8.4.3 Problem Behaviours

Psychological Methods of Assessment and an Understanding of Psychological Theories as to the Cause of Problem Behaviours

Psychological assessment and understanding of psychological theories are crucial for diagnosing and treating problem behaviours in people with learning disabilities. Psychologists use various psychological methods of assessment, including behavioural observations, self-reports, and cognitive assessments, to assess cognitive, emotional, and behavioural functioning in individuals with learning disabilities (Lindsay, 2017). Understanding the psychological theories that underpin problem behaviours in people with learning disabilities can inform the development of behavioural modification techniques to address these issues.

Several psychological theories explain the causes of problem behaviours in people with learning disabilities. These theories include the cognitive-behavioural theory, the social learning theory, and the psychodynamic theory (Lindsay, 2017). According to the cognitive-behavioural theory, problem behaviours in people with learning disabilities result from maladaptive thoughts and behaviours. The social learning theory suggests that problem behaviours are learned through observation and imitation of others. The psychodynamic theory posits that problem behaviours result from unresolved conflicts and trauma.

Behavioural disorders are more common in individuals with intellectual disabilities (ID), with a prevalence of 7% in the ID population, increasing to 14% for inpatients and 5% in the community. These disorders include a range of behaviours, such as antisocial actions, aggressive outbursts, self-injury, social withdrawal, and stereotypic behaviours. Severe cases are often labelled as “challenging.” Various factors contribute to these behaviours, including cognitive functioning, temperament, physical problems, medication, psychological factors, communication difficulties, adverse experiences, environmental factors, and comorbid psychiatric disorders. Additionally, specific genetic causes of ID may present characteristic behavioural patterns, which can aid in diagnosis and management.

An Understanding of Relevant Behavioural Modification Techniques

Behavioural modification techniques are commonly used to address problem behaviours in people with learning disabilities. These techniques include positive reinforcement, token economies, and systematic desensitization (Dagnan & Sandhu, 2017). Positive reinforcement involves rewarding positive behaviour to increase its frequency, while token economies involve the use of tokens as rewards for desired behaviour. Systematic desensitization is a technique used to reduce anxiety and phobias by gradually exposing the individual to the feared situation or object.

Managing behavioural disorders in individuals with intellectual disabilities involves collaboration with parents, carers, and other professionals throughout the assessment and intervention process. Assessment should include excluding psychiatric and physical disorders, evaluating general health, physical impairments, communication difficulties, cognitive impairments, and environmental factors, and conducting a functional assessment of behaviour.

Management strategies should address specific factors identified during assessment, reduce stimuli, and modify environmental factors. Approaches may include educational interventions for families and patients, social interventions, facilitating communication, creating behaviour support plans, employing cognitive approaches, and considering pharmacotherapy for comorbid conditions. Physical interventions, such as restraint, should be used only as a last resort. All interventions must be closely monitored for compliance, acceptability, and effectiveness, with medication side effects minimized and carefully withdrawn if deemed ineffective.

In summary, psychological assessment methods and an understanding of psychological theories are critical for diagnosing and treating problem behaviours in people with learning disabilities. Behavioural modification techniques, such as positive reinforcement and token economies, can be effective in addressing problem behaviours in this population.

References:

1. Dagnan, D., & Sandhu, S. (2017). Cognitive behavioural therapy and intellectual disabilities. In Oxford textbook of intellectual disability (pp. 811-819). Oxford University Press.
2. Lindsay, W. R. (2017). Psychological approaches to understanding and treating challenging behaviour in intellectual disability. Current Opinion in Psychiatry, 30(2), 103-107.