Reducing challenging behaviours among children and adolescents with intellectual disabilities in community settings: a systematic review of interventions

Long-Term Outcomes for a Student with Severely Challenging Behavior in a Special Needs School for Intellectual Disabilities: A School Consultation Case Study

Self-injurious, stereotyped, and aggressive/destructive behaviors exhibited by individuals with intellectual disabilities and autism spectrum disorders are called challenging behaviors (CBs). Severe CBs often require long-term treatment involving psychosocial approaches based on behavioral interventions and/or medication. A boy with severe CB enrolled in a special needs school, with diagnoses of autism and intellectual disability, was the client of the study. This case report describes the long-term outcomes of eight years of continuous school consultation. The student's severe CB improved with environmental adjustments in the classroom, unified teacher involvement, instruction of leisure and communication skills, and medication. Long-term research on changes in CBs through school consultation is limited, and this case report provides important insights into the development of effective educational programs and curricula for severe CBs in school-aged children.

Interventions addressing challenging behaviours in Arab children and adults with intellectual disabilities and/or autism: A systematic review

BACKGROUND

Arabs with intellectual disabilities and/or autism may exhibit challenging behaviour that affects them and their caregivers. Early, appropriate intervention may reduce these effects. This review synthesised and critically appraised challenging behaviour intervention research for this population.

METHODS

All published empirical research on challenging behaviour interventions for Arabs with intellectual disabilities and/or autism was included. In September 2022, 15 English and Arabic databases yielded 5282 search records. Studies were appraised using the MMAT. Review findings were narratively synthesised.

RESULTS

The 79 included studies (n = 1243 participants) varied in design, intervention, and evaluation method. Only 12.6% of interventions were well-designed and reported. Arab interventions primarily targeted children, were applied collectively on small samples, lacked individualised assessment, and were based on an inconsistent understanding of challenging behaviour.

CONCLUSION

The evidence base on interventions for Arabs with intellectual disabilities and/or autism and challenging behaviour needs strengthening. Attention should be given to culturally relevant adaptations.

Deep brain stimulation may be a viable option for resistant to treatment aggression in children with intellectual disability

INTRODUCTION

Deep brain stimulation (DBS) is a surgical technique used to manage aggression in patients who do not improve despite the use of appropriate drug treatment.

OBJECTIVE

The objective of this study is to assess the impact of DBS on aggressive behavior refractory to the pharmacological and behavioral treatment of patients with Intellectual Disabilities (ID).

METHODS

A follow-up was conducted on a cohort of 12 patients with severe ID, undergoing DBS in posteromedial hypothalamic nuclei; evaluated with the Overt Aggression Scale (OAS), before the intervention, at 6, 12, and 18 months of medical follow-up.

RESULTS

After the surgical procedure, there was a significant reduction in the aggressiveness of patients in the follow-up medical evaluation at 6 months (t = 10.14; p < 0.01), 12 months (t = 14.06; p < 0.01), and 18 months (t = 15.34; p < 0.01), respect to the initial measurement; with a very large effect size (6 months: d = 2.71; 12 months: d = 3.75; 18 months: d = 4.10). From 12 months onward, emotional control stabilized and is sustained at 18 months (t = 1.24; p > 0.05).

CONCLUSION

DBS in posteromedial hypothalamic nuclei may be an effective treatment for the management of aggression in patients with ID refractory to pharmacological treatment.