Incidence, types and characteristics of aggressive behaviour in treatment facilities for adults with mild intellectual disability and severe challenging behaviour.
In specialized ID units, half of clients engage in aggression but a small subgroup drives the bulk of incidents—target them first.
01Research in Context
What this study did
Workers watched adults with mild intellectual disability for 20 weeks. They wrote down every time someone hit, kicked, or hurt themselves. The home treats severe challenging behavior.
The team wanted to know how often aggression happens and who does it most.
What they found
They counted 639 aggressive events. About half of the clients showed outward aggression. One in eight hurt themselves.
A small group of clients caused most of the incidents.
How this fits with other research
S-Johnson et al. (2009) followed people for two years. They saw 27% stop being aggressive. H et al. found the snapshot; S-A et al. show the behavior can fade.
Rojahn et al. (1994) surveyed 2,412 people across Queensland. Only 11% were aggressive, but the rate jumped to 35% inside large institutions. The new study took place in one such setting, so the high rate matches.
Hattier et al. (2011) linked certain mental-health diagnoses to specific types of aggression. Their big survey adds detail to the raw counts H et al. provide.
Why it matters
You now know that in a high-care ID unit, half the clients will show aggression, but a handful will eat up most of your crisis time. Find that handful first. Run a brief functional assessment on them, schedule extra check-ins, and teach staff proactive de-escalation. Targeted effort early can spare the whole house dozens of incidents later.
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02At a glance
03Original abstract
BACKGROUND: Inpatient aggression in treatment facilities for persons with intellectual disability (ID) can have aversive consequences, for co-clients and staff, but also for the aggressors themselves. To manage and eventually prevent inpatient aggressive incidents, more knowledge about their types and characteristics is necessary. METHOD: In four facilities, totalling 150 beds, specialized in the treatment of adults with mild ID or severe challenging behaviour, aggressive incidents were registered during 20 weeks using the Staff Observation Aggression Scale-Revised. Characteristics of auto-aggressive and outwardly directed incidents and differences in their incidence in male and female clients in these facilities were compared. RESULTS: During the observation period of 20 weeks, 639 aggressive incidents were documented. Most of these (71%) were outwardly directed, predominantly towards staff, while most of the remaining incidents were of an auto-aggressive nature. Of the 185 clients present during the observation period, 44% were involved in outwardly directed incidents (range per client 1-34), and 12% in auto-aggressive incidents (range per client 1-92). Auto-aggressive and outwardly directed incidents differed regarding source of provocation, means used during the incident, consequences of the incident and measures taken to stop the incident. The proportion of men and women involved in each type of incident was comparable, as well as the majority of the characteristics of outwardly directed incidents caused by men and women. CONCLUSIONS: Although approximately half of all clients were involved in aggressive incidents, a small minority of clients were responsible for the majority of incidents. Therefore, better management and prevention of aggressive incidents for only a small group of clients could result in a considerable overall reduction of aggressive incidents in treatment facilities. Comparability of aggressive behaviour in these facilities shown by men and women and differences in characteristics of auto-aggressive and outwardly directed incidents are discussed.
Journal of intellectual disability research : JIDR, 2008 · doi:10.1111/j.1365-2788.2007.00968.x