Background Anxiety and challenging behaviour (CB) often occur simultaneously in people with intellectual disabilities (ID). Understanding the associations between anxiety and CB may contribute to more accurate diagnoses and management of both anxiety and CB in this population. Aims To examine the relationship between anxiety and CB. Methods A literature review covering the period from January 2000 to January 2012. Results Seven studies about the relationship between psychiatric disorders, including anxiety, and CB were identified. These studies confirm the relationship between anxiety and CB in people with ID, although the precise nature of this relationship remains unclear. Conclusions The study points toward the existence of a moderate association between anxiety and CB. Further research is needed to clarify the complex nature of the association between anxiety and CB.
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Aim. This study aims to identify ways that allow studying how intellectually impaired persons showing challenging behaviour interact with space, without impacting their daily lives. Back-ground. Research about space that better suits these persons’ needs is challenging to conduct, since they may have difficulties expressing themselves verbally and are extremely sensitive to-wards sensory stimuli. Therefore, researchers collecting data may be disturbing and intrusive, and requires great caution. Tapping into existing data may be a promising alternative. Residential care organisations routinely collect data about residents during their regular work processes, such as personal information and incident registration. Also useful may be routinely collected spatial data, such as drawings and repair reports. This study explores how routinely collected data (RCD) can provide insight into how residents interact with space, without impacting their daily lives. Methods. We reflect on the possibilities of using RCD (related to resident or space) based on explorations in the context of a case study at a Dutch very-intensive-care facility. The data were analysed to identify general patterns, such as locations with a high density of incidents/repairs and verified initial findings by member checking with staff. Results. The RCD analysed provide a basic and relevant insight into incidents and repairs connected to challenging behaviour. However, most data were neither complete or relevant for analysis. Therefore, we dis-cussed the RCD were with staff and only then it was possible to draw conclusions regarding relevance of RCD and the residents-space interactions. Conclusions. Only in conjunction with an ex-tended approach on member checking the use of RCD seems relevant. RCD have little meaning of their own. But the combination of RCD with member checking seems to provide insight into the interaction between residents and space, without interfering with the residents’ daily lives.
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Background and aim – Challenging behaviour, such as aggression towards oneself, others, or objects, arises in interaction with the environment and may prevent individuals from participating in society and enjoying a high quality of life (QoL). Literature suggests that architects can contribute to prevention, by influencing challenging behaviour before rather than after its occurrence. The objective is to explore how architecture can contribute to the quality of life of intellectually impaired (and autistic) individuals showing challenging behaviour (CB). Methods – The case study is based on interviews with residents and care providers, and direct observations of their daily life. Results – Residents turn out to be dependent on the (visual) connection with the care provider and may experience stress from the behaviour of fellow residents. They also may experience stress when faced with unexpected situations and by sensory overload. Originality – The relevance of architecture for CB reduction is new to this particular field of healthcare. Practical or social implications – If these preliminary findings can be confirmed, they provide a basis for developing guidelines to design better environments for intellectually impaired individuals showing CB. Architecture might promote choice in interpersonal distance, by generous floorplans, a variety of spaces, and escape possibilities. Predictability might be enhanced by providing visual overview and previews into rooms. Finally, architecture that promotes sensory adjustment might improve the QoL of individuals showing CB by preventing sensory overload, and by doing so, mitigate related behaviours.Type of paper – Research paper.
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Challenging behaviour, such as aggression towards oneself, others, or objects, arises in interaction with the environment and may prevent individuals from participating in society and compromise their quality of life (QoL). Literature suggests that architects can contribute to prevention, by influencing challenging behaviour before rather than after its occurrence. By conducting a case study at a very-intensive-care facility, we explore how architecture can contribute to the QoL of intellectually impaired (and autistic) individuals showing challenging behaviour. The case study is based on interviews with residents and care providers, and direct observations of their daily life. Preliminary findings confirm the relevance of architecture in influencing challenging behaviour. They suggest that the residents are dependent on the (visual and auditory) connection with the care provider. Also, care providers confirm the importance of this connection for the quality of the care they provide. At the same time, residents may experience anxiety triggered by fellow residents and their challenging behaviour. Residents may also feel stress when faced with unexpected situations and this may lead to an onset of challenging behaviour. Sensory sensitivity, specifically to noise and heat is also relevant for their QoL.The findings will be further substantiated through multiple triangulation with available data (personal files, incident reports, photographs). Future research, specifically focused on intellectually impaired individuals showing challenging behaviour, is needed to better understand the similarities and differences between their needs and the needs of autistic people.
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The present study focuses on the level of stress a teacher perceives when dealing with the most behaviorally challenging student in his or her classroom. To measure stress in Dutch elementary classrooms, a sample was drawn of 582 teachers. Two questions concerning this relation between student and teacher will be addressed. First of all, we focus on background variables of teachers and students as sources of variation in explaining the magnitude of challenging student behavior and the associated level of stress teachers experience. The second topic of this paper is to accommodate the potentially stressful relationship between student and teacher in a wider network of surrounding variables, which are, Self-efficacy, Negative affect, Autonomy in taking decisions, and Support amongst colleagues. To evaluate the presence of challenging behavior, the behavior of the student is related to more general variables like student responsibility, class size and ratio of boys to girls. We close our paper by assessing the validity of the studied relationship between teacher and student with respect to possible burnout.
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BACKGROUND: The care sector for persons with disabilities considers the physical environment relevant for the quality of life of people with intellectual disabilities. However, scientific evidence is limited. OBJECTIVE: To obtain evidence regarding comforting and encouraging environments and to develop an overview of studies addressing the effect of the physical environment on people with intellectual disabilities. METHODS: A scoping review, accompanied by expert panels and case findings combining scientific evidence and knowledge from practice, was performed to investigate the interaction between challenging behaviour and the physical environment. Between January and March 2020, several scientific databases were searched in the English, Dutch, and German language for relevant studies. Social media, care professionals, and experts in building physics were consulted. RESULTS: Studies on building-related factors as passive interventions and care- or therapy-related interventions could be distinguished. The majority of the studies report on building-related factors such as sound, acoustics, light, and colours and their influence on behaviour. Specific guidelines are lacking on how to adjust the indoor environment to an environment that is safe, comforting and encouraging for people displaying challenging behaviour. Proposed solutions are case-based. CONCLUSION: In future studies individual cases could be studied in a more in-depth manner, aligned and categorised to the building-related factors and to the expressions of challenging behaviour.
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The present study focuses on the level of stress male and female teachers perceive when dealing with the most behaviorally challenging student in his or her classroom. To measure stress in Dutch elementary classrooms, a sample was drawn of 582 teachers. First, they rated the most challenging student in their classroom on six different behavioral components: Against the grain, Full of activity/Easily distractible, Needs a lot of attention/Week student, Easily upset, Failuresyndrome/Excessively perfectionist, and Aggressive/Hostile. Teachers then scored perceived stress as a result of this challenging behavior. Two questions concerning gender relations in class rooms will be addressed. Do female and male teachers select the same type of behaviorally challenging students as the most challenging? And: do they perceive the same level of stress? Our data shows that female teachers do indeed report significantly more incidence of challenging behavior, but no evidence is found for differences between stress levels of male and female teachers.
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Abstract Background: Although there is little evidence on their efficacy regarding challenging behaviour, antipsychotics are the most used psychotropic drugs in residential intellectually disabled people. Discontinuation is possible for some residential clients with intellectual disabilities. This study aimed to gain insight into support staff's perceptions of discontinuing antipsychotics in residential clients with intellectual disabilities. Method: Four focus groups were conducted in this mixed‐methods study, followed by a survey. Results: A large majority of support staff perceive antipsychotics to be effective in controlling challenging behaviour. Support staff regarded themselves as willing to contribute to the discontinuation of antipsychotics, but were more confident about achieving reductions. Conclusions: The attitude of the majority of support staff towards discontinuation provides a good basis for regularly reviewing antipsychotics use. A reduction plan should include preliminary steps, methods of monitoring and evaluating the process, and establishing measures for dealing with possible crises.
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(‘Co’-)Designing for healthy behaviour greatly benefits from integrating insights about individual behaviour and systemic influences. This study reports our experiences in using insights about individual and systemic determinants of behaviour to inform a large co-design project. To do so, we used two design tools that encourage focusing on individual determinants (Behavioural Lenses Approach) and social / systemic aspects of behaviour (Socionas). We performed a qualitative analysis to identify 1) when and how the team applied the design tools, and 2) how the tools supported or obstructed the design process. The results show that both tools had their distinctive uses during the process. Both tools improved the co-design process by deepening the conversations and underpinnings of the prototypes. Using the Behavioural Lenses under the guidance of a behavioural expert proved most beneficial. Furthermore, the Socionas showed the most potential when interacting with stakeholders, i.c. parents and PPTs.
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Objective. To study the prevalence, nature and determinants of aggression among inpatients with acquired brain injury. Background. Patients with acquired brain injury often have difficulty in controlling their aggressive impulses. Design. A prospective observational study design. Methods. By means of the Staff Observation Aggression Scale-Revised, the prevalence, nature and severity of aggressive behaviour of inpatients with acquired brain injury was assessed on a neuropsychiatric treatment ward with 45 beds. Additional data on patient-related variables were gathered from the patients’ files. Results. In total, 388 aggressive incidents were recorded over 17 weeks. Of a total of 57 patients included, 24 (42%) patients had engaged in aggressive behaviour on one or more occasions. A relatively small proportion of patients (n = 8; 14%) was found to be responsible for the majority of incidents (n = 332; 86%). The vast majority of aggression incidents (n = 270; 70%) were directly preceded by interactions between patients and nursing staff. In line with this, most incidents occurred at times of high contact intensity. Aggressive behaviour was associated with male gender, length of stay at the ward, legal status and hypoxia as the cause of brain injury. Conclusion. Aggression was found to be highly prevalent among inpatients with acquired brain injury. The results suggest that for the prevention of aggression on the ward, it may be highly effective to develop individually tailored interventions for the subgroup with serious aggression problems. Relevance to clinical practice. Insight into the frequency, nature and determinants of aggressive behaviour in inpatients with acquired brain injury provides nurses with tools for the prevention and treatment of aggressive behaviour.
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