The influence of the indoor environment on people displaying challenging behaviour: A scoping review

Abstract

BACKGROUND: The care sector for persons with disabilities considers the physical environment relevant for the quality of life of people with intellectual disabilities. However, scientific evidence is limited. OBJECTIVE: To obtain evidence regarding comforting and encouraging environments and to develop an overview of studies addressing the effect of the physical environment on people with intellectual disabilities. METHODS: A scoping review, accompanied by expert panels and case findings combining scientific evidence and knowledge from practice, was performed to investigate the interaction between challenging behaviour and the physical environment. Between January and March 2020, several scientific databases were searched in the English, Dutch, and German language for relevant studies. Social media, care professionals, and experts in building physics were consulted. RESULTS: Studies on building-related factors as passive interventions and care- or therapy-related interventions could be distinguished. The majority of the studies report on building-related factors such as sound, acoustics, light, and colours and their influence on behaviour. Specific guidelines are lacking on how to adjust the indoor environment to an environment that is safe, comforting and encouraging for people displaying challenging behaviour. Proposed solutions are case-based. CONCLUSION: In future studies individual cases could be studied in a more in-depth manner, aligned and categorised to the building-related factors and to the expressions of challenging behaviour.

Challenging Behavior in Context: A Case Study on How People, Space, and Activities Interact

“…The spatial context, our analyses suggests, interrelates with challenging behavior mostly by acoustic and visual stimuli and to a lesser degree by odor and temperature. This supports studies that consider acoustics a major influence on challenging behavior and individuals on the autism spectrum (Casson et al, 2021; Embregts et al, 2009; Mostafa, 2008, 2014; Mueller-Schotte, 2022; Parris & Watson, 2011; Nguyen Lan et al, 2020). The findings on the influence of visual stimuli strengthen previous research that emphasizes the alleged importance of clarity, order, and visual calm to foster emotional well-being and reduce stress in individuals showing challenging behavior or being on the autism spectrum (Embregts et al, 2009; Khare & Mullick, 2009; Kinnaer et al, 2015; Mostafa, 2014; Resnik & Blackbourn, 2009).…”

“…Our findings suggest an impact of co-residents on challenging behavior, which is visible in two ways: direct triggering and transfer of stress. This observation supports the perspective that challenging behavior may be triggered by the lack of choice in interpersonal interaction, such as the amount of attention from caregivers; the distance to caregivers or co-residents; the number of persons around a resident; the presence of a person one dislikes; or the inability to leave a setting (Embregts et al, 2009;Kinnaer, 2015;Mueller-Schotte, 2022). Our findings are consistent with Emerson's (2001) implication that "seriously challenging behaviors may significantly impair the health and/or QoL of the person themselves, those who care for them and those who live or work with them."…”

“…The “interactional” model conceptualizes challenging behavior as a product of the individual and the external context (Farrell et al, 2010). A built environment that suits these individuals’ needs is important to their quality of life (QoL; Bradley & Korossy, 2016; Mueller-Schotte et al, 2022). Also, to support person-centered care, we need to understand how person-centered environments can be created (Hamilton, 2021).…”