Risk factors associated with challenging behaviour in people with profound intellectual and multiple disabilities.
Fix sleep and hearing before you chase challenging behavior in adults with profound ID.
01Research in Context
What this study did
Poppes et al. (2016) looked at 198 adults with profound intellectual and multiple disabilities. They asked: what everyday factors go hand-in-hand with more hitting, screaming, or self-injury?
The team ran a big regression. They tested sleep problems, hearing issues, staff training history, and even how many staff were on duty.
What they found
Two body-based problems stood out. Poor sleep and trouble hearing were linked to more challenging behavior. Staffing numbers made no difference.
Earlier staff training actually showed a link too, but sleep and hearing were the strongest signals.
How this fits with other research
Horwood et al. (2019) saw the same sleep link in kids with cerebral palsy. Their odds ratio was huge (9.1), while P et al. found only a modest link. The gap makes sense: kids with CP often feel pain at night, so sleep loss hits harder.
Reid et al. (2005) and Richardson et al. (2008) tracked adults with severe ID for over a decade. They showed that early severe behavior plus poor language predicts long-term problems. P et al. add a new layer: check ears and sleep, not just skills.
Bruder et al. (2012) already flagged that autism severity feeds sleep trouble. P et al. flip the direction: bad sleep may feed behavior, no matter the diagnosis.
Why it matters
Before you write a behavior plan, run a two-minute check. Ask the night staff: did the client sleep? Ask the nurse: when was the last hearing test? If either is off, treat that first. You may cut problem behavior without a single token or timeout.
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02At a glance
03Original abstract
BACKGROUND: Several factors that correlate with the onset or continuation of challenging behaviour are mentioned in research. These are factors related to persons with ID, but also to direct support professionals and the context. Although many of these factors seem to affect the onset or continuation of challenging behaviour in people with ID in general, results are often inconclusive and have little focus on people with profound intellectual and multiple disabilities (PIMD). The present study aimed to assess the extent to which known factors related to challenging behaviour are also applicable to a group of 198 people with PIMD. METHOD: To determine which factors were associated with challenging behaviour, univariate analyses on associations between known risk factors and challenging behaviour were conducted. The associated factors were then subject to a regression analysis to determine the extent to which they explain the prevalence of challenging behaviour and can thus be seen as factors associated with challenging behaviour. RESULTS: The results show that, in particular, factors concerning the personal characteristics of people with PIMD, such as sleeping problems and auditory problems, were related to the variance in mean frequency of challenging behaviour. Only one factor related to the direct support professionals was found: when these professionals had been offered training on the subject of challenging behaviour in people with intellectual disabilities in general, they identified significantly more withdrawn behaviour. We found no contextual factors related to challenging behaviour. CONCLUSION: These findings are generally consistent with findings reported in other studies, especially concerning the personal characteristics of people with PIMD. Further research should focus on the effects of providing safe auditory environments and appropriate sleep schedules for people with PIMD on the occurrence of challenging behaviour.
Journal of intellectual disability research : JIDR, 2016 · doi:10.1111/jir.12268