People with intellectual disabilities (PwID) are at a higher risk of developing challenging behaviours (CB). Despite the poor evidence for the effectiveness of medications in managing CB, they are used widely among PwID (50–63%). The aims of our study were to develop a training programme, SPECTROM for support staff to help reduce overmedication in PwID and carry out field testing of SPECTROM including a process evaluation. We developed SPECTROM using the Experience-based co-design method that included four focus groups and a one-day co-design event. Twenty trainees received SPECTROM training. We used the Management of Aggression and Violence Attitudes Scale-Revised-Intellectual Disabilities (MAVAS-R-ID) and the Psychotropic knowledge questionnaire. A semi-structured interview and a feasibility questionnaire were used for process evaluation. SPECTROM website contains 14 modules, resources, and face-to-face training. MAVAS-R-ID scores showed change in staff attitude to ‘medication management’ domain was statistically significant (p < 0.05). Psychotropic knowledge questionnaire showed statistical post-training improvement in correct responses (p < 0.05). Process evaluation data showed that SPECTROM was acceptable, applicable, practical, and relevant to staff practice, and helped to improve self-reflection, knowledge, and support to PwID. SPECTROM is a useful training that helps to change the support staff’s attitude toward CB and improve their knowledge of psychotropic medications.

In the beginningMy son Christopher is a beautiful 21-year-old young man who can sing like a bird and loves nothing better than splashing about in the swimming pool. He also happens to have autism and severe learning disabilities. Christopher finds our neuro-typical world incredibly frightening and confusing. This fear and this confusion make him very anxious. These anxieties frequently make him very distressed. When he becomes distressed he is likely to injure himself and others around him. Christopher is an incredibly complex young man. Every day is a challenge for him, and for those who live and work with him. When we get it right the rewards are enormous, but when we get it wrong the results can be disastrous. My biggest fear has always been that, as he came into adulthood, I would not be able to protect him from a system that on the whole was ill-equipped to deal with the complexity of his condition.Christopher was diagnosed when he was three years old. We were first offered medication when he was five. A paediatrician watched amazed as Christopher zoomed around his office as if on the wall of death at the funfair. He said 'Of course there's always haloperidol -but it's a bit fierce for a five year old'. This was in response to my enquiry about suggestions on how to deal with the fact that Christopher didn't sleep. Needless to say, I never mentioned it again.When Christopher was nine he was excluded from his special school, we moved to another county to secure appropriate specialist education for him and I made enquiries about what services were available for us. A social worker for the children with disabilities team said: 'We use family link but the Christophers of this world are really hard to place, challenging behaviour is a bit of a problem.' After observing Christopher for a few minutes he added 'Is he on any medication?' Needless to say, we did not access any residential respite services.When puberty hit Christopher it was like a locomotive out of control. It hit him full on. It was as if overnight he became a different child. Intellectually, as a family we knew it would happen, but we could not have been prepared for the impact it had on him or us. His mood oscillated from extreme anxiety and excitability to being incredibly distressed and tearful. It took all our inner reserves, and it became increasingly difficult, to keep Christopher on an even keel. His behaviour became more and more erratic and he began to hurt himself and us. We became more and more