Challenging Behaviours and Severe Learning Disabilities: Recent Developments in Behavioural Analysis and Intervention

Abstract

Recent years have witnessed the gradual emergence of a technology of nonaversive behavioural support for people with severe learning disabilities and seriously challenging behaviours. Three key aspects of these developments are reviewed, including: the functional perspective to analysis and intervention; the incorporation of the analysis and modification of setting events into behavioural practice; and the use of experimental techniques to conduct functional analyses of the contextual control of challenging behaviours. Attention is drawn to the practical implications and limitations of these developments.

Difficult behaviour and dementia in nursing homes: five cases of psychosocial intervention

“…A person-centred paradigm that acknowledges the unique past and present experience of the person with dementia is often significant in planning a psychosocial intervention. In the field of learning disability, the re-emergence of a functional perspective in applied behavioural analysis and intervention has been a significant development (Emerson, 1993). Samson and McDonnell (1990) discuss the weaknesses of some definitions of functional analysis, which restrict the range of hypotheses that are investigated.…”

“…Second, we considered aspects of the broader context, i.e. the setting events (Emerson, 1993): for example the role of neuroleptics in Betty's 'throwing herself about' and of physiological arousal in early evening restlessness. It was necessary to understand the neuropsychological basis of their difficulties in order to help Jack, Jane and Betty to overcome the devastating effect of apraxia, perceptual distortion and perseveration on their attempts to communicate and/or attend to their self-care needs.…”

“…Interestingly in case 4, certain residents appeared to respond to Violet's screaming by 'looking after her', without extensive prompting, from staff. This potential for the displacement of challenging behaviours by establishing socially appropriate, 'functionally equivalent', alternatives (Emerson, 1993) has been highlighted recently. For example, Bird and his colleagues (1995) demonstrated that retention of information is possible in dementia if it possesses 'practical value', and Ikeda and colleagues (1998) describe the retention of emotionally significant experiences in cases of dementia.…”

Psychiatric illness and learning disability: a dual diagnosis

“…Severely challenging behaviour refers to beha viour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to the use of ordinary community facilities (Emerson et al, 1991). The term challenging behaviour neither necessitates nor excludes a formal psychiatric diagnosis.…”

“…Behavioural treatments, based on functional behavioural analysis, have been shown to be effective in managing, reducing, or eliminating challenging behaviour such as aggression or selfinjury in individuals (Emerson, 1993).Most studies have been done in staffed settings. Less infor mation is available about other psychological methods.…”