How do carers assess the severity of challenging behaviour? A total population study.
Carers in family and community homes rate more behaviors as severely problematic than hospital staff, so adjust staff training and support accordingly.
01Research in Context
What this study did
Lowe et al. (1995) asked carers across the UK to rate how severe different challenging behaviors are. They compared answers from family homes, community houses, and big hospitals. Everyone looked at the same list of behaviors like hitting, screaming, or self-injury.
What they found
Carers agreed on which acts are the worst, but family and community staff labeled more behaviors as severe. Hospital staff were stricter; they called fewer behaviors severe even when the acts looked the same.
How this fits with other research
Scheithauer et al. (2025) later showed why those labels matter. They counted real harm: 73% of carers were hurt, 64% saw property damage, and 11% called emergency teams. The 1995 severity ratings line up with these hard numbers.
Allen et al. (2001) adds daily numbers. Among kids with ID, 60% showed aggression every single day. That high rate helps explain why family carers in the 1995 study called more acts severe; they live with the fallout around the clock.
Godoy-Giménez et al. (2024) flips the picture. They found adults in residential care suffer twice as much caregiver victimization. This seems to clash with the 1995 finding that hospital carers viewed behaviors as less severe. The gap is about lens: 1995 measured staff opinion, 2024 measured actual abuse records.
Why it matters
When you read a behavior support plan, check who wrote the severity section. Family and community staff may score higher because they bear the daily bruises. Use that insight to decide where extra training, respite, or protective equipment is needed most.
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02At a glance
03Original abstract
The severity of management problems of 13 types of problem behaviour presented by a total population sample of people with learning disabilities, as reported by their primary carers on eight separate assessments over 5 years, was examined. Three types of residential setting were represented: hospitals, family homes and community houses. The results showed a remarkable consistency in carers' assessments of the severity of management problem posed to them. An association was found between the reported frequency of occurrence and the assessment of the severity of behaviours, with certain behaviours likely to be rated as severe regardless of the frequency with which they occurred. Differences between residential settings were found, with carers in family homes and community houses rating more behaviours as presenting severe management problems than carers in hospital. The results from this study and other studies which have examined the relative severity of different behaviour topographies are discussed.
Journal of intellectual disability research : JIDR, 1995 · doi:10.1111/j.1365-2788.1995.tb00479.x