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Intellectual disability (ID) is prevalent in 1 per cent of the population. Premenstrual syndrome (PMS) affects up to 5 per cent of the general population of adult women. Identification of PMS is challenging in women with ID due to differences in communication. Management of PMS in the ID population requires careful consideration of baseline function, co-existing mental and physical health problems, drug interactions as well as complex ethical considerations. The paper aims to discuss this issue.

Prospero-registered systematic review (CRD42019119398) of papers exploring the diagnosis and management of patients with PMS and ID (n=414). In total, 35 relevant titles were identified and 27 full text papers were assessed for eligibility, resulting in 10 studies for final qualitative analysis.

Ten original research papers were included. There are no standardised symptom criteria for diagnosis of PMS in women with ID. Studies relied on observer-reported data. All papers demonstrated higher rates of PMS in women with ID compared with the general adult population. Management was not standardised and varied between centres. Mainstays of treatment included non-steroidal anti-inflammatories, combined oral contraceptive pills and intramuscular progesterone. Newer evidence suggests levonorgestrel intrauterine systems may be appropriate. There was no quantitative method of establishing success of management.

A modified symptom diary should be used for diagnosis in this population. Differentiation between cyclical behavioural change due to pain vs mood disturbance remains challenging. Conservative, psychological and medical management should be the mainstay of treatment, with surgery considered in exceptional cases.

This paper demonstrates the current limited evidence for the management of PMS in women with a diagnosis of ID and offers an overview of the current options for managing these patients’ symptoms.

The current study aimed to examine the population of girls in two secure children’s homes (SCHs) in the North East of England to consider the impact of menstruation on girls’ physical, mental and emotional wellbeing within secure settings. Gender-responsive approaches and understanding gender differences are central to trauma-informed provision within the Children and Young People Secure Estate (CYPSE). Whilst trauma-informed approaches are central, it could be argued that basic gender differences, such as the menstrual cycle, are currently being overlooked within research and practice.

A case file audit examined documentation of 24 girls who were admitted across both sites between January 2022 and January 2023.

Of the sample (n = 24), 50% had information recorded regarding their menstrual cycle during admission assessments. Six girls (25%) disclosed experiencing irregular menstruation. Painful cramping was noted by two girls (8%). One girl (4%) disclosed heavy bleeding, and menorrhagia (abnormal heavy bleeding) was reported for one further girl (4%). One girl (4%) disclosed early onset menarche. Case formulations tended to focus less on girls’ menstrual cycles or the potential impact of this on wellbeing. However, 100% of case formulations considered the potential impact of trauma and/or disrupted attachment on girls’ presentations.

The results indicate the impact of menstrual cycles on girls’ physical, mental and emotional wellbeing may benefit from much further consideration. Implications are presented alongside directions for future research.

The aim of this paper is to provide an overview of the dominant approaches used to explain causes of challenging behaviour.

This paper is the second in a two‐part series. It presents the causes of challenging behaviour according to the three theoretical approaches that have dominated the literature: applied behaviour analysis; biological factors; and psychiatric disorders.

It is apparent that the causes of challenging behaviour are likely to be complex and involve multiple factors. The approaches that have dominated the literature focus on single causes and do not explore possible interactions between various causes. Given the shortcomings of existing approaches, a fourth approach, the biopsychosocial model, is proposed as an alternative model to explain the causes of challenging behaviour.

This paper is the most recent of only a few providing an overview of the various approaches that seek to explain the causes of challenging behaviour.

Socio‐affective state can affect appetite, and choice of food or drink can affect mood and social perception. Effects of dietary constituents on the brain often play some role in these food‐mood linkages but they are forged into strong and particular shape by personal involvement in cultural practices surrounding consumption of particular items. Briefly discusses psychological research into the following examples: alcoholic drinks, tea and coffee, nutritive tonics and dieters′ “danger foods”.

Although affecting most women during their fertile years, PMS remains a poorly understood condition. The purpose of this paper is to present some diet and lifestyle treatment options based on literature review findings tempered with the author's experience of treating this condition.

Findings from the literature over the last 20 years and the experience of treating women with this condition have resulted in the development of a phased approach to treat PMS.

The phased approach is outlined as such: for phase 1 ensure the diet is healthy and balanced. In phase 2 swap high Glycemic Index foods for lower GI ones and eat regular meals. For phase 3 try supplements with evidence of efficacy such as calcium and vitamin D. Finally, in phase 4 address lifestyle factors such as activity, stress and weight plus control chronic health conditions.

More research is needed in this area; future work should focus on the use of the lower GI diet and weight loss.

The four phased approach should be implemented before resorting to pharmacological intervention. Women may not need to follow all four phases and may find relief after just phase 1.

For PMS relief, women do not need to be following a diet that does not fit into a family situation; following the guidelines can have knock on health benefit on the rest of the family.

Unsubstantiated anecdotes are often the main source of help for PMS sufferers. This approach sets achievable phased targets based on sound science and practical experience.