© unsplash

Managing Behavior of People with Intellectual Disability

Challenging behavior is prevalent among individuals with disabilities, and it can prove to be hard to diagnose and manage the condition. People living with an intellectual disability need to be equipped with the necessary skills to help manage their counterparts’ conditions.

People with disabilities require specific attention to their needs to help them learn skills and unlearn behavioral problems. Behavioral management is a teaching practice on numerous management procedures that can be used to help individuals with disabilities. Behavioral management is useful since it can be applied to adults and children through the context that may vary across cases. 

Challenging behavior is prevalent among individuals with disabilities, and it can prove to be hard to diagnose and manage the condition. The condition can harm an individual’s life and may result in the hospitalization of patients. People living with an intellectual disability need to be equipped with the necessary skills to help manage their counterparts’ conditions. 

Behavioral problems are widespread among people with intellectual disability and can present health practitioners with several challenges. According to behavioral experts, any behavior stems from an inevitable reaction and holds an inherent meaning concerning the individual and immediate environment. Behavioral challenges are socially constructed concepts suggesting that an individual has to classify displayed actions as dangerous or distressing, making them socially unacceptable. 

More often than not, what is defined as challenging varies across cultures and means available. Medically behavioral problems encompass continuous pervasive and maladaptive behavior that directly affects an individual’s quality of health and safety. The terms can refer to different behaviors, including self-harm tendencies, sexually inappropriate behavior, and physical aggression towards people and inanimate objects.  

Individuals whose behavior is considered threatening to their health and others’ lives are excluded from the community. People considered dangerous or violent are often restricted from interacting with other people. Challenging behavior can be a cry for help or an attempt to express a particular need or request. Experts are encouraged to employ strategies that help them identify and address the behavioral challenge’s cause. 

Officially challenging behavior in adults with intellectual disability can vary depending on the methodology used, population, and ascertainment methods. Research identifies the population of individuals with intellectual disability at around 10%, with those exhibiting serious behavioral challenges between 10-15%. The study also shows that behavioral challenges are more pervasive for individuals with complex intellectual disabilities or multiple disabilities. 

Studies reveal that people with multiple disabilities are more predisposed to self-injury and aggressive or destructive tendencies. The meta-analysis reveals that aggressive behavior is more common among the male gender. Self-inflicted injuries are mainly reported among individuals with a profound intellectual disability or those experiencing expressive communication issues. For instance, a patient diagnosed with autism showed signs of self-injury and aggression. 

Causes of behavior change in people with intellectual disabilities

The causes of behavioral challenges are multifaceted, complex and they should be examined from a biopsychosocial perspective. Some of the common biological factors leading to challenging behavior are genetic conditions related to behavioral phenotypes like Prader-Willi syndrome and aggression, a physical illness like epilepsy, and other conditions like pain, visual impairment, and medication side effects. 

A recent scientific breakthrough in genetics shows that rare chromosomal anomalies like microdeletions and duplication are linked to intellectual disability, leading to challenging behavior. 

Psychological elements can cause behavioral challenges in mental illness, deep psychological trauma, and neuropsychiatric conditions like autism or epilepsy. On the other hand, social factors contributing to the condition may include extreme poverty and family discord, or traumatic events. 

It is a familiar feat for people to use challenging behavior to communicate their need for a particular object or activity and avoid something or someone. Sometimes individuals may use challenging behavior to dissatisfaction with specific environments or unavailability of professional staff. In most cases, people use challenging behavior to express discomfort or cry for help with certain activities. 

Mental illness and Challenging behavior

Psychological experts are quick to admit that the relationship between mental health and challenging behavior is complicated and yet to be fully understood. Mental illness appears to be more prevalent with people displaying signs of behavior challenges. Researchers have identified several potential causes of the relationship between mental illness and challenging behavior in individuals with intellectual disability. 

Behavioral challenges are often signs of underlying conditions; for example, self-injury through persistent skin picking may be attributed to unidentified obsessive-compulsive disorder. The behavior may also stem from mental illness; for instance, aggression may be caused by depression or may result from mental illness. 

Diagnostic Concerns

Determining the root cause of behavioral challenges is often a long and complicated exercise. Medical professionals experience difficulties in diagnosing mental illness in people with intellectual disabilities and challenging behavior.  Diagnosis complications may arise when atypical symptoms are observed or in cases where irregularities are present in medical and informant reports. 

Autism may pose complications in the identification of psychiatric symptoms.  Inappropriate sexual behavior and easy agitation in a young man with the condition may be misdiagnosed with hypomania. A young woman observed talking to herself or showing signs of concrete thinking may be misdiagnosed with psychosis. In some cases, individuals with autism may experience psychotic-like symptoms due to stress. 

Some of the common conditions experienced by people with autism include anxiety, persecutory ideas and thought disorder, and lack of proper coordination during activities. Diagnostic overshadowing is common where behavior or symptom caused by intellectual disability may be attributed to mental or physical sickness.  

Here’s a brief breakdown of the assessment of challenging behavior 

Functional Analysis 

The first stage of assessing challenging behavior entails gathering information concerning the behavioral challenges like medical records, relatives, and patient information. Underlying psychiatric conditions can be discovered by examining psychiatric history, taking a mental examination of the client, and performing a physical examination. 

For patients who do not exhibit signs or symptoms of preexisting psychiatric conditions, it is advisable to proceed to perform a functional analysis of the behavior in question. 

The functional analysis involves examining individuals and their habitat to identify the cause and purpose of certain activities. The examination helps the medical professional to identify the risk factors contributing to a particular behavior and how to help the patient manage the condition. Experts can identify triggers for specific behavioral challenges and how to overcome them. 

In some cases, the patients exhibit behavioral changes in the presence of specific biological and environmental aspects. For instance, fatigue may increase the chances of behavior change for people with intellectual disabilities. 

How to manage challenging behavior

Experts tend to recommend varying methods to manage challenging behavior like medication and psychosocial measures. Studies show that psychiatrists recommend non-pharmacological interventions with patients without preexisting psychiatric conditions. Experts result to pharmacological means when treating individuals with aggressive behavior or when other treatment methods have failed. 

Psychosocial interventions 

Several psychosocial interventions are proposed to address behavioral challenges experienced by individuals with disabilities. Some of the interventions commonly used to treat people with intellectual disabilities include: 

Social interventions 

Social interventions to address behavioral challenges in people with intellectual disability and may include environmental modification, level of care, and enhanced communication. In some cases, nidotherapy is recommended, and it involves implementing systematic environmental changes to address the patient’s needs. This form of therapy involves making modifications to the immediate environment to suit the patient’s requirements. 

Active support is a social intervention applied to help individuals with intellectual disabilities. People offering care services are recommended to pursue training to develop customized activity plans to remedy challenging behavior. Patients are encouraged to seek other treatment methods to improve their behavior instead of just modifying their environment. More research show is carried out on the effectiveness of active support. 

Cognitive-behavioral therapy 

CBT has recently been introduced as a treatment option for people with intellectual disabilities. Medical evidence showing the effectiveness of the program in resolving challenging behavior. Studies on the effectiveness of the therapy program in managing intellectual disability depict varying results.  

Cognitive-behavioral therapy is used when addressing anger management and emotional distress. According to the caregivers, when the program is used in a group setting, patients who completed the 12- week program recorded lower anger rates. The study shows with proper training, and an individual can administer the therapy without medical training. 

Mindfulness 

This intervention initiative originates from Buddhism and is characterized by redirecting an individual’s attention to the present. Some people with intellectual disabilities report mindfulness as an effective intervention method when dealing with challenging behavior. This intervention method has been proven to be effective in managing aggression. 

Mindfulness can also be used to achieve progress for individuals with self-harm tendencies or violent individuals and people with deviant sexual behavior. According to recent caregivers can receive training on how to perform mindfulness intervention. It is crucial to note that this treatment method requires more research to determine the level of effectiveness.  

Pharmacological interventions 

  1. Mood stabilizers 

Recent research depicts the positive effects of lithium in managing aggression in individuals with intellectual disability compared to placebo. The study shows that male test subjects did not respond well to lithium-based treatment programs. From the study, the researchers discovered that the following elements attributed to the success of the treatment program; 

  • History of epilepsy 

  • Stereotypical behavior 

  • Lower aggression rates before treatment 

  • Hyperactivity 

Research shows that mood stabilizers are not very effective in managing explosive aggression issues. However, the treatment intervention has been proven to be effective in mitigating the frequency of aggressive episodes. Some of the common mood stabilizers are; phenytoin, lithium, oxcarbazepine, and levetiracetam. 

  1. Antipsychotics 

Individuals with intellectual disabilities are commonly prescribed antipsychotic medications to deal with behavioral disorders. Research shows that risperidone is more effective in improving the behavior of people with intellectual disabilities. Currently, there is limited evidence on the effectiveness of antipsychotic medication in treating intellectual disability. 

Numerous studies show that risperidone is an adequate treatment regimen for behavioral challenges for children with a spectrum disorder, autism, and challenging behavior. Adults with autism use antipsychotic medication to decrease anxiety and arousal of behavioral challenges.