Clinical and cost effectiveness of staff training in the delivery of Positive Behaviour Support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial
Specialist PBS teams produced no extra benefit for adults with ID and autism over usual care.
01Research in Context
What this study did
Researchers asked if training specialist learning-disability teams in Positive Behaviour Support (PBS) helps adults with ID and autism.
They split the adults into two groups. One group got the full PBS package from trained teams. The other group got the usual services.
They tracked challenging behaviour, quality of life, and service costs for one full year.
What they found
over the study period both groups looked the same. Challenging behaviour stayed high. Costs stayed high.
The PBS training did not move the needle on any key measure.
How this fits with other research
Taylor et al. (2017) saw big drops in problem behaviour when three kids got PBS plus CBT. The kids were younger and each plan was built just for them.
Tonge et al. (2014) also got gains when parents of preschoolers learned behaviour skills. Adults may need different tactics than children.
Eldevik et al. (2006) tested low-intensity ABA for children and saw only tiny gains. Together these studies hint that age, dose, and who delivers the plan matter more than the PBS label.
Why it matters
If you serve adults with ID and autism, do not assume a specialist PBS team will fix behaviour. You may need to add individualised strategies, higher intensity, or parent and staff coaching. Check data early and pivot if nothing changes.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Audit one adult client’s plan: if behaviour is flat after three months, boost individualisation or intensity instead of waiting a full year.
02At a glance
03Original abstract
Although Positive Behaviour Support (PBS) is a widely used intervention for ameliorating challenging behaviour (CB), evidence for its use in adults with intellectual disability (ID) and comorbid autism (ASD) is lacking. We report a planned subsidiary analysis of adults with both ASD and ID who participated in a randomised trial of PBS delivered by health professionals. The study was a multicentre, cluster randomised trial conducted in 23 community ID services in England, participants were randomly allocated to either the delivery of PBS (n = 11 clusters) or to treatment as usual (TAU; n = 12). One-hundred and thirteen participants (46% of all participants in the trial) had a diagnosis of ID, autism spectrum disorder and CB (ASD+); (47 allocated to the intervention arm, and 66 to the control). CB (primary outcome) was measured with the Aberrant Behaviour Checklist total score (ABC-CT). Secondary outcomes included mental health status, psychotropic medication use, health and social care costs and quality adjusted life years (QALYs) over 12 months. There were no statistically significant differences in ABC-CT between ASD+ groups randomised to the two arms over 12 months (adjusted mean difference = − 2.10, 95% CI: − 11.3 7.13, p = 0.655) or other measures. The mean incremental cost of the intervention per participant was £628 (95% CI -£1004 to £2013). There was a difference of 0.039 (95% CI − 0.028 to 0.103) for QALYs and a cost per QALY gained of £16,080. Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions. ClinicalTrials.gov: NCT01680276.
BMC Psychiatry, 2020 · doi:10.1186/s12888-020-02577-1