Frequency and severity of challenging behaviour in people with profound intellectual and multiple disabilities.
Challenging behavior is everyday life for most adults with profound ID, even when staff say it is minor.
01Research in Context
What this study did
The team asked staff about 181 adults with profound intellectual and multiple disabilities. They wanted to know how often and how severe challenging behavior was.
Staff filled out a survey. They noted self-injury, stereotypy, and aggression. They also listed vision, hearing, and mental health issues.
What they found
Eight out of ten adults showed self-injury or repetitive movements. About half showed aggression. Most of these behaviors happened daily or weekly.
Yet staff rated the behaviors as minor, not severe. Visual problems, touch issues, and psychiatric diagnoses were linked to higher behavior scores.
How this fits with other research
Keintz et al. (2011) extends this picture. They found adults with profound ID scored lower on behavior checklists than those with severe ID. This seems opposite, but both can be true: behaviors are common yet may look mild on paper.
Ganz et al. (2004) looks like a contradiction. They saw fewer psychiatric symptoms in profound ID than in moderate ID. The key difference is measurement. B et al. counted mood and anxiety labels. P et al. counted observable behaviors like head-hitting.
Hassiotis et al. (2022) give us a yardstick. Their meta-analysis shows a tiny to small change on the ABC-Irritability scale counts as meaningful. This helps you judge if survey scores reflect real-life impact.
Why it matters
If you serve adults with profound ID, expect challenging behavior every day. Do not let low severity ratings stop you from assessing function and providing care. Pair your behavior plan with vision, hearing, and mental health checks. Use short, concrete items from tools like the ABC-I to track change, and set your goal above the 5-point mark Angela et al. suggest is the smallest worthwhile drop.
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02At a glance
03Original abstract
The main goals of this study were to determine the prevalence, frequency and severity of challenging behaviour in people with profound intellectual and multiple disabilities (PIMD). Because in the literature several health problems and sensory impairments are associated with the onset and existence of challenging behaviour, this relationship was also examined. This study involved 181 people with PIMD (age: mean: 35; SD: 19, 56% male). The Behaviour Problem Inventory was used to determine prevalence, frequency and severity of self-injurious (SIB), stereotypical and aggressive/destructive behaviour, and an additional questionnaire was used to determine the presence of sensory impairments and health problems among the participants. Results show a prevalence of 82% for SIB and stereotypical behaviour in the sample. Aggressive/destructive behaviour was seen in 45% of the participants. Concerning the frequency, on average SIB occurs on a daily or weekly basis. Stereotypical behaviour is seen on a daily basis and aggressive/destructive behaviour is usually reported once a week. All three types of challenging behaviour also occur on an hourly basis. The severity of challenging behaviour is usually rated by staff as of minor consequence for the person with PIMD. Furthermore, a relationship was found between having visual, tactile or psychiatric problems and the occurrence of challenging behaviour. Participants with visual impairments, tactile impairments or psychiatric problems showed significantly higher mean scores regarding challenging behaviour. Challenging behaviour within the target group of people with PIMD is very common. The prevalence figures are high, but direct support professionals are not inclined to rate such behaviour as of serious consequence.
Research in developmental disabilities, 2010 · doi:10.1016/j.ridd.2010.07.017