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    Behaviour Problems in Children and Adolescents With Intellectual Disability

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    Gaoudam Natarajan
    1) Children with intellectual disabilities experience high rates of behavioural and emotional problems, around 40% have severe problems which is 3-4 times higher than typically developing children. 2) The cause of a child's intellectual disability can provide insight into their strengths, weaknesses, and types of behavioural issues. 3) A functional behavioural assessment involving observation, interviews, and checklists can help identify the purpose and causes of problematic behaviours to develop an effective intervention plan.

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    Behaviour Problems in Children and Adolescents With Intellectual Disability

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    Gaoudam Natarajan
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    1) Children with intellectual disabilities experience high rates of behavioural and emotional problems, around 40% have severe problems which is 3-4 times higher than typically developing children. 2) The cause of a child's intellectual disability can provide insight into their strengths, weaknesses, and types of behavioural issues. 3) A functional behavioural assessment involving observation, interviews, and checklists can help identify the purpose and causes of problematic behaviours to develop an effective intervention plan.

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    1) Children with intellectual disabilities experience high rates of behavioural and emotional problems, around 40% have severe problems which is 3-4 times higher than typically developing children. 2) The cause of a child's intellectual disability can provide insight into their strengths, weaknesses, and types of behavioural issues. 3) A functional behavioural assessment involving observation, interviews, and checklists can help identify the purpose and causes of problematic behaviours to develop an effective intervention plan.

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    Behaviour Problems in Children and Adolescents With Intellectual Disability

    Uploaded by

    Gaoudam Natarajan
    1) Children with intellectual disabilities experience high rates of behavioural and emotional problems, around 40% have severe problems which is 3-4 times higher than typically developing children. 2) The cause of a child's intellectual disability can provide insight into their strengths, weaknesses, and types of behavioural issues. 3) A functional behavioural assessment involving observation, interviews, and checklists can help identify the purpose and causes of problematic behaviours to develop an effective intervention plan.

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    Behaviour problems in children and adolescents with intellectual disability

    Dr Kylie Gray Centre for Developmental Psychiatry & Psychology School of Psychology & Psychiatry

    Behaviour problems in intellectual and developmental disability


    Lack of resources for teachers and school staff Overview behaviour and emotional problems Considerations when working with families Importance of cause of intellectual disability Understanding and managing behaviour problems Resources

    Children with intellectual disability in schools


    Australian Institute of Health and Welfare report (2008) Estimate 45% of children with disability in Australia attended mainstream education in 2003
    Degree of Mainstream Special class in Special school

    intellectual disability
    Severeprofound ID

    classroom

    mainstream school

    37.4%

    33.7%

    28.9%

    Moderate mild ID

    47.6%

    47.5%

    4.8%

    Behaviour and emotional problems in ID


    Experience the same behaviour and emotional problems and mental health difficulties as typically developing children and adolescents Occur at high rates
    around 40% have severe degree of behaviour and emotional problems 3-4 times higher than in typically developing children and adolescents

    Persist over time

    Behaviour and emotional problems in the classroom


    Increased levels of behaviour and emotional problems in special education classrooms compared to integrated school settings

    Why?
    May be a bias for those children with less behaviour problems towards integrated settings Integrated children with too many behaviour problems may transfer to special education settings Integration may reduce levels of behaviour problems / special education setting may aggravate problems
    Parmenter, T., Einfeld, S., & Tonge, B. (1998). Behavioural and emotional problems in the classroom of children and adolescents with intellectual disability. Journal of Intellectual and Developmental Disability, 23(1), 71-78.

    Working with parents: Parent psychosocial distress


    Higher levels of stress and mental health problems in parents of children with intellectual disability Stress not associated with severity of intellectual disability or child diagnosis Psychosocial distress is associated with child behaviour problems, particularly for mothers

    More behaviour problems, the higher the parent reported psychosocial distress
    Herring, S., Gray, K., et al.. (2006). Journal of Intellectual Disability Research, 50(12), 874-882. Hastings, R. P. (2002). Journal of Intellectual & Developmental Disability, 27(3), 149-160.

    Working with parents: Parent psychosocial distress


    Higher levels of child behaviour and emotional problems are associated with higher rates of parent mental health problems Over time, increases in child social relating problems and self-absorbed behaviours are associated with increases in parent mental health difficulties
    particularly depression and anxiety

    Implications for working with parents


    Gray, K.M., Piccinin, A.M., Hofer, S.M., Mackinnon, A., Bontempo, D.E., Einfeld, S.L., Parmenter, T., & Tonge, B.J. The longitudinal relationship between behavior and emotional disturbance in young people with intellectual disability and maternal mental health. Manuscript under review.

    Cause of intellectual disability


    Cause of a childs intellectual disability can provide information on strengths and weaknesses, and assist in developing an education curriculum Can also provide information on what types of behaviour and emotional problems child may present with eg Fragile X, Williams syndrome, Prader Willi syndrome, Down syndrome, autism

    Overall behavioural and emotional problems


    0.7 0.6
    Epidemiological
    Autism Down

    Mean TBPS

    0.5 0.4 0.3 0.2 0.1 0

    Fragile X Williams Prader Willi

    Fragile X syndrome
    Caused by a gene mutation (FMR1) on X chromosome, inherited Cognitive - learning difficulties to severe ID Distractible, impulsive, overactive, short attention span Anxious, shy, poor eye contact. Anxiety may present as tantrums Hand flapping, sound / light sensitivities, sensitivity to touch Changes in routine problematic Difficulties with crowds, new situations can be overwhelming

    Williams syndrome
    Deletion of the 7q11.23 region of chromosome 7 Cognitive average through to moderate severe ID Friendly, outgoing, loquacious Short attention span and distractibility Difficulty modulating emotions - extreme excitement when happy Tearfulness in response to apparently mild distress Terror in response to apparently mildly frightening events Heightened sensitivity to sounds (hyperacusis) Perseverating on certain favourite conversational topics Anxiety, difficulties with changes in routines / schedules Difficulties building friendships

    Autism
    Cognitive average / high average to severe ID High levels of behaviour and emotional problems Disruptive behaviour eg tantrums, aggression, abusive, noisy, impatient, stubborn Anxiety Difficulties with change in routine and surroundings Symptoms of depression Inattention, impulsivity, hyperactivity Social difficulties
    www.autismspeaks.org/community/family_services/school_kit.php

    Prader Willi syndrome


    Abnormality on part of chromosome 15 Cognitive average to moderate ID Hyperphagia - extreme unsatisfied drive to consume food Food foraging / obsession with food Increased appetite, weight control issues Temper tantrums, oppositional, argumentative Stealing, lying, stubborn, rigid, possessive Obsessive/compulsive behaviour Skin picking Impulsivity

    Down syndrome
    Extra copy of chromosome 21 Trisomy 21 Cognitive mild to moderate / severe ID Typically fewer emotional and behavioural problems compared to other children with ID
    but still higher rates than typically developing children

    Inattention, hyperactivity Stubborn Depression Down Syndrome Association Victoria offers an Education Support Service www.dsav.asn.au

    Understanding behaviour
    Define, describe the behaviour
    behavioural checklists can be useful

    What happens? When does it happen? What are the consequences? Understanding the meaning of the behaviour where possible Working with parents and other professionals where necessary

    Functional behavioural assessment


    Observe behaviour across settings eg classroom, playground, different activities Use parent and teacher behaviour checklists

    Interviews with parents and teachers


    Identify characteristics of behaviour problem Problem solving process to identify the purpose of a behaviour
    develop an intervention plan

    Case example
    Dylan is described as disruptive in class Observations of him in class and discussion with teachers he pinches, hits, pulls the hair of other children, yells out is removed from class behaviour occurs during work sheet tasks involving hand writing Further observations, discussion with parents reveals that Dylan has very poor fine motor skills struggles with pencil and paper tasks Occupational therapy and support to initially reduce amount writing and providing support tools Monitor behaviour, reduction in behaviour problems

    Functional assessment checklist


    Define the problem behaviour

    Devise a plan to collect data


    Compare and analyze the data Formulate the hypothesis Develop and implement a behaviour intervention plan Monitor the plan is the intervention working?

    Some general tips for managing behaviour problems


    Parents best person to alert you to their needs and behaviours Understanding of childs strengths and weaknesses and ensure that work and other expectations are appropriate Routines, preparing for changes in classroom Consistent, predictable routines and schedules visual guides / schedules, date books Visual prompts Minimise distractions visual and auditory

    Some general tips for managing behaviour problems


    Break tasks up into smaller components Clear expectations Classroom buddy
    Make use of peers / peer tutoring

    Computers and aides Positive reinforcement, goal setting and rewards Use interests as motivators build into curriculum Flexibility Warnings when schedule or routine has to change Social stories not just for children with autism

    Social stories
    Short stories

    Describe situations or concepts in a format that is meaningful and engaging for children with ID
    Help navigate or understand a situation they find difficult

    Used as a communication and learning tool


    Can help a child to understand a situation

    learn how to respond or behave in that situation

    Summary
    High rates of behaviour and emotional problems in children and adolescents with intellectual disability Understanding of childs cognitive ability and strengths and weaknesses important in understanding behaviour Cause of intellectual disability can provide information on types of behavioural difficulties Clear definitions of problem behaviours, with functional assessment can be helpful in developing intervention approach

    Resources
    Fragile X - www.fragilex.org Williams syndrome Autism Speaks school tool kit
    www.autismspeaks.org/community/family_services/school_kit.php

    www.fragilex.org.au

    www.williams-syndrome.org www.agsa-geneticsupport.org.au

    Prader Willi syndrome


    www.pws.org.au www.pwsausa.org

    Down syndrome
    www.dsav.asn.au www.ndss.org

    Social stories
    www.thegraycenter.org/ http://www.cheri.com.au/documents/Whataresocialstories_000.pdf

    Resources - programmes
    Signposts for building better behaviour
    Different levels of support for parents Victorian Parenting Centre www.parentingrc.org.au

    Stepping Stones
    Triple P for behaviour problems in children with developmental delay / ID Parent programme, also supports and information for teachers http://www10.triplep.net/?pid=2032

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