Short report : correlates of behaviours that challenge in children with intellectual disability in special education settings

Background: Understanding the correlates of behaviours that challenge (CB) can help in both identifying children with intellectual disabilities (ID) at risk of developing CB and designing support programmes and interventions. Aims: This study explores the correlates of CB exhibited by children with ID in special educational settings in the UK. Methods and procedures: Data on behaviours that challenge were provided by educators of 71 children with ID. Additional measures of adaptive and pro-social behaviours, maternal anxiety, depression, and stress, and demographic variables were included in the cross-sectional binary logistic regression analyses. Outcomes and results: Results showed that pro-social behaviours of children with ID were associated negatively with overall CB (OR=0.72, 95% CI [0.62, 0.84], p < 0.001), stereotyped (OR=0.81, 95% CI [0.70, 0.94], p = 0.005), self-injurious (OR=0.80, 95% CI [0.70, 0.90], p < 0.001), and aggressive/destructive behaviours (OR=0.79, 95% CI [0.69, 0.90], p < 0.001). Stereotyped behaviours were associated with lower adaptive skills (OR=0.95, 95% CI [0.91, 0.99], p = 0.026) and male gender (OR=9.20, 95% CI [1.07, 79.44], p = 0.044). Aggressive/Destructive behaviours were associated with maternal stress (OR=0.82, 95% CI [0.70, 0.97], p = 0.022), and increased maternal anxiety (OR=1.21, 95% CI [1.00, 1.47], p = 0.050) was a marginally significant predictor of self-injurious behaviours. Conclusions and implications: The findings of this study emphasise the potential role of pro-social and adaptive behaviours, gender of children with ID, and maternal stress, as factors associated with CB in special education settings. Therefore, the present study contributes to extending the literature on correlates of CB for children with ID in special education settings while adopting an evidence-informed methodology for defining and measuring CB that facilitates replicability and allows for comparisons across findings of studies that explore CB thus increasing a more coherent evidence-base regarding assessment of CB

Positive behavioural support for children and young people with developmental disabilities in special education settings : a systematic review

Background Positive behavioural support (PBS) can be effective in supporting children and young people (CYP) with developmental disabilities. This systematic review focused on describing the components and nine characteristics of PBS that have been used with CYP with developmental disabilities in special education settings, and the evidence for PBS effectiveness in these settings. Additionally, facilitators and barriers to PBS implementation, and experiences of stakeholders, were investigated. Method Systematic searches followed a registered protocol, and 30 studies were identified, narratively synthesised, and critically appraised. Results From the 30 studies included, 10 reported the presence of all 9 PBS characteristics, 17 reported on 8 PBS characteristics, and 3 reported on 7 characteristics. Overall, 28 studies demonstrated significant decreases in behaviours that challenge and increases in alternative behaviours, if increasing alternative behaviours was part of the interventions. Conclusions There was a lack of evidence on facilitators and barriers, and a lack of qualitative studies exploring experiences of stakeholders with PBS in special education settings. The available evidence suggested that not all studies reported on all PBS characteristics when describing the approach followed. In addition, available evidence suggested that most studies demonstrated effectiveness of PBS regarding the measured outcomes. Implications and future directions are discussed

Interventions addressing challenging behaviours in Arab children and adults with intellectual disabilities and/or autism : a systematic review

Background: Arabs with intellectual disabilities and/or autism may exhibit challenging behaviour that affects them and their caregivers. Early, appropriate intervention may reduce these effects. This review synthesised and critically appraised challenging behaviour intervention research for this population. Methods: All published empirical research on challenging behaviour interventions for Arabs with intellectual disabilities and/or autism was included. In September 2022, 15 English and Arabic databases yielded 5,282 search records. Studies were appraised using the MMAT. Review findings were narratively synthesised. Results: The 79 included studies (n= 1,243 participants) varied in design, intervention, and evaluation method. Only 12.6% of interventions were well-designed and reported. Arab interventions primarily targeted children, were applied collectively on small samples, lacked individualised assessment, and were based on an inconsistent understanding of challenging behaviour. Conclusion: The evidence base on interventions for Arabs with intellectual disabilities and/or autism and challenging behaviour needs strengthening. Attention should be given to culturally relevant adaptations

Implementing evidence-based practice: the challenge of delivering what works for people with learning disabilities at risk of behaviours that challenge

There is an apparent disconnect between the understanding of best practice and service delivery in the support of people with learning disabilities at risk of behaviours that challenge. We suggest, is a problem of implementation. The purpose of this paper is to explore reasons why this might be the case: a failure to recognise the collective works of successive generations of research and practice; and a failure to address the macro-systems involved and systems changes needed to support implementation. Design/methodology/approach: This paper reviews the consensus that exists in respect of best practice. Drawing upon ideas from implementation science the paper highlights the complexities involved in the implementation of all evidence-based practices and uses this as a framework to propose ways in which an infrastructure that facilitates the delivery of services in the learning disabilities field might be built. Findings: This paper highlights core recommended practices that have been consistent over time and across sources and identifies the systems involved in the implementation process. This paper demonstrates that many of the necessary building blocks of implementation already exist and suggests areas that are yet to be addressed. Critically, the paper highlights the importance of, and the part that all systems need to play in the process. Originality/value: In the absence of any generalised implementation frameworks of evidence-based practice in the learning disabilities field, the paper suggests that the findings may provide the basis for understanding how the gap that exists between best practice and service delivery in the support of people with a learning disability at risk of behaviours that challenge might be closed

The READ-IT study protocol for a feasibility randomised controlled trial of using a support worker/family carer mediated online reading programme to teach early reading skills to adults with intellectual disabilities

Background: Many individuals with intellectual disability (ID) have not learnt basic reading skills by the time that they reach adulthood, potentially limiting their access to critical information. READ-IT is an online reading programme developed from the Headsprout® Early Reading (HER®) intervention and supplemented by support strategies tailored for adults with ID. HER® has been successfully used to teach adults with ID to read in a forensic setting by trained staff. The aim of this study is to assess the feasibility of delivering READ-IT to adults with ID by family carers/support workers and will assess whether it would be feasible to conduct a later definitive randomised controlled trial (RCT) of the effectiveness of the programme. The study will aim to contribute to the evidence base on improving outcomes for adults with ID and their caregivers. Methods: This study is a feasibility RCT, with embedded process evaluation. Forty-eight adults with ID will be recruited and allocated to intervention: control on a 1:1 basis. Intervention families will be offered the READ-IT programme immediately, continuing to receive usual practice and control participants will be offered the opportunity to receive READ-IT at the end of the trial follow-up period and will continue to receive usual practice. Data will be collected at baseline and 6 months post-randomisation. Discussion: The results of this study will inform a potential future definitive trial, to evaluate the effectiveness of READ-IT to improve reading skills. Such a trial would have significant scientific impact internationally in the intellectual disability field. Trial registration: ISRCTN1140909

Creating effective teaching and learning environments: Building a positive behavioural support (PBS) model for UK special schools

The importance of reducing restraint and restrictive interventions in special schools has been recognised across the four nations of the UK. Government guidance for England and Wales, and recommendations produced by Restraint Reduction Scotland, both reference Positive behavioural support (PBS) as an evidence‐based approach that can be used to proactively support pupils with, or at risk of, behaviours that challenge. The Department of Education of Northern Ireland recommends the development of behaviour support plans to support children with special education needs and disabilities. Special schools, however, also have a responsibility to set high expectations for every pupil, to provide access to the respective national curricula and to meet individual needs. School‐wide positive behavioural support (SW‐PBS), originated in the USA in the 1990s in response to a body of evidence that showed improved social and academic outcomes when behavioural interventions were implemented across whole school settings. It is increasingly being adopted in the UK. Drawing upon examples from schools in England and Wales with which the authors are familiar, this paper outlines the rationale for a special schools' model of SW‐PBS and illustrates the ways in which this can be adjusted to meet the specific needs of each setting. Key Points: Reducing restraint and restrictive interventions in schools is a high priority across all four nations of the UK. Special schools also have a responsibility to provide children with special education needs and disabilities positive learning environments that maximise learning opportunities and meet individual needs. School‐wide positive behaviour support (SW‐PBS) provides a useful framework to help special schools meet these expectations

Challenging behaviour and its correlates in preschool-aged children with an intellectual disability in Saudi Arabia

Background: Young children with an intellectual disability have a higher risk of developing challenging behaviour (CB). Early identification of risk factors for CB allows for earlier intervention. The aim of the current study was to assess the prevalence and correlates of CB in preschool-aged children with an intellectual disability in Riyadh (Saudi Arabia). Methods: One hundred twenty parents of preschool-aged (3-6 years old) children who had been diagnosed (DSM-5 criteria) with an intellectual disability completed an online cross-sectional survey that included demographic, CB, and child adaptive skills measures. The relationship between CB and 15 potential correlates (e.g. gender and degree of disability) was examined using independent samples t-tests and chi-squared tests. Results: Most preschool-aged (3-6 years old) children with an intellectual disability exhibited CB (78.8%, 95% CI [70.3, 85.8]), with a 63.2% prevalence rate for self-injurious behaviours (95% C [53.8, 72.0]), a 57.6% rate for aggressive destructive behaviours (95% CI [48.2, 66.7]) and a 25% rate for stereotypy (95% CI [17.7, 34.0]). The likelihood of a child engaging in self-injurious and stereotyped behaviours was higher in those with autism and intellectual disability. Children with Down syndrome displayed fewer stereotyped behaviours. Low adaptive skill levels were associated with increased overall CB, self-injurious, and stereotyped behaviours. Conclusions: The identified correlates of CB in this population and cultural context align with the international evidence base. Findings have implications for the importance of early systematic screening of CB in preschool-aged children in Saudi Arabia and other similar contexts. Preventative measures are suggested for preschool-aged children with an intellectual disability who are more likely to demonstrate CB, such as those with autism and poor adaptive behaviours

Assessing the impact of the UK Positive Behavioural Support (PBS) Academy: An internet survey

Background: The Positive Behavioural Support (PBS) Academy is a collective of organisations and individuals in the UK working together to promote PBS as a framework for working with children and adults with intellectual disabilities who are at risk of behaviour that challenges. This paper presents a stakeholder perspective of the activities of the PBS Academy as part of an overall evaluation and impact study of its work to date. Methods and materials: The study used an internet-based survey designed by the authors and members of the PBS Academy. Results: Over one third of participants rated the activities of the PBS Academy as being done 'well' or 'very well' and the resources developed by the Academy were rated as 'useful' or 'very useful' by over 70% of participants for all but one resource. The most frequently used resources were the PBS Competence Framework and the International Journal of Positive Behavioural Support (IJPBS) 2013 special edition articles by Gore et al and Hastings et al. The PBS Academy was rated as having done less well in bringing stakeholders together to share practice. Conclusions: The results suggest that there is a role for a national body for PBS in the UK, with a focus on facilitation and enablement, especially in relation to workforce and individual professional and service development

Developing a logic model to guide evaluation of impact for learning disability projects: the case of the Positive Behavioural Support (PBS) Academy

Purpose: Measuring “impact” is an important aspect of the dissemination of evidence-based practice and relevant to all disciplines. However, it has only recently become a focus of enquiry and is not commonly directly researched within the learning disabilities field. The purpose of this paper is to describe the process of developing a logic model for the UK Positive Behavioural Support (PBS) Academy as part of an evaluation and impact study of its work to date. Design/methodology/approach: Logic models are a visual representation of the relationship between a project’s resources, activities and outputs and identified outcomes, in relation to key stakeholder groups. This representation allows for key impact measures to be identified and can be a useful tool for evaluation purposes. The authors used the process outlined by McLaughlin and Jordan (1998) to develop a bespoke logic model for the PBS Academy. Findings: The model was particularly helpful in making clear the distinction between output and impact, identifying impact criteria differentiated by stakeholder group and across time scales, and highlighting areas of activity that are needed to increase the impact of the work of the PBS Academy in the longer term. Originality/value: In the absence of any generalised impact evaluation frameworks in the learning disabilities field, the authors suggest that logic models may provide a useful framework for evaluating the impact of policy, practice, and research interventions

Special educators’ experiences of a numeracy intervention for autistic students

Very little qualitative research has been carried out about the experiences of educators who deliver mathematics evidence-based teaching programmes to autistic students. Using a semi-structured format, we interviewed ten educators who had been delivering the Teaching Early Numeracy to Children with Developmental Disabilities (TEN-DD) programme for eight months with autistic students in a special school setting. Reflexive thematic analysis findings indicated that taking part in the numeracy intervention was a valuable experience for both the educators and their students. There was initial scepticism about the intervention, but this was transformed to conviction during the implementation period. Educators reported an increased sense of competence in their teaching skills, evident in greater satisfaction and increased self-efficacy. Furthermore, there was a strong interest in continuing to use the numeracy intervention with students. There were also implementation challenges with TEN-DD, including students’ challenging behavior. The implications of these findings are discussed