Call for guidelines on role of physical conditions in challenging behaviour


Physical factors can be a cause of some challenging behaviours in people with learning disabilities and this systematic review set out to determine what these conditions might be.

The search covered the period 1990 and 2008and identified 45 studies. These looked at general medical conditions, motor impairment, epilepsy, sensory impairment, gastrointestinal disease, sleep disorders, dementia and others.

The authors found significant associations between challenging behaviours and urinary incontinence, pain related to cerebral palsy and chronic sleep problems.

They also found associations between self-injurious behaviour and visual impairment. Many physical conditions were not addressed in the literature at all.

They conclude that medical conditions play a role in challenging behaviour and that these must be evaluated in clinical settings. The level of evidence is low with a lack of any longitudinal studies and the authors recommend systematic research to enable the eventual development of clinical guidelines.

Physical conditions and challenging behaviour in people with intellectual disability: a systematic review, de Winter C et al., in Journal of Intellectual Disability Research, 55: 675–698

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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