Majority of challenging behaviours in people with learning disabilities not underpinned by psychiatric disorders says screening study

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The PAS-ADD (Psychiatric Assessment Schedule for Adults with a Developmental Disability) checklist is a 25 item questionnaire which uses non technical language and was designed to be used by support staff and families. The thinking was that it was these groups of people who spent the most time with the disabled person and so would have a good idea about how and when their behaviour might change. The checklist is used to see whether there is a need for further assessment of an individual’s mental health, although it can also be used to screen groups or for regular monitoring of people considered at risk of mental ill health.

The researchers in this study used the checklist to help explore the possible relationships between the presence of symptoms of psychiatric disorder and challenging behaviours in people with learning disabilities.

They worked with people in 800 service settings in a single geographical area using the checklist as a screening tool. They were looking for people identified in those services as having challenging behaviour. They collected behavioural data, PAS-ADD checklist information and they also used the Adaptive Behaviour Scale (a measure of personal and social skills for everyday living)

They found that under 17% of participants reached threshold scores on one on more subscales of the PAS-ADD checklist.

In terms of associations they found some evidence that increasing behavioural severity might be associated with increasing psychiatric symptoms.

However, they did not find any evidence of any associations between specific forms of challenging behaviour and individual symptoms.

The authors conclude that their study adds to the existing view from the evidence that

it is unlikely that the majority of challenging behaviours in adults with intellectual disability are underpinned by psychiatric disorder.

Screening for Psychiatric Disorders in a Total Population of Adults with Intellectual Disability and Challenging Behaviour Using the PAS-ADD Checklist, Allen D et al., in  Journal of Applied Research in Intellectual Disabilities, 25: 342–349.

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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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