Evidence of the chronicity of challenging behaviors in individuals with intellectual disabilities (ID) and autism spectrum disorder while receiving active treatment over long periods is limited. Analysis of the chronicity of these behaviors and the corresponding intensity of treatment has important implications for clinical practice and provision of services.
The aim was to examine chronicity of challenging behaviors in individuals with ID receiving residential treatment over a 20-year period addressing the following questions: (1) What is the prevalence of challenging behaviors requiring a Behavior Support Plan (BSP) within the population of the facility during the study? (2) Is there a significant decline in frequency of challenging behaviors of these persons with ID over time? (3) Is there a significant decrease in intensity of intervention targeting challenging behaviors of these persons with ID over time?
The treatment records of 216 persons with ID were examined to identify individuals for whom challenging behaviors required a Behavior Support Plan. The chronicity of five categories of challenging behavior and associated treatment interventions over a 20-year period was analyzed through repeated measures analyses.
A significant decline was found for the frequency of Physical Aggression, and Physical Disruption over 20 years, but not for Self-Injury, Verbal Disruption, and Program Refusal. There was a corresponding significant reduction of intervention intensity for Physical Aggression and Physical Disruption, however, the need for interventions persisted over time for all challenging behaviors.
Results demonstrate that rates of challenging behaviors are chronic, but remain relatively low in the repertoire of persons with ID. Parallel findings on interventions suggest that comprehensive treatment programs are needed to maintain low rates of these challenging behaviors with implications for provision of services for persons with ID, as well as planning and policy implications for managing challenging behaviors.