Managing Behaviours of Concern in Adults with Learning Disabilities
Author: Min-Ai Lim
Prevalence and Impact of Behaviours of Concern
Behaviours of concern affect up to 15% of adults with intellectual disabilities (ID). These behaviours may include aggression, self-injury, property destruction, or verbal outbursts. Individuals with more severe disabilities are at greater risk, and these behaviours can significantly impact their quality of life and that of their caregivers (Heyvaert et al. 2010; Bruinsma et al. 2020). Effectively addressing these behaviours is crucial to improving the well-being of individuals and their support networks.
Identifying the Root Causes of Behaviours
To manage behaviours of concern, it is essential first to understand their root causes to determine the most appropriate interventions. These behaviours often signal that something is wrong, but the individual is unable to communicate it effectively (Hagopian & Gregory 2016). Causes may be multifaceted, involving physical health discomfort, mental health concerns, sensory sensitivities, or changes in social circumstances (Campbell et al. 2014).
Physical Health Discomfort as a Trigger
One of the most common but frequently overlooked causes of behaviour of concern is physical health discomfort. Many individuals with intellectual disabilities struggle to communicate pain or discomfort, which can lead to frustration and behavioural outbursts. For instance, untreated dental pain, gastrointestinal problems, or infections can cause significant distress, manifesting as aggression or self-harm (Matson & Neal 2009; Gomez et al. 2021). Conducting a thorough medical evaluation is essential whenever behaviour of concern arises to rule out any underlying physical health issues.
Mental Health and Psychological Interventions
Mental health concerns can also play a critical role in behaviours of concern. Conditions such as anxiety, depression, or psychosis may increase irritability, leading to behaviours like withdrawal or aggression (Sohanpal et al. 2007; Deb et al. 2014). Addressing these issues requires careful assessment by mental health professionals. Psychological interventions, particularly behavioural therapy, are highly effective in teaching individuals healthier ways to communicate and cope with stress (Campbell et al. 2014; Bruinsma et al. 2024). Cognitive-behavioural therapy (CBT) is another valuable approach for individuals capable of reflecting on their emotions, helping them manage their responses more constructively (Hassiotis et al. 2018).
Role of Psychotropic Medications
While psychological interventions are often beneficial, they may not always suffice. In cases where behaviours pose significant risks to the individual or others, psychotropic medications may be necessary. Antipsychotics, mood stabilizers, or antidepressants can help manage different symptoms, but they should always be used cautiously and with close monitoring for side effects (Matson & Neal 2009; Tsiouris 2010). Regular reassessment ensures that medications remain appropriate and beneficial (Deb et al. 2008).
Social Circumstances and Environmental Triggers
Changes in social circumstances, such as a new caregiver, moving to a different living environment, or the loss of a loved one, can also trigger behaviours of concern. These stressors may cause confusion, anxiety, or a sense of insecurity, leading individuals to act out (Hassiotis et al. 2018). Understanding the person’s social environment and recent changes is essential for caregivers and professionals to identify and address these triggers effectively. Contextual interventions focus on creating supportive environments that reduce stress and encourage positive behaviours. Caregivers are trained in de-escalation techniques and the importance of maintaining consistent routines (Bruinsma et al. 2024). Additionally, engaging individuals in structured, meaningful activities can provide a sense of purpose and reduce idle time, which often exacerbates behavioural issues (Lewis et al. 2021).
Sensory Sensitivities in Autistic Individuals
For autistic individuals, sensory overload or deprivation can be significant triggers for behaviours of concern. Adjusting the sensory environment using sensory integration techniques can help reduce stress and create a more calming atmosphere. For instance, minimizing noise, adjusting lighting, or providing sensory tools can alleviate discomfort and reduce the likelihood of behavioural outbursts (Prior et al. 2023; Hagopian & Gregory 2016).
Conclusion: A Collaborative and Comprehensive Approach
In summary, behaviours of concern in adults with intellectual disabilities are complex. Collaboration among healthcare providers, caregivers, and individuals themselves is crucial for success. By identifying and addressing the physical, mental, social, and sensory causes of behaviours of concern, evidence-based interventions can be tailored to each person’s unique circumstances. This comprehensive approach leads to more effective and lasting outcomes, helping individuals lead healthier, more fulfilling lives while reducing the burden on their caregivers.
About the Author
Dr. Min-Ai LIM is a psychiatry registrar currently pursuing dual training in Intellectual Disabilities Psychiatry and Child and Adolescent Psychiatry under the South London and Maudsley NHS Foundation Trust.
References
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