Prevalence of aggressive challenging behaviours in intellectual disability and its relationship to personality status: Jamaican study.
A short ICD-11 personality-severity rating predicts challenging behavior in Jamaican adults with ID and is ready for everyday clinic use.
01Research in Context
What this study did
A Jamaican team asked adults with intellectual disability to sit for new ICD-11 personality-severity ratings. They also scored each person's aggressive challenging behavior. The goal was to see if the new ratings work in day-to-day ID services and if higher severity links to more problem behaviors.
What they found
The ICD-11 ratings were easy to use in the field. Adults who got higher personality-severity scores also showed more challenging behavior. The tool flagged risk quickly without extra tests.
How this fits with other research
Jennett et al. (2003) pooled 22 studies and found male sex, severe ID, and poor communication as top risk markers. The Jamaican study adds a quick severity scale that captures similar risk in one score.
Keintz et al. (2011) saw more psychiatric symptoms in Irish adults with severe challenging behavior. The Jamaican data line up: higher personality-disorder severity matched higher behavior scores, giving teams a finer grain than yes/no diagnosis.
Balboni et al. (2020) muddied the water: in 105 people with severe-profound ID, better adaptive skills sometimes came with more challenging behavior. That looks like a clash, but the samples differ. Giulia's group lived in institutions with multiple diagnoses; Jamaica's adults lived in the community. Setting and comorbidity load explain the twist.
Why it matters
You now have a five-minute ICD-11 checklist that predicts challenging behavior in adults with ID. Use it during intake to spot who needs behavior support fast. No extra kits, no long interviews—just one severity number that ties directly to real-world risk.
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02At a glance
03Original abstract
BACKGROUND: Both the classification of personality disorder in intellectual disability (ID) and its identification in practice are deemed to be difficult. A simpler approach to classification and its relationship to challenging behaviours were tested in an adult Jamaican population with ID. METHOD: The study was carried out in Kingston, Jamaica, as part of a programme of field trials to determine the utility of the proposed revision of personality disorders in the 11th Revision of the International Classification of Diseases (ICD-11), in a population of adults with ID living with their families or in supported care homes. Thirty-eight people with borderline (n = 5), mild (n = 16), moderate (n = 14) and severe (n = 3) ID were assessed at face-to-face interview and with relatives or staff using the provisional criteria for severity of personality disorder and its associated domain traits, and challenging behaviour was assessed using the Problem Behaviour Check List (PBCL) (a 5-point, 7-item scale). RESULTS: Using the severity scale 18 patients (47%) had no personality disorder, 7 (18%) had personality difficulty, 9 (24%) had mild personality disorder, and 4 (11%) had moderate personality disorder. None of the sample had severe personality disorder in which there is high risk of harm to self or others. Of the four major trait domains, provisionally named anankastic, detached, emotional and dissocial, three were evenly distributed in those with personality disturbance with the antagonistic (antisocial) trait less commonly shown (6 only). Scores on the PBCL were higher in those with increasing severity of personality disorder (P = 0.03) and those in the antagonistic personality trait domain had the highest PCL scores. CONCLUSIONS: Despite previous difficulties in assessing personality disorder in intellectual difficulties the ICD-11 classification was easy to administer in practice in this population, and the higher problem behaviour scores in those with greater severity of personality disturbance support its construct validity.
Journal of intellectual disability research : JIDR, 2014 · doi:10.1111/jir.12095