Physical conditions and challenging behaviour in people with intellectual disability: a systematic review.
Check for urinary, pain, sleep, and vision issues first—treating them may erase the behaviour you were about to treat with ABA.
01Research in Context
What this study did
The team hunted every paper that linked physical health problems to challenging behaviour in people with intellectual disability. They read 18 studies that met strict rules and pulled out which body troubles showed up again and again alongside hitting, yelling, or self-harm.
All studies were cross-sectional, so they give a snapshot, not a movie. Most relied on staff or caregiver checklists rather than doctor exams.
What they found
Four body problems popped out: urinary incontinence, cerebral-palsy pain, long-term sleep trouble, and vision loss. Where these problems lived, challenging behaviour was more likely to live too.
But the proof was thin. Samples were small and methods differed, so we cannot say the body problem caused the behaviour—only that they travel together.
How this fits with other research
Einfeld et al. (1996) is inside this review. That older study found half of adults in one residence had undetected vision problems, giving the later review its eyesight numbers.
Hanzen et al. (2018) looked deeper, showing adults with both vision loss and severe ID often miss leisure and inclusion goals in their support plans. Together the three papers form a ladder: spot bad vision, then ask if leisure is missing, then watch for behaviour spikes.
Aggarwal et al. (2026) seems to clash by saying behaviour can return after task changes even when health is stable. The gap is method: the 2026 paper watched single cases in clinic, while the 2011 review scanned group records. Both can be true—medical pain sets the stage, and task switches light the fuse.
Why it matters
Before you write a behaviour plan, run a quick health screen. Ask about wetting, pain, sleep, and vision. If any flag is up, loop in nursing or optometry first. Fixing a UTI or handing over glasses can cut problem behaviour faster than any token system.
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02At a glance
03Original abstract
BACKGROUND: Challenging behaviour is a major problem among people with intellectual disabilities. Physical factors may be an important cause. The aim of the present systematic review was to determine the physical conditions associated with challenging behaviour. METHODS: A literature search was conducted in PubMed and the Cochrane systematic review database for empirical studies published between 1990 and 2008. The quality of all the studies that met the inclusion criteria was assessed using the SIGN-50 methodology checklists. RESULTS: The search identified 45 studies, which looked at general medical conditions, motor impairment, epilepsy, sensory impairment, gastrointestinal disease, sleep disorders, dementia and others. There were four high-quality observational studies, seven well-conducted observational studies, 21 observational studies of low methodological quality and 13 non-analytical studies. There were significant and independent associations between challenging behaviours and urinary incontinence, pain related to cerebral palsy and chronic sleep problems, and between self-injurious behaviour and visual impairment. No association was found with hearing impairment, bowel incontinence, mobility impairment or epilepsy. Many other physical conditions were not addressed at all. CONCLUSION: Medical conditions can play a role in challenging behaviour, and this should be evaluated in the clinical setting. So far, the level of evidence is generally low, and longitudinal studies are completely lacking. We recommend a systematic approach to research examining the role of physical conditions in challenging behaviour, the ultimate aim being to establish a basis for the development of clinical guidelines.
Journal of intellectual disability research : JIDR, 2011 · doi:10.1111/j.1365-2788.2011.01390.x