Formal versus informal interventions for challenging behaviour in persons with intellectual disabilities.
Over half of challenging-behavior help for adults with ID is undocumented and less effective.
01Research in Context
What this study did
Burack et al. (2004) mailed a survey to every agency serving adults with intellectual disability in Ontario. They asked how staff handle challenging behavior. They wanted to know if teams use formal plans or just wing it.
Six hundred twenty-five adults got their behavior recorded. The team counted who had a written behavior plan, who got training, and who just used common sense.
What they found
Fifty-five percent of interventions were informal. No plan on paper. No BCBA sign-off. Caregivers said these off-the-cuff tactics worked less often.
Staff with informal plans also got less training. Less training predicted weaker gains.
How this fits with other research
Poppes et al. (2010) later asked staff about the same clients. Staff said behaviors were “minor,” yet 82% showed self-injury daily. The same survey style shows staff under-rate problems when no formal data are kept.
Taylor et al. (2017) pooled real sleep-intervention studies. They found big, fast gains when teams used written behavioral protocols. A et al.’s undocumented tactics would likely miss those gains.
Vy et al. (2025) reviewed nursing papers and begged for staff training. Their plea lines up with A et al.’s finding: informal equals untrained.
Why it matters
If you supervise adults with ID, audit one record today. If you see “redirect as needed” instead of a behavior plan, you just found an informal intervention. Write a one-page plan, add a data sheet, and schedule staff training. That single step moves your caseload from the 55% pile into the evidence-based group.
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02At a glance
03Original abstract
BACKGROUND: Although effective, humane treatments exist for persons with intellectual disabilities (ID) who have challenging behaviour, little research has examined the extent to which clients receive formal, documented vs. undocumented interventions. METHODS: Caregivers (of 625 persons with ID living in community and institutional residences in Ontario, Canada) were interviewed to examine the prevalence of different types of interventions. RESULTS: Overall, 55% of the 2506 different interventions (for 1464 target behaviours) were informal (i.e. lacking documented input from a professional, written intervention plans, and systematic evaluation). No significant differences emerged on formality of intervention across participant gender, age, level of ID, and type of residence. There were significantly more informal than formal behavioural interventions and counselling/psychotherapy, and no significant difference in the overall prevalence of formal and informal intrusive procedures. Behaviour control medications were paired more often with formal (67%) than informal interventions for dangerous behaviours. Formal interventions were associated with higher caregiver-reported estimates of behavioural improvement, higher inter-rater agreement on the descriptions of an individual client's target behaviours and interventions, and more caregiver training and supervision. CONCLUSIONS: The low levels of intervention accountability, training and supervision may place many clients with challenging behaviour at increased risk for ineffective and unnecessary restrictive interventions, and physical abuse. The results of this survey stimulated the government to write province-wide standards (that have yet to be implemented).
Journal of intellectual disability research : JIDR, 2004 · doi:10.1111/j.1365-2788.2004.00578.x