This is the first paper from the recent Early Intervention Project, created by the Challenging Behaviour Foundation, which aims to identify, assess and improve the use of evidence-based early interventions for challenging behaviour around the country.

The Project suggests that the delivery of early interventions for children is inconsistent across the UK, with a glaring lack of local support for children and their families. To address this, the Project compiled a briefing paper to examine current evidence around early interventions for children and young people with learning disabilities and challenging behaviour, with the aim to present recommendations for the future delivery of early interventions.

Behaviours that challenge are defined as any behaviours that are associated with personal or social risks. This can include aggression towards others, self-harm or running away.

Challenging behaviours have significant consequences for the children and young people displaying them, as well as their families and carers.

Children and young people with challenging behaviour are at greater risk of social exclusion, deprivation, physical harm and abuse. They are also more likely to be placed in costly residential placements.

Research shows that the families and carers of these children are at greater risk of physical and mental health issues, increased financial burden and reduced quality of life.

There has been a general consensus that early interventions are an appropriate and effective form of intervention for children without learning disabilities who have challenging behaviours. The authors suggest that the same may be true for those children with a learning disability.

The aim of the authors was to use current evidence to argue for the adoption of early interventions for children with learning disabilities with challenging behaviour.

Methods

As the authors of this briefing paper point out clearly, this is not a systematic review of the literature, but a “narrative review based on expert consensus” of the current body of literature around children with learning disabilities and challenging behaviour. The footnotes give the reader a brief overview of the type of evidence sources used in this briefing paper, including systematic reviews/meta-analyses, narrative reviews, primary research papers, and national data collections.

To accompany this paper, a data supplement was released with details of the national data sources, the Special Educational Needs data drawn from the School Census and the Learning Disabilities Census, which were used to calculate the population and cost statistics.

Results

Using the national data sources, the authors found that the prevalence of children with learning disabilities with challenging behaviour in England was just over 40,000 and was considerably higher than those children without a learning disability.

The data also showed that there was an increased risk of challenging behaviour in children with learning disabilities from a young age.

Also that the current provisions for these children with learning disabilities and challenging behaviours (i.e. residential placements) are extremely costly, rising to around £171,176 for a 52-week placement. This cost only increases when adults with challenging behaviour.

When the authors examined the use of early interventions with learning disabled children with challenging behaviour, they found good evidence for its effectiveness. The evidence suggested that parenting programmes such as “Triple P” can improve parenting skills and well-being, and reduce challenging behaviour in children.

The authors found Positive Behavioural Support, an early behavioural intervention, to be the most effective evidence-based intervention for supporting children with learning disabilities and challenging behaviour.

The research also suggests that interventions such as Positive Behavioural Support, if used instead of residential placements, could lead to possible savings.

The authors also found that early screening of children with learning disabilities for risk factors associated with the development of challenging behaviours allowed for earlier intervention and reduced the likelihood of challenging behaviours developing later in life.

Conclusion

The authors concluded their briefing paper by laying out recommendations for policy makers and commissioners based on the results found above.

They suggest that it is important that all children with learning disabilities and their families have access to evidence-based early intervention programmes; that with improved methods, children with learning disabilities should be screened for risk factors contributing to the development of challenging behaviour; and that local specialist behavioural support should be provided to those children and families that need it.

They conclude that these measures would be cost-effective and even save money in comparison to expensive provisions such as residential placements.

The authors also suggest that improvements be made to the national data collection which would mean including more information of different types of placements for children, as well as more information on costs.

Strengths and limitations

The aim of this paper was to investigate the use of early interventions for children with learning disabilities and challenging behaviour in England. The briefing paper does exactly this. It clearly lays out evidence for the effectiveness of such interventions with this highly vulnerable population.

The paper used multiple forms of evidence, such as meta-analyses, random control trials and longitudinal studies, to inform its conclusions.

However, there is a lack of clarity around the inclusion/exclusion criteria used by the authors for their evidence search. It is difficult to make comment on the validity and integrity of the evidence cited by this briefing paper as we are unaware of how the authors chose which papers to serve as evidence, and which to leave out of the discussion.

The authors themselves do not comment on the validity or reliability of the evidence they used. A clear, published set of protocol used in this literature search would have been useful.

The publication of the data supplement alongside this briefing paper was also revealing, as the independent researcher pointed out the distinct lack of national data sets that could be used in this paper, only two.

Further to this, the authors of both papers highlight that these two data sets lead to further problems in that they lack rich information, and do not report on areas such as length of stay in residential placements, the primary needs of those in the placements, independent schools with SEN pupils, or the costs of such placements.

This large gap in the picture may leave some of the conclusions of the briefing paper open to question. However, the authors are clear that there is much more to be done in terms of collecting national figures and that the areas missing need to be investigated thoroughly to ensure that a full national picture of children with learning disabilities and challenging behaviours, along with intervention effectiveness and cost data, is available.

In summary, this briefing paper puts forward an effective case for the use of early interventions with children with learning disabilities whose behaviour challenges, and gives fair recommendations that give a clear picture of how early interventions can be implemented in England, as well as suggestions for the improvement of data collection for national sources.

Links

Early Intervention Project. (2014). Early intervention for children with learning disabilities whose behaviours challenge. The Challenging Behaviour Foundation [full text pdf]

Pinney, A. (2014). Children with learning disabilities whose behaviours challenge: What do we know from national data?. The Challenging Behaviour Foundation [full text pdf]

References

Barlow, J., Smailagic., N., Bennett, C., Huband, N., Jones, H., & Coren, E. (2011). Individual and group based parenting programmes for improving psychosocial outcomes for teenage parents and their children. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD002964. DOI: 10.1002/14651858.CD002964.pub2.

Families Special Interest Research Group of IASSIDD (2014). Families Supporting a Child with Intellectual or Developmental Disabilities: The Current State of Knowledge. Journal of Applied Research in Intellectual Disabilities, 27, 420–430.

Gore, N. J., Hastings R., & Brady (under review for TLDR). Building the Case for Early Intervention: Making use of what we know to prevent emotional and behavioural difficulties amongst children with disabilities.

Iemmi, V., Reid, C., Sholl, C., Buescher, A., Ferdinand, M., Trachtenberg, M., Knapp, M. (in press). Economic evaluation of intensive therapeutic intervention for children and adolescents with learning disabilities and challenging behaviours.

Learning Disabilities Census (2013) special data request. Data requested for 0-18 year olds inclusive.

McClean, B., Dench, C., Grey, I., Shanahan, S., Fitzsimons, E., Hendler, J., & Corrigan, M. (2005). Person focused training: a model for delivering positive behavioural supports to people with challenging behaviours. Journal of intellectual disability research, 49(5), 340-352.

McGill, P., & Poynter, J. (2012). High cost residential placements for adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 25, 584-587.

School Census data for England, January 2013 (special request)