More research is needed for people with learning disabilities and challenging behaviour

Hassiotis AA, Hall I

Published Online:

July 8, 2009

Challenging behaviour is a significant cause of social exclusion for people with learning disabilities. ('Learning disabilities' is also known as ' intellectual disabilities'). There is no firm evidence as yet about which interventions help people with learning disabilities most with their challenging behaviour. In this review we assess the efficacy of behavioural and cognitive behavioural interventions for a specific type of challenging or 'problem' behaviour, that is, outwardly-directed aggression.

Abstract (click to read)

Background:

Outwardly directed aggressive behaviour is a significant part of problem behaviours presented by people with learning disabilities. Prevalence rates between 3.3% to 36% have been reported in the literature. Such behaviours often run a long term course and are a major cause of social exclusion.

Objectives:

To determine the efficacy of behavioural and cognitive behavioural interventions for outwardly-directed aggressive behaviour for people with learning disabilities.

Search strategy:

The Cochrane Library (CENTRAL) 2007 (Issue 1), MEDLINE 1966 to February 2007, EMBASE 1980 to February 2007, PsycINFO 1872 to February 2007 and Dissertation Abstracts late 1960s to February 2007 were searched. Where appropriate, research filters were used.

Selection criteria:

Studies were selected if more than four participants, children or adults, were allocated by random or quasi-random methods to either intervention or standard treatment/wait list.

Data collection and analysis:

References identified by electronic searches, examinations of bibliography and personal contacts were screened against inclusion criteria by two independent reviewers. Two reviewers independently extracted and entered data into RevMan (Cochrane Collaboration software).

Main results:

Four studies based on adult populations with learning disabilities were deemed to be suitable for inclusion in the current version of this review. Data were only available in a form suitable for meta-analysis in three studies, but due to heterogeneity of populations and interventions, meta-analysis was not performed. Direct interventions based on cognitive-behavioural methods (modified relaxation, assertiveness training with problem solving, and anger management) appear to have some impact on reduction of aggressive behaviour at the end of treatment and in some studies also at follow up (up to six months).

Authors' conclusions:

The existing evidence on the efficacy of cognitive behavioural and behavioural interventions on outwardly directed aggression in children and adults with learning disabilities is scant. There is a paucity of methodologically sound clinical trials. Given the impact of such behaviours on the affected individual, his or her carers and on service providers, effective interventions are essential. It is also important to investigate cost efficacy of treatment models against existing treatments. We recommend that randomised controlled trials of sufficient power are carried out using primary outcomes of reduction in outward directed aggression, improvement in quality of life and cost efficacy as measured by standardised scales.

This record should be cited as:

Hassiotis AA, Hall I. Behavioural and cognitive-behavioural interventions for outwardly-directed aggressive behaviour in people with learning disabilities. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD003406. DOI: 10.1002/14651858.CD003406.pub3

Assessed as up to date:

March 5, 2007

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Primary Review Group:

Developmental, Psychosocial and Learning Problems Group

Health topics:

Developmental, psychosocial, and learning problems > Learning problems > Challenging behaviour

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

More research is needed for people with learning disabilities and challenging behaviour

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