–retest reliability and good internal consistency also was observed. The CBS quickly identifies young children from low-income, urban, diverse populations that may be at-risk for developing significant behavior disorders and should be considered by health care professionals who work with very young children.

Staff's views on managing symptoms of dementia in nursing home residents.

Aim To identify the most common and distressing behavioural and psychological symptoms of dementia (BPSD) in nursing homes and to identify staff preferences regarding its behavioural management. Method A descriptive cross-sectional survey was completed by a self-selected sample of 247 staff working in 21 nursing homes in a defined catchment area. The survey contained items relating to experience in aged care work, attitudes towards BPSD, ratings of the importance of certain behavioural strategies for managing BPSD, and the Challenging Behaviour Scale. Results Shouting, wandering and restlessness had the highest incidence, frequency and difficulty ratings. Frequency of BPSD and level of satisfaction with how they were managed had the greatest effect on overall level of difficulty in managing behaviours. Staff rated discussing behavioural concerns at a group level and with senior nursing staff as the most important behavioural strategies. Conclusion A strong relationship was found between frequency and difficulty of BPSD. Therefore, interventions targeted at lowering frequency of BPSD are recommended. Communication across a number of levels may enhance the implementation of behavioural interventions.

Update on the Child's Challenging Behaviour Scale following evaluation using Rasch analysis

The Child's Challenging Behaviour Scale (CCBS) was designed to measure a mother's rating of her child's challenging behaviours. The CCBS was initially developed for mothers of school-aged children with developmental disability and has previously been shown to have good psychometric properties using classical test theory techniques. The aim of this study was to use Rasch analysis to fully evaluate all aspects of the scale, including response format, item fit, dimensionality and targeting. The sample consisted of 152 mothers of a school-aged child (aged 5-18 years) with a disability. Mothers were recruited via websites and mail-out newsletters through not-for-profit organizations that supported families with disabilities. Respondents completed a survey which included the 11 items of the CCBS. Rasch analysis was conducted on these responses using the RUMM2030 package. Rasch analysis of the CCBS revealed serious threshold disordering for nine of the 11 items, suggesting problems with the 5-point response format used for the scale. The neutral midpoint of the response format was subsequently removed to create a 4-point scale. High levels of local dependency were detected among two pairs of items, resulting in the removal of two items (item 7 and item 1). The final nine-item version of the scale (CCBS Version 2) was unidimensional, well targeted, showed good fit to the Rasch model, and strong internal consistency. To achieve fit to the Rasch model it was necessary to make two modifications to the CCBS scale. The resulting nine-item scale with a 4-point response format showed excellent psychometric properties, supporting its internal validity.

Urban adolescents with intellectual disability and challenging behaviour: costs and characteristics during transition to adult services

Young persons with intellectual disabilities and challenging behaviour in transition usually have complex needs, which may not be served well within existing resources. In this article, we present a survey of all the young people, between 16 and 18 years of age with intellectual disabilities and challenging behaviour identified in one inner London borough. They were in transition to adult services at the time of the study (between 2006 and 2008). The objective was to examine their socio-demographic and clinical characteristics, pattern of service use and associated costs of care. An assessment toolkit was devised to measure the mental and physical health, challenging behaviour and service use of the sample. Instruments within the toolkit included the Strengths and Difficulties Questionnaire, challenging behaviour scale, Client Service Receipt Inventory (CSRI) and socio-demographic data form. Twenty-seven individuals in transition to adult services had challenging behaviour, 23 of whom had mental health diagnoses and 18 of whom had physical diagnoses. Severity of challenging behaviour did not correlate with cost of care. Informal care accounted for the highest proportion of the total cost of care (66%) with education being the second largest contributor at 22%. Evidence on transition outcomes for young people with complex needs and intellectual disabilities and associated costs is lacking. This article illustrates some of the relevant issues in this area. Further research is required to investigate these aspects and guide commissioning of appropriate services.

Challenging Behavior Training for Teaching Staff and Family Carers of Children With Intellectual Disabilities: A Preliminary Evaluation

AbstractTraining programs on the topic of challenging behaviors have often been offered to teaching staff and family carers of children with intellectual disabilities (ID). These efforts have been found to be effective in bringing about positive changes for both children with ID and those who support them. Generally, such training has been offered to either staff or family carers but not at the same time. The authors conducted a study to evaluate the efficacy of a brief training program delivered at the same time to teaching staff and family carers (who were involved with the same child). The study also examined differences in outcomes between the two groups, which were drawn from local schools where some children exhibited challenging behaviors. Both teaching staff and family carers completed the Checklist of Challenging Behaviour, the Challenging Behaviour Attributions Scale, and the Emotional Reactions to Challenging Behaviour Scale prior to, and following, the training workshops. The workshops were divided into two segments. The content was the same, but in the first segment, one was held for teaching staff and one for parent carers. In the second segment, both groups met together. After the first segment, all participants completed a related homework task before joining each other for the second segment. Training used a functional model of challenging behavior and facilitated the production of individualized support plans for the target children. Significant positive changes were found regarding ratings of challenging behavior, participants' causal attributions, and emotional reactions following the training. Some differences were found regarding outcomes for teaching staff vs. family carers. The study showed that teaching staff and family carers can benefit from receiving combined training to support challenging behavior in children with ID.

Development of the Child's Challenging Behaviour Scale (CCBS) for mothers of school‐aged children with disabilities

Caring for a child with a disability can be especially difficult when the child exhibits challenging behaviours. Childhood disability often calls for the mother to be conscientious, capable and organized to meet the child's health and developmental needs. Mothers are known to feel particularly stressed when their child also behaves in ways that are difficult to manage. In these circumstances maternal mental health may be compromised and mothers therefore need more support. The Child's Challenging Behaviour Scale (CCBS) is an 11-item scale that measures a mother's report of challenging behaviours exhibited by their child with disability, that are associated with compromised maternal mental health and caregiving difficulties. This paper describes the initial development and psychometric evaluation of the CCBS. A mixed methodology instrument design model was used to develop the CCBS. A qualitative study generated items, and quantitative data were collected from 152 mothers of a child with a disability. The CCBS showed excellent internal consistency (Cronbach's alpha = 0.89) and factor analysis supported its unidimensionality. Construct validity was supported by correlations with the PedsQL Psychosocial Health Summary Score (rho =-0.51) and cooperation taking medication (rho = 0.40). There were significant differences in CCBS scores between groups of children with and without either autism or psychiatric conditions. The CCBS showed moderate correlations with self-reported health status; the mother's sense of empowerment (rho =-0.44); and family cohesion (rho =-0.30). Mothers with a mental health condition recorded significantly higher CCBS scores. The CCBS is a brief, psychometrically sound instrument that provides clinicians with a new tool that measures a mother's rating of their child's behaviours that are challenging and associated with reduced maternal well-being. The CCBS assists professionals to identify mothers and family situations who may be in need of more support and interventions.

The Emotional Reactions to Challenging Behavior Scale-Korean (ERCBS-K): Modification and Validation

The purpose of this study was to explore the original version of Mitchell and Hastings's (1998) Emotional Reaction to Challenging Behavior Scale (ERCBS) and estimate validity and reliability of a revised version containing 29 items. The Emotional Reaction to Challenging Behavior Scale-Korean (ERCBS-K) was studied using 445 in-service physical educators (228 females; 217 males). Data were collected using onsite administration as well as mail survey administration procedures. Confirmatory and exploratory factor analyses results supported a five-factor, 28-item scale ERCBS-K. Acceptable internal consistency coefficients were found for each of the subscales of the ERCBS-K (Cronbach's alpha ranged from 0.71 to 0.87).

The MDS Challenging Behavior Profile for long-term care

The objective was to construct a reliable and valid challenging behavior scale with items from the Minimum Data Set (MDS). Exploratory factor analyses of a sample of 656 nursing home residents yielded a 16-item Behavior Profile containing four internally consistent and valid subscales measuring conflict behavior, withdrawn behavior, agitation and attention seeking behavior (alpha range: 0.69–0.80). On a second dataset of 227 nursing home residents, internal consistency, inter-rater reliability and validity against the Behavior Rating Scale for Psychogeriatric Inpatients (GIP) were established. Internal consistency of the subscales ranged between 0.54 and 0.78. The overall inter-rater reliability of the items was 0.53 (kappa); of the scale it was 0.75 (ICC). The MDS Challenging Behavior Profile could potentially be an important contribution to existing clinical MDS-scales but additional studies on reliability, validity and usefulness are needed.