Prevalence of challenging behaviour in adults with intellectual disabilities, correlates, and association with mental health

Purpose of Review To summarise findings about the prevalence and correlates of challenging behaviour in adults with intellectual disabilities from robust research. We also describe findings on the interplay between challenging behaviour and mental health. Recent Findings Recent studies that have utilised psychometrically evaluated tools, with clear operational definitions, show similar findings on the prevalence of challenging behaviour of about 1 in every 5–6 adults known to services. We describe common correlates identified such as communication impairments, severity of intellectual disability, and living in institutional settings or congregate care. We also describe the complex and multifaceted relationship between challenging behaviour and mental health. Summary Based on recent studies, we propose a revised framework model to help understand challenging behaviour. We propose a number of areas where more research is required, particularly the development of risk tools clinicians can utilise in practice

Risk factors for offending behaviour in adults with an intellectual disability

Research on risk assessment with offenders with an intellectual disability (ID) has been scarce; the overwhelming majority of risk tools available are developed for mainstream populations. This thesis is primarily concerned with understanding static and dynamic risk factors for physical and sexual violence among offenders with an ID. This thesis described a series of quantitative and qualitative studies investigating the utility and predictive accuracy of risk assessments among this population and culminated in the development of a new ID focused risk tool. In Chapter 1, a brief introduction outlined current research and practice regarding risk assessment and prediction in the ID field and identified significant limitations in the evidence base. In Study 1 (Chapter 2) a dynamic risk assessment (ARMIDILO-S) for sexual offenders with an ID resulted in the best prediction of sexual reoffending when compared with established static risk assessment tools (STATIC-99 and VRAG) developed for mainstream offenders. Study 2 (Chapter 3) adopted a public health model of understanding how static and dynamic risk factors ‘work together’ to predict violent behaviour. The findings suggested that the two approaches essentially measure similar underlying risk which has important implications for the future of risk assessment procedures with this population. Offenders with an ID were the focus of a qualitative study (Chapter 4) in which it was found that environmental factors featured heavily in the participant’s explanations of their own aggressive behaviour. The final empirical study (Chapter 5) details the construction and initial validation of a new dynamic risk measure: Current risk of Violence (CuRV). The CuRV demonstrated promising reliability and validity as an assessment of aggression. Finally, in Chapter 6, findings from the four empirical studies were discussed in relation to their contribution to the literature, theoretical and clinical implications, methodological limitations, and potential avenues for future research

Risk factors for offending behaviour in adults with an intellectual disability

Research on risk assessment with offenders with an intellectual disability (ID) has been scarce; the overwhelming majority of risk tools available are developed for mainstream populations. This thesis is primarily concerned with understanding static and dynamic risk factors for physical and sexual violence among offenders with an ID. This thesis described a series of quantitative and qualitative studies investigating the utility and predictive accuracy of risk assessments among this population and culminated in the development of a new ID focused risk tool. In Chapter 1, a brief introduction outlined current research and practice regarding risk assessment and prediction in the ID field and identified significant limitations in the evidence base. In Study 1 (Chapter 2) a dynamic risk assessment (ARMIDILO-S) for sexual offenders with an ID resulted in the best prediction of sexual reoffending when compared with established static risk assessment tools (STATIC-99 and VRAG) developed for mainstream offenders. Study 2 (Chapter 3) adopted a public health model of understanding how static and dynamic risk factors ‘work together’ to predict violent behaviour. The findings suggested that the two approaches essentially measure similar underlying risk which has important implications for the future of risk assessment procedures with this population. Offenders with an ID were the focus of a qualitative study (Chapter 4) in which it was found that environmental factors featured heavily in the participant’s explanations of their own aggressive behaviour. The final empirical study (Chapter 5) details the construction and initial validation of a new dynamic risk measure: Current risk of Violence (CuRV). The CuRV demonstrated promising reliability and validity as an assessment of aggression. Finally, in Chapter 6, findings from the four empirical studies were discussed in relation to their contribution to the literature, theoretical and clinical implications, methodological limitations, and potential avenues for future research

How effective are risk assessments/measures for predicting future aggressive behaviour in adults with intellectual disabilities (ID): A systematic review and meta-analysis

Background: Risk assessments assist professionals in the identification and management of risk of aggression. The present study aimed to systematically review evidence on the efficacy of assessments for managing the risk of physical aggression in adults with intellectual disabilities (ID). Methods: A literature search was conducted using the databases PsycINFO, EMBASE, MEDLINE, Web of Science, and Google Scholar. Electronic and hand searches identified 14 studies that met the inclusion criteria. Standardised mean difference effect sizes Area Under Curve (AUC) were calculated for studies. Random effects subgroup analysis was used to compare different types of risk measures (Actuarial, Structured Professional Judgment and dynamic), and prospective vs. catch-up longitudinal study designs. Results: Overall, evidence of predictive validity was found for risk measures with ID populations: (AUC) = 0.724, 95% CI [0.681, 0.768]. There was no variation in the performance of different types of risk measures, or different study design. Conclusions: Risk assessment measures predict the likelihood of aggression in ID population and are comparable to those in mainstream populations. Further meta-analysis is necessary when risk measures are more established in this population

Dynamic risk and violence in individuals with an intellectual disability : tool development and initial validation

Without a violence risk assessment designed for people with an intellectual disability (ID), assessors are reliant upon tools developed for mainstream offenders or develop their own tools. This study describes the early stages of development of the Current Risk of Violence (CuRV), an informant-reported measure of dynamic risk for aggression in adults with an ID. The pool of items was generated from a multitude of sources. Predictive accuracy for aggression was tested prospectively among 64 adults with an ID and history of aggression. The 34-item CuRV was found to be a brief, uncomplicated risk assessment. Initial findings revealed good predictive validity over a five-month period: area under the curve (AUC) range from .72, 95% CI [.59, .85] to .77, 95% CI [.66, .89]. These preliminary findings suggest that the CuRV may assist staff to perform assessments of risk in busy clinical settings. Future research effort is needed to fully explore the psychometric properties of the CuRV