Complex interventions for aggressive challenging behaviour in adults with intellectual disability: a rapid realist review informed by multiple populations

Royston, R. et al. (2023) Complex interventions for aggressive challenging behaviour in adults with intellectual disability: a rapid realist review informed by multiple populations. PLoS ONE, 18(5), e0285590. (doi: 10.1371/journal.pone.0285590) (PMID:37200247) (PMCID:PMC10194976)

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Objectives: Approximately 10% of people with intellectual disability display aggressive challenging behaviour, usually due to unmet needs. There are a variety of interventions available, yet a scarcity of understanding about what mechanisms contribute to successful interventions. We explored how complex interventions for aggressive challenging behaviour work in practice and what works for whom by developing programme theories through contexts-mechanism-outcome configurations. Methods: This review followed modified rapid realist review methodology and RAMESES-II standards. Eligible papers reported on a range of population groups (intellectual disability, mental health, dementia, young people and adults) and settings (community and inpatient) to broaden the scope and available data for review. Results: Five databases and grey literature were searched and a total of 59 studies were included. We developed three overarching domains comprising of 11 contexts-mechanism-outcome configurations; 1. Working with the person displaying aggressive challenging behaviour, 2. Relationships and team focused approaches and 3. Sustaining and embedding facilitating factors at team and systems levels. Mechanisms underlying the successful application of interventions included improving understanding, addressing unmet need, developing positive skills, enhancing carer compassion, and boosting staff self-efficacy and motivation. Conclusion: The review emphasises how interventions for aggressive challenging behaviour should be personalised and tailored to suit individual needs. Effective communication and trusting relationships between service users, carers, professionals, and within staff teams is essential to facilitate effective intervention delivery. Carer inclusion and service level buy-in supports the attainment of desired outcomes. Implications for policy, clinical practice and future directions are discussed. Prospero registration number: CRD42020203055.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Jahoda, Professor Andrew and Cooper, Professor Sally-Ann
Creator Roles:
Jahoda, A.Conceptualization, Funding acquisition, Methodology, Writing – review and editing
Cooper, S.-A.Conceptualization, Funding acquisition, Methodology, Writing – review and editing
Authors: Royston, R., Naughton, S., Hassiotis, A., Jahoda, A., Ali, A., Chauhan, U., Cooper, S.-A., Kouroupa, A., Steed, L., Strydom, A., Taggart, L., and Rapaport, P.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
Journal Name:PLoS ONE
Publisher:Public Library of Science
ISSN (Online):1932-6203
Copyright Holders:Copyright © 2023 Royston et al.
First Published:First published in PLoS ONE 18(5): e0285590
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
304752Personalised treatment packages for adults with intellectual developmental disabilities (IDD) and aggressive behaviour in community settingsCraig MelvilleNational Institute for Health Research (NIHR)PerTALD 2C57 - NIHR200120HW - Mental Health and Wellbeing