Tỷ Lệ Hành Vi Thách Thức ở Người Lớn Có Khuyết Tật Trí Tuệ, Các Tương Quan và Mối Liên Hệ với Sức Khỏe Tâm Thần

Current Developmental Disorders Reports - Tập 6 - Trang 173-181 - 2019
Darren L. Bowring1,2, Jon Painter3, Richard P. Hastings1,4
1CEDAR, University of Warwick, Coventry, England
2Government of Jersey, Saint Helier, UK
3Department of Nursing and Midwifery, Collegiate Crescent Campus, Sheffield Hallam University, Sheffield, UK
4Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Australia

Tóm tắt

Tóm tắt các phát hiện về tỷ lệ và các yếu tố tương quan của hành vi thách thức ở người lớn có khuyết tật trí tuệ từ các nghiên cứu vững chắc. Chúng tôi cũng mô tả những phát hiện về sự tương tác giữa hành vi thách thức và sức khỏe tâm thần. Các nghiên cứu gần đây sử dụng các công cụ đã được đánh giá tâm lý, với các định nghĩa hoạt động rõ ràng, cho thấy các phát hiện tương tự về tỷ lệ hành vi thách thức khoảng 1 trong mỗi 5–6 người lớn được biết đến trong các dịch vụ. Chúng tôi mô tả các yếu tố tương quan phổ biến được xác định, chẳng hạn như khuyết tật giao tiếp, mức độ nghiêm trọng của khuyết tật trí tuệ, và sống trong các cơ sở thể chế hoặc chăm sóc tập trung. Chúng tôi cũng mô tả mối quan hệ phức tạp và đa diện giữa hành vi thách thức và sức khỏe tâm thần. Dựa trên các nghiên cứu gần đây, chúng tôi đề xuất một mô hình khung đã được sửa đổi để giúp hiểu hành vi thách thức. Chúng tôi đề xuất một số lĩnh vực mà cần có thêm nghiên cứu, đặc biệt là phát triển các công cụ đánh giá rủi ro mà các chuyên gia có thể sử dụng trong thực hành.

Từ khóa

#hành vi thách thức #khuyết tật trí tuệ #sức khỏe tâm thần #tỷ lệ #tương quan

Tài liệu tham khảo

• Jones S, Cooper S-A, Smiley E, Allen L, Williamson A, Morrison J. Prevalence of, and factors associated with, problem behaviors in adults with intellectual disabilities. J Nerv Ment Dis. 2008;196:678–86. https://doi.org/10.1097/NMD.0b013e318183f85cThis study investigated prevalence and correlates of CB in a population sample of adults with ID. Lundqvist L. Prevalence and risk markers of behaviour problems among adults with intellectual disabilities: a total population study in Orebro County. Sweden Res Dev Disabil. 2013;34:1346–56. https://doi.org/10.1016/j.ridd.2013.01.010. •• Bowring DL, Totsika V, Hastings RP, Toogood S, Griffiths GM. Challenging behaviours in adults with an intellectual disability: a total population study and exploration of risk indices. Br J Clin Psychol. 2017;56:16–32. https://doi.org/10.1111/bjc.12118This is one of the first studies to consider how risk factors for CB might act together. Cooper S-A, Smiley E, Morrison J, Williamson A, Allan L. Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. Brit J Psychiatry. 2007;190:27–35. https://doi.org/10.1192/bjp.bp.106.022483. • Hemmings C, Deb S, Chaplin E, Hardy S, Mukherjee R. Review of research for people with ID and mental health problems: a view from the United Kingdom. J Ment Health Res Intellect Disabil. 2013;6(2):127–58. https://doi.org/10.1080/19315864.2012.708100This study provides a helpful account of research into MH problems and treatment in the UK for people with ID. Emerson E, Kiernan C, Alborz A, Reeves D, Mason H, Swarbrick R, et al. The prevalence of challenging behaviors: a total population study. Res Dev Disabil. 2001;22:77–93. https://doi.org/10.1016/S0891-4222(00)00061-5. Cooper S-A, Smiley E, Jackson A, Finlayson J, Mantry D, Morrison J. Adults with intellectual disabilities: prevalence, incidence and remission of aggressive behaviour and related factors. J Intellect Disabil Res. 2009;53:217–32. https://doi.org/10.1111/j.1365-2788.2008.01127.x. Holden B, Gitlesen JP. A total population study of challenging behaviour in the county of Hedmark, Norway: prevalence and risk markers. Res Dev Disabil. 2006;27:456–65. https://doi.org/10.1016/j.ridd.2005.06.001. Glover G, Olson V. Assessment and treatment units and other specialist inpatient care for people with learning disabilities in the Count-Me-In surveys, 2006 to 2010. Improving Health and Lives: Learning Disabilities Observatory; 2012. www.improvinghealthandlives.org.uk/gsf.php5?f=16342. Accessed 2015 Matson JL, Bamburg JW, Mayville EA, Pinkston J, Bielecki J, Kuhn D, et al. Psycho-pharmacology and mental retardation: a 10 year review (1990–1999). Res Dev Disabil. 2000;21:263–96. https://doi.org/10.1016/s0891-4222(00)00042-1. Matson JL, Nebel-Schwalm M. Assessing challenging behaviors in children with autism spectrum disorders: a review. Res Dev Disabil. 2007;28:567–79. https://doi.org/10.1016/j.ridd.2006.08.001. Royal College of Psychiatrists, British Psychological Society and Royal College of Speech and Language Therapists. Challenging Behaviour: a unified approach: clinical and service guidelines for supporting people with learning disabilities who are at risk of receiving abusive or restrictive practices. London: Royal College of Psychiatrists; 2007. Hastings RP, Brown T. Behavioural knowledge, causal beliefs and self-efficacy as predictors of special educator’s emotional reactions to challenging behaviours. J Intellect Disabil Res. 2002;46:144–50. https://doi.org/10.1046/j.1365-2788.2002.00378.x. •• Hastings RP, Allen D, Baker P, Gore NJ, Hughes JC, McGill P, et al. A conceptual framework for understanding why challenging behaviours occur in people with developmental disabilities. Int J Posit Behav Support. 2013;3:5–13 This paper proposes a causal framework for understanding CB, which we have revised in the current article. Bouras N, Drummond C. Behaviour and psychiatric disorders of people with mental handicaps living in the community. J Intellect Disabil Res. 2008;36:349–57. https://doi.org/10.1111/j.1365-2788.1992.tb00533.x. Poppes P, van der Putten AJJ, Vlaskamp C. Frequency and severity of challenging behaviour in people with profound intellectual and multiple disabilities. Res Dev Disabil. 2010;31:1269–75. https://doi.org/10.1016/j.ridd.2010.07.017. Kiernan C, Moss S. Behaviour disorders and other characteristics of the population of a mental handicap hospital. Ment Handicap Res. 1990;3:3–20. https://doi.org/10.1111/j.1468-3148.1990.tb00077.x. Kiernan C, Qureshi H. Challenging Behaviour. In: Kiernan C, editor. Research to Practice? Implications of research on the challenging behaviour of people with learning disability. Clevedon: British Institute of Learning Disabilities Publications; 1993. Emerson E, Bromley J. The form and function of challenging behaviours. J Intellect Disabil Res. 1995;39:388–98. https://doi.org/10.1111/j.1365-2788.1995.tb00543.x. Lowe K, Allen D, Jones E, Brophy S, Moore K, Jones W. Challenging behaviours: prevalence and topographies. J Intellect Disabil Res. 2007;51:625–36. https://doi.org/10.1111/j.1365-2788.2006.00948.x. Borthwick-Duffy SA. Prevalence of destructive behaviors. In: Thompson T, Gray DB, editors. Destructive behavior in developmental disabilities: diagnosis and treatment. Thousand Oaks: Sage; 1994. p. 3–23. Jacobson JW. Problem behavior and psychiatric impairment within a developmentally disabled population. I: behavior frequency. Appl Res Ment Retard. 1982;3:121–39. https://doi.org/10.1016/0270-3092(82)90002-9. • Sheehan R, Hassiotis A, Walters K, Osborn D, Strydom A, Horsfall C. Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. Br Med J. 2015;351:4326. https://doi.org/10.1136/bmj.h4326This study explores prescribing in a large sample of over 33,000 adults with ID in the UK. Crocker AG, Mercier C, Lachapelle Y, Brunet A, Morin D, Roy ME. Prevalence and types of aggressive behaviour among adults with intellectual disabilities. J Intellect Disabil Res. 2006;50:652–61. https://doi.org/10.1111/j.1365-2788.2006.00815.x. McClintock K, Hall S, Oliver C. Risk markers associated with challenging behaviours in people with developmental disabilities: a meta-analytic study. J Intellect Disabil Res. 2003;47:405–16. https://doi.org/10.1046/j.1365-2788.2003.00517.x. Rojahn J, Rowe EW, Sharber AC, Hastings R, Matson JL, Didden R, et al. The Behavior Problems Inventory-Short Form for individuals with intellectual disabilities: Part I: development and provisional clinical reference data. J Intellect Disabil Res. 2012;56:527–45. https://doi.org/10.1111/j.1365-2788.2011.01507.x. Deb S, Thomas M, Bright C. Mental disorder in adults with intellectual disability. II. The rate of behaviour disorders among a community-based population aged between 16 and 64 years. J Intellect Disabil Res. 2001;45:506–14. https://doi.org/10.1046/j.1365-2788.2001.00373.x. Tyrer P, Oliver-Africano PC, Ahmed Z, Bouras N, Cooray S, Deb S, et al. Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trail. Lancet. 2008;371:57–63. https://doi.org/10.1016/s0140-6736(08)60072-0. Lofthouse R, Golding L, Totsika V, Hastings RP, Lindsay W. How effective are risk assessments/measures for predicting future aggressive behaviour in adults with intellectual disabilities (ID): a systematic review and meta-analysis. Clin Psychol Rev. 2017:76–85. https://doi.org/10.1016/j.cpr.2017.10.001. Davies LE, Oliver C. Self-injury, aggression and destruction in children with severe intellectual disability: incidence, persistence and novel, predictive behavioural risk markers. Res Dev Disabil. 2016:291–301. https://doi.org/10.1016/j.ridd.2015.12.003. Rutter M. Protective factors in children’s responses to stress and disadvantage. In: Kent MW, Rolf JE, editors. Primary prevention in psychopathology. Vol. 8: Social competence in children. Hanover: University Press of New England; 1979. p. 49–74. Painter J, Hastings R, Ingham B, Trevithick L, Roy A. Correlates for the risk of specialist ID hospital admission for people with intellectual disabilities: development of the LDNAT inpatient index. Tizard Learning Disability Review. 2018:42–50. https://doi.org/10.1108/TLDR-04-2017-0015. Evans GW, Dongping L, Sepanski-Whipple S. Cumulative risk and child development. Psychol Bull. 2013;139:1342–96. https://doi.org/10.1037/a0031808. • Hassiotis A, Robotham D, Canagasabey A, Romeo R, Langridge D, Blizard R, et al. Randomized, single-blind, controlled trial of a specialist behavior therapy team for challenging behavior in adults with intellectual disabilities. Am J Psychiatry. 2009;166:1278–85. https://doi.org/10.1176/appi.ajp.2009.08111747This paper utilises a robust research design to explore the impact of a specialised CB team. Durand VM, Hieneman M, Clarke S, Wang M, Rinaldi ML. Positive family intervention for severe challenging behavior I: a multisite randomized clinical trial. J Posit Behav Interv. 2013;15(3):133–43. https://doi.org/10.1177/1098300712458324. • Bowring DL, Totsika V, Hastings RP, Toogood S. Outcomes from a community-based positive behavioural support team for children and adults with developmental disabilities. J Appl Res Intellect Disabil. 2019:1–11. https://doi.org/10.1111/jar.12660One of the largest real world evaluations of a specialised PBS service working across the lifespan. Pruijssers AC, van Meijel B, Maaskant M, Nijssen W, van Achterberg T. The relationship between challenging behaviour and anxiety in adults with intellectual disabilities: a literature review. J Intellect Disabil Res. 2014;58:162–71. https://doi.org/10.1111/jir.12012. Melville C, Johnson P, Smiley E, Simpson N, Purves D, McConnachie A, et al. Problem behaviours and symptom dimensions of psychiatric disorders in adults with intellectual disabilities: an exploratory and confirmatory factor analysis. Res Dev Disabil. 2016;55:1–13. https://doi.org/10.1016/j.ridd.2016.03.007. Myrbakk E, von Tetzchner S. Psychiatric disorders and behavior problems in people with intellectual disability. Res Dev Disabil. 2008;29:316–32. https://doi.org/10.1016/j.ridd.2007.06.002. Tsiouris JA, Mann R, Patti PJ, Sturmey P. Challenging behaviours should not be considered as depressive equivalents in individuals with intellectual disability. J Intellect Disabil Res. 2003;47(1):14–21. https://doi.org/10.1046/j.1365-2788.2003.00456. Sturmey P, Laud RB, Cooper CL, Matson JL, Fodstad JC. Challenging behaviors should not be considered depressive equivalents in individuals with intellectual disabilities. II. A replication study. Res Dev Disabil. 2010;31(5):1002–7. https://doi.org/10.1016/j.ridd.2010.04.018. Melville C, Johnson PCD, Smiley E, Simpson N, McConnachie A, Purves D, et al. Statistical modelling studies examining the dimensional structure of psychopathology experienced by adults with intellectual disabilities: systematic review. Res Dev Disabil. 2016;53–54:1–10. https://doi.org/10.1016/j.ridd.2016.01.018. McCarthy J, Hemmings C, Kravariti E, Dworzynski K, Holt G, Bouras N, et al. Challenging behavior and co-morbid psychopathology in adults with intellectual disability and autism spectrum disorders. Res Dev Disabil. 2010;31(2):362–6. https://doi.org/10.1016/j.ridd.2009.10.009. Sappok T, Budczies J, Dziobek I, Bolte S, Dosen A, Diefenbacher A. The missing link: delayed emotional development predicts challenging behavior in adults with intellectual disability. J Autism Dev Disord. 2014;44(4):786–800. https://doi.org/10.1007/s10803-013-1933-5. Felce D, Kerr M, Hastings RP. A general practice-based study of the relationship between indicators of mental illness and challenging behaviour among adults with intellectual disabilities. J Intellect Disabil Res. 2009;53(3):243–54. https://doi.org/10.1111/j.1365-2788.2008.01131.x. Painter J, Hastings R, Ingham B, Trevithick L, Roy A. Associations between mental health problems and challenging behavior in adults with intellectual disabilities: a test of the behavioral equivalents hypothesis. J Ment Health Res In. 2018;11(2):157–72. https://doi.org/10.1080/19315864.2018.1431747. Poppes P, van der Putten AJJ, Post WJ, Vlaskamp C. Risk factors associated with challenging behaviour in people with profound intellectual and multiple disabilities. J Intellect Disabil Res. 2016;60(6):537–52. https://doi.org/10.1111/jir.12268. Kishmore M, Nizamie S, Nizamie A. The behavioural profile of psychiatric disorders in persons with intellectual diability. J Intellect Disabil Res. 2005;49(11):852–7. https://doi.org/10.1111/j.1365-2788.2005.00763.x. Speece D. Cluster analysis in perspective. Exceptionality. 1994;5(1):19–30. https://doi.org/10.1207/s15327035ex0501_3. Clatwort J, Buick D, Hankins M, Weiman J, Horne R. The use and reporting of cluster analysis in health psychology: a review. Br J Health Psychol. 2005;10:329–58. https://doi.org/10.1348/135910705X25697. Crocker AG, Mercier C, Allaire JF, Roy ME. Profiles and correlates of aggressive behaviour among adults with intellectual disabilities. J Intellect Disabil Res. 2007;51(10):786–801. https://doi.org/10.1111/j.1365-2788.2007.00953.x. Painter J, Hastings R, Ingham B, Trevithick L, Roy A. Identifying needs-based groupings among people accessing intellectual disability services. Am J Intellect Dev Disabil. 2018;123(5):426–42. https://doi.org/10.1352/1944-7558-123.5.426. Bertelli MO, Rossi M, Scuticchio D, Bianco A. Diagnosing psychiatric disorders in people with intellectual disabilities: issues and achievements. Adv Ment Health Intellect Disabil. 2015;9(5):230–42. https://doi.org/10.1108/AMHID-05-2015-0023. Holden B, Gitlesen JP. The overlap between psychiatric symptoms and challenging behaviour: a preliminary study. Res Dev Disabil. 2009;30(2):210–8. https://doi.org/10.1016/j.ridd.2008.03.003. • Thakker Y, Bamidele K, Ali A, Hassiotis A. Mental health and challenging behaviour: an overview of research and practice. Adv Ment Health Intellect Disabil. 2012;6:249–58. https://doi.org/10.1108/20441281211261131This study offers a good overview of research into CB, associations with MH problems, and considers treatment options. Totsika V, Felce D, Kerr M, Hastings RP. Behavior problems, psychiatric symptoms, and quality of life for older adults with intellectual disability with and without autism. J Autism Dev Disord. 2010;40(10):1171–8. https://doi.org/10.1007/s10803-010-0975-1. Hayes S, McGuire B, O’Neill M, Oliver C, Morrison T. Low mood and challenging behaviour in people with severe and profound intellectual disabilities. J Intellect Disabil Res. 2011;55(2):182–9. https://doi.org/10.1111/j.1365-2788.2010.01355.x. Emerson E. Challenging behaviour: analysis and interventions in people with learning difficulties. 2nd ed. Cambridge: Cambridge Unbiversity Press; 2001. https://doi.org/10.1017/CBO9780511543739. Henderson A, Kinnear D, Morrison J, Allen L, Cooper SA. Psychotropic drug prescribing in a cohort of adults with intellectual disabilities in Scotland. Presented at the Seattle Club Conference, Cardiff, December 11th, 2015. Bowring DL, Totsika V, Hastings RP, Toogood S, McMahon M. Prevalence of psychotropic medication use and association with challenging behaviour in adults with an intellectual disability. A total population study. J Intellect Disabil Res. 2017;61:604–17. https://doi.org/10.1111/jir.12359. Fleming I, Caine A, Ahmed S, Smith S. Aspects of the use of psychoactive medication among people with intellectual disabilities who have been resettled from long-stay hospitals into dispersed housing. J Appl Res Intellect. 1996;9:194–205. https://doi.org/10.1111/j.1468-3148.1996.tb00109.x. Holden B, Gitlesen JP. Prevalence of psychiatric symptoms in adults with mental retardation and challenging behaviour. Res Dev Disabil. 2003;24:323–32. https://doi.org/10.1016/s0891-4222(03)00060-x. Aman MG, Ramadan Y. Pharmacotherapy. In: Jacobson JW, Mulick JA, Rojahn J, editors. Handbook of intellectual and developmental disabilities. Issues in clinical child psychology. New York: Springer Publishing Co; 2007. p. 657–71. Crossley R, Withers P. Antipsychotic medication and people with intellectual disabilities: their knowledge and experiences. J Appl Res Intellect. 2009;22:77–86. https://doi.org/10.1111/j.1468-3148.2008.00454.x. Doan TN, Lennox NG, Taylor-Gomez M, Ware RS. Medication use among Australian adults with intellectual disability in primary health care settings: a cross sectional study. J Intellect Develop Disabil. 2013;38:177–81. https://doi.org/10.3109/13668250.2013.778968. Scheifes A, Egberts TCG, Stolker JJ, Nijman Henk LI, Heerdink ER. Structured medication review to improve pharmacotherapy in people with intellectual disability and behavioural problems. J Appl Res Intellect. 2015;29:346–55. https://doi.org/10.1111/jar.12183. Emerson E, Baines S. Health inequalities and people with learning disabilities in the UK: 2010. Durham: Improving Health & Lives: Learning Disabilities Observatory. p. 2010. Tsiouris JA. Pharmacotherapy for aggressive behaviours in persons with intellectual disabilities: treatment or mistreatment? J Intellect Disabil Res. 2010;54:1–16. https://doi.org/10.1111/j.1365-2788.2009.01232.x. Paton C, Flynn A, Shingleton-Smith A, Mcintyre S, Bhaumik S, Rasmussen J, et al. Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services. J Intellect Disabil Res. 2011;55:665–74. https://doi.org/10.1111/j.1365-2788.2011.01421.x. Wilner P. The neurobiology of aggression: implications for the pharmacotherapy of aggressive CB by people with ID. J Intellect Disabil Res. 2014;59:82–92. https://doi.org/10.1111/jir.12120. Deb S, Unwin GL. Psychotropic medication for behavior problems in people with intellectual disability: a review of the current literature. Curr Opini Psychiatry. 2007;20:461–6. https://doi.org/10.1097/yco.0b013e3282ab9952. Maher AR, Maglione M, Bagley S, Suttorp M, HuJ H, Ewing B, et al. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. J Am Med Assoc. 2011;306:1359–69. https://doi.org/10.1001/jama.2011.1360. Deb S, Unwin G, Deb T. Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with ID who exhibit CB. J Intellect Disabil Res. 2014;59:11–25. https://doi.org/10.1111/jir.12119. Sheehan R, Horsfall L, Strydom A, Osborn D, Walters K, Hassiotis A. Movement side effects of antipsychotic drugs in adults with and without intellectual disability: UK population cohort. Br Med J. 2017;7(8):e017406. https://doi.org/10.1136/bmjopen-2017-017406. Kraemer HC, Stice E, Kazdin A, Offord D, Kupfer D. How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Am J Psychiatry. 2001;158:848–56. https://doi.org/10.1176/appi.ajp.158.6.848. NICE Guidelines. Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges. NG 11, 2015.