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Discuss How the Study of Challenging Behaviour Can Enhance Our Understanding of Psychopathology in People with Learning Disability

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Discuss how the study of challenging behaviour can enhance our

understanding of psychopathology in people with learning disability

Challenging behaviour- the definition

The term 'challenging behaviour' refers to behaviour that has been developed to express, communicate or meet individual needs and desires. It often has a negative impact on a person's quality of life or the quality of life of the people with whom they live (Baker, 2002).

Emerson et al (1988) offered a succinct definition that has become widely regarded as both useful and accurate and is this: 'Severe challenging behaviour refers to the behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour that is likely to seriously limit or deny access to the use of ordinary community facilities (Emerson et al, 1988, p16).

This often used definitions focuses on how the negative effects of challenging behaviour impact on the individual and others without mentioning specific challenging behaviour. The term challenging behaviour comprises a wide spectrum of behaviours. The range of intensity of challenging behaviour is diverse it can be low-key behaviour such as continuous repetition of words and phrases as well as it can include physical aggression, self-injury, anti-social behaviours causing harm to the person themselves or to others. Challenging behaviour has a huge effect on the individual. It limits their access to the community and may lead to them being excluded from services. They may be separated from others by being placed in 'specialist services'. People who present with challenging behaviour are also at greater risk of abuse. Numerous studies have shown that, although estimates of the prevalence of the problem behaviours do vary, challenging behaviour occurs in sufficient proportions of the target population. This makes a real concern for those responsible for service planning and delivery.

It has been estimated that self-injurious behaviours occur in 8 to 15 per cent of people with mental handicap institutions (Ballinger, 1971; Oliver et al, 1987). Approximately two-thirds of residents in mental handicap institutions show stereotyped behaviours (Kaufman & Levitt, 1965), and approximately 4 per cent of adolescents and adults with severe or profound mental handicaps living at home and around 17 per cent in residential services are estimated to have problem behaviours serious enough for the individuals to be categorised as 'severely behaviour disordered' and 'requiring constant supervision' (Kushlick & Cox, 1973).

Learning disability refers to individuals whose IQ is measured at less than 70 and is defined as a state of arrested or incomplete development of mind. Overall the prevalence of learning disability in the UK is between 1 and 2% of the population, 85% will have mild learning disability.

Numerous research studies have shown that challenging behaviour is very common in this group. The lower the IQ greater the prevalence of challenging behaviour, approaching 40% in those with severe learning disability. These behaviours often emerge early in childhood, are of a chronic, long-term nature and are the primary risk factor for out of family placement.

Up to 15 per cent of people with a learning disability show some form of challenging behaviour (Emerson et al., 2001). A total of 16 per cent of people with learning disability in the UK have challenging behaviour (Qureshi & Alborz, 1992). Severe challenging behaviour occurs in approximately 6 per cent of people with a learning disability. This is where injury has been caused and behaviour which places the person or others in danger and an intervention is required from staff or carers.

Two surveys by the University of Manchester's Hester Adrian Research Centre (Emerson et al. 1997) reported that between one in six and one in eight people with intellectual disabilities had some form of challenging behaviour, and that one in 18 people had 'more demanding' challenging behaviour.

Quine (1986) studied a sample of 200 18-year-olds with learning disabilities and identified a range of behaviour difficulties such as: attention seeking (29%), over activity (21%), temper tantrums (25%), aggressiveness (21%), screaming (22%), wandering off (18%), destructiveness (14%) and self-injurious behaviour (12%).

The finding that a greater degree of learning disability is correlated with the presence of self-injury is well established. Individuals who have a severe learning disability may have adaptive behaviours that can influence the behaviour of others and self-injury may therefore serve this function. Evidence for this assumption comes from the observations that expressive communicative abilities are impaired in people who show self-injury (Schroeder, Schroeder, Smith &: Dalldorf, 1978), that adaptive behaviour is limited in people who show self-injury (Murphy et al, 1993) and that self-injury may decrease when functionally equivalent behaviours increase (Carr &: Durand, 1985b). The association between a greater degree of learning disability and the presence of challenging behaviour may best be understood therefore, in terms of self-injurious responding compensating for the absence of alternative behaviours.

Other individual characteristics, such as the presence of autism (Schroeder et al, 1978), visual and physical disabilities (Schroeder et al, 1987; Kiernan & Kieman, 1987) and specific syndromes such as Lesch-Nyhan (Christie et al, 1982). These characteristics may take place because they reduce the capacity for adaptive behaviour, e.g. physical disability. For example, poor vision may not be easily communicated by someone with a LD. A change in vision may manifest as a change in behaviour or withdrawal, and these symptoms are under-recognised. Others may exert difference influences. Autism for example, may increase the likelihood that stereotypies are present in an individual's repertoire and thus become subject to shaping into self-injurious responses.

Therefore, the presence of challenging behaviour in people with learning disabilities has serious consequences for their quality of life. They may suffer self-injury through self-abuse or through living with others who show aggression. They may live in deprived circumstances, excluded from the settings and opportunities that most take for granted. They may experience social deprivation arising from a greater level of avoidance by others and by psychotropic restraint (Brown & Craft, 1989). Problem behaviour has



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