Predictors of Behaviours that Challenge in Individuals with Moderate-Severe Intellectual Disability: A Systematic Literature Review

Abstract

Background: Behaviours that challenge (BtC) represents a poorly-defined, yet common occurrence in individuals with moderate-to-profound intellectual disability (ID). Previous systematic reviews have synthesised information relating to predictors of BtC in individuals with ID, with particular focus on aggression, self-injurious behaviour (SIB) and destruction. Identifying predictors of BtC promotes a greater understanding of why individuals exhibit a given behaviour and informs measures to reduce the risk of the BtC and associated harms occurring.

Aims: The aim of the present study was to extend the systematic reviews carried out by McClintock et al. (2003) and Bamford (2020).

Method: The methodology for the present study mirrored that of the currently unpublished Bamford (2020) systematic review. A systematic search of the MEDLINE, Embase and PsycINFO databases was carried out on literature published between January 2019 and October 2022, the results of which formed the basis of this review.

Results: Review findings further corroborate previously defined predictors of BtC; presence of autism spectrum disorder predicted both SIB and aggression, and lower adaptive level and skills and presence of epilepsy predicted SIB. Age, pro-social behaviour and history of suicidal ideation were found to predict either SIB or aggression. Lower levels of emotional development were found to predict all three components of BtC.

Conclusion: The synthesis of current literature has further corroborated predictors of BtC evaluated previously and has identified additional predictors which warrant future investigation. This review, alongside the work of McClintock et al. (2003) and Bamford (2020) represent a comprehensive, up-to-date assessment of predictors of aggression, SIB and destruction in individuals with ID.