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Grouping people with learning disabilities and challenging behaviour in residential care has been the focus of several recent research studies. This paper describes these studies and what they found. In general, they show negative effects of grouping people with challenging behaviour together in terms of the quality of staff interaction with them and the outcomes they experience.

This article is the first in a two‐part series exploring challenging behaviour, its prevalence, risk factors and causes. The aim of this article is to provide an overview of prevalence studies and explore the various risk factors that have been associated with challenging behaviour. The authors also seek to explore methodological differences across studies that may contribute to the prevalence variations reported in the literature.

The article summarises the findings from frequently cited prevalence studies as well as more recent studies.

The prevalence of challenging behaviour reported in the literature has varied due to methodological differences across studies. Despite this, the best estimate is believed to be from 15 to 17.5 per cent. A range of factors have been associated with challenging behaviour and include gender, age, severity of disability and residential setting.

This article appears to represent the most current overview of research in this area.

Assessment, care management and service planning for people with challenging needs should be sensitive to gender and ethnicity for equitable and appropriate service provision. This paper explores the relevant literature to map and identify the issues, and profiles a exploratory study of special schools, adult residential services and community support teams, to identify the gender and ethnic characteristics of people with learning disabilities and challenging behaviours. The findings suggest that gender stereotypes contribute to the attribution of maladaptive behaviour in boys, significant in severe and moderate learning disabilities in schools. The findings on ethnicity are discussed with reference to staff training and the implications of providing gender‐sensitive and culturally appropriate service responses and support.

The purpose of this paper is to look at whether a move to a supported living model of care from traditional residential group homes could improve the quality of life for those with a severe intellectual disability and other challenging needs.

Six men with severe intellectual disabilities moved from two residential homes into new-build individual flats. Their quality of life was measured using a battery of assessments looking at; environment, relationships, community participation, interactions, mood interest and pleasure, activities, physical health and challenging behaviour. These measures were taken before the move, immediately after and six months after the move. The views of staff and family carers were also assessed at each stage.

The move had a positive effect on the tenants in that it caused an improvement in their mood and a decrease in their challenging behaviours. Further improvements could be made in the tenant’s quality of life by introducing more activities. The initial concerns of family members about the move decreased over time. However staff found the changes to their working practices stressful.

The study was a small scale one because of the small number of tenants. The tenants were unable to express their own views because of their limited communication abilities so a combination of direct observation and indirect measures were used.

In the light of the Winterbourne view report by Stephen Bubb this study looks at the impact on quality of life of a move to supported living for a group of people with complex and challenging needs who might otherwise be placed in an out of borough placement similar to Winterbourne view.

The study also looks at the impact of such a move on the family members of the individuals and on the staff who had to change their working practices to adapt to both a new working environment and model of care.

This study also looks at the impact of a model of supported living for people with severe intellectual disabilities and complex needs rather than those with mild intellectual disabilities. This is particularly important in the post Winterbourne view climate when the authors need to look carefully at positive alternative models of care for these individuals.

The purpose of this article is to explore the current evidence base in understanding the relationship between mental health and challenging behaviour in people with intellectual disabilities.

The article discusses how challenging behaviour is associated with psychiatric disorders. Common aetiological factors between challenging behaviour and psychiatric disorders and diagnostic issues are considered. The article ends with a review of the assessment and management of challenging behaviour within the context of mental health.

Several studies have highlighted common aetiological factors that are responsible for challenging behaviour and psychiatric disorders in people with intellectual disabilities, and although there is an overlap in the symptoms, both are thought to be different phenomena. Treatment of the psychiatric disorder should ameliorate the challenging behaviour, although a functional analysis of the behaviour may still be required in order to understand the purpose of the behaviour. There is evidence for a range of different treatment approaches.

The article will assist professionals working with people with intellectual disabilities to understand the complex relationship between mental health and challenging behaviour. It also gives guidance on principles of management of people with complex mental health and behavioural needs.

In Scotland, following the closure of long stay learning disability hospitals in 2005, focus has shifted on to developing robust community services/resources to cater for the healthcare needs of people with learning disabilities. In the absence of robust in‐patient services, a small number of individuals with learning disabilities and associated severe challenging behaviours, despite not being regarded as “forensic” cases, do inappropriately get referred and sometimes admitted to forensic learning disability services. This study aims to explore this area of clinical practice in the context of referrals to the high secure forensic setting of The State Hospital, Carstairs, Scotland and in light of key UK and Scottish Government policies.

All referrals made to the State Hospital's forensic learning disability service between August 2005 and July 2010, which met the criteria, were reviewed (n=5) and common determinants leading to these referrals identified and thematically analysed.

The identified determinants leading to the making of these referrals were broadly classifiable into psychiatric, environmental and staffing themes.

In Scotland, there does appear to be a requirement for a specialist in‐patient service to meet the needs of this complex and challenging group of patients. There is a need for effective supra‐regional planning to meet the needs of similar “high cost, low volume” patient groups.

This study highlights the wider issue of “gaps” within services in Scotland for individuals with severe challenging behaviours and autism and the requirement for a national specialist service.

The paper considers the kinds of treatment available for people with learning disabilities and challenging behaviour. It draws on research data on the use of reactive strategies and behaviour plans for 235 children and adults rated by carers as extremely challenging, and 276 rated as very challenging, to identify any trends in the management and treatment of challenging behaviour. It finds an increase in written plans for adults but not for children, and no information on the extent to which plans are based on sound functional analyses and contain proactive as well as reactive strategies. Only half the plans were said to have been drawn up with any support from behavioural specialists, and there was no discernible change in the use of reactive strategies.

Self‐injurious behaviour can become an intransigent difficulty, reduce people's quality of life and lead to hospital admissions or other restrictive outcomes (such as the wearing of protective devices to prevent serious injury). Over the last 15 years there have been some important developments in the treatment of severe self‐injury, but the evidence is that these are making little impact on most people's lives. The reasons why this might be are discussed, and it is proposed that it is time for a radical new approach to interventions for self‐injurious behaviour.

Autism spectrum disorder (ASD) is an exclusion criterion for one of the two attachment disorders in the DSM 5. However, previous findings indicate that ASD and attachment disorder are unrelated conditions and may co-occur. The purpose of this paper is to explore the diagnostic assessment of an adolescent male with ASD, intellectual disability (ID), severe challenging behaviour and a suspected attachment disorder.

Case study methodology was chosen because of its suitability in the exploration of complex clinical phenomena where prior knowledge is sparse.

It was possible to identify symptoms of attachment disorder in a case involving ASD, ID, anxiety and severe challenging behaviour. The Disturbances of Attachment Interview was particularly useful in this assessment, as was assessment of ASD symptoms and developmental history. Differentiating the two attachment disorders proved challenging.

There is a need for further research in ASD and attachment disorders not limited by current diagnostic categories.

Co-occurring symptoms of attachment disorder may be identified in individuals with ASD and ID, and exploration of these symptoms in assessments of children and adolescents with ASD/ID and challenging behaviour may be beneficial.

The study adds to previous findings on attachment disorder in ASD, demonstrating that identification of attachment disorder is possible even in the presence of a highly complex clinical picture involving severe challenging behaviour. It may also assist other clinicians in identifying and making more accurate assessment of attachment disorder in ASD and ID.

In June 2002 the Government issued long‐awaited guidance on the use of restrictive physical interventions. The need for the guidance was recognised in the White Paper, Valuing People, and its publication is anticipated in both the recently published National Care Standards and the 1996 Education Act. It represents a clear and unambiguous commitment by government departments to work together to improve practice across a range of services for adults and children with learning disabilities and autistic spectrum disorders, and for pupils with a range of special educational needs. The guidance is particularly addressed to staff working with adults and children with learning disabilities (including those with autistic spectrum disorders) and to those in special school settings responsible for pupils with severe behavioural difficulties associated with learning difficulties and/or autistic spectrum disorders. It will also be relevant to staff in schools which make provision for pupils with severe emotional and behavioural difficulties. This article describes the development of the guidance, the areas of practice it covers and its implications for managers, professionals, staff working directly with service users and family carers. It will do this by attempting to answer six questions. Why do we need new guidance on the use of restrictive physical interventions? Who will be affected by the guidance? How was the guidance developed? What does the guidance say? What needs to be done to implement the guidance? What still needs to be done?