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Behavioural and cognitive-behavioural interventions for outwardly-directed aggressive behaviour in people with learning disabilities

  • Review
  • Intervention

Authors


Abstract

Background

Outwardly directed aggressive behaviour is a significant part of problem behaviours presented by people with learning disabilities. Prevalence rates between 3.3% to 36% have been reported in the literature. Such behaviours often run a long term course and are a major cause of social exclusion.

Objectives

To determine the efficacy of behavioural and cognitive behavioural interventions for outwardly-directed aggressive behaviour for people with learning disabilities.

Search methods

The Cochrane Library (CENTRAL) 2007 (Issue 1), MEDLINE 1966 to February 2007, EMBASE 1980 to February 2007, PsycINFO 1872 to February 2007 and Dissertation Abstracts late 1960s to February 2007 were searched. Where appropriate, research filters were used.

Selection criteria

Studies were selected if more than four participants, children or adults, were allocated by random or quasi-random methods to either intervention or standard treatment/wait list.

Data collection and analysis

References identified by electronic searches, examinations of bibliography and personal contacts were screened against inclusion criteria by two independent reviewers. Two reviewers independently extracted and entered data into RevMan (Cochrane Collaboration software).

Main results

Four studies based on adult populations with learning disabilities were deemed to be suitable for inclusion in the current version of this review. Data were only available in a form suitable for meta-analysis in three studies, but due to heterogeneity of populations and interventions, meta-analysis was not performed. Direct interventions based on cognitive-behavioural methods (modified relaxation, assertiveness training with problem solving, and anger management) appear to have some impact on reduction of aggressive behaviour at the end of treatment and in some studies also at follow up (up to six months).

Authors' conclusions

The existing evidence on the efficacy of cognitive behavioural and behavioural interventions on outwardly directed aggression in children and adults with learning disabilities is scant. There is a paucity of methodologically sound clinical trials. Given the impact of such behaviours on the affected individual, his or her carers and on service providers, effective interventions are essential. It is also important to investigate cost efficacy of treatment models against existing treatments. We recommend that randomised controlled trials of sufficient power are carried out using primary outcomes of reduction in outward directed aggression, improvement in quality of life and cost efficacy as measured by standardised scales.

摘要

背景

行為與認知行為介入,對於學習障礙者其外顯的侵略性行為之影響

外顯的侵略性行為是學習障礙者一項重要的問題。文獻上報告,其盛行率約3.3% 至36% 。這類的行為通常會一段相當長的時間,且是造成社交孤立的重要原因。

目標

確認對學習障礙者,行為和認知行為介入對於外顯侵略行為治療之療效。

搜尋策略

結合 ‘學習或同義詞’ 、 ‘失能或同意詞’ 、 ‘行為或同義詞’ 、 ‘治療或同義詞’ 等關鍵字,搜尋資料庫: the Cochrane Library (CENTRAL) ,MEDLINE, EMBASE,CINAHL,ERIC和PsycINFO 到2002年的文獻。適當時使用搜尋過濾工具。

選擇標準

選擇大於四名參與者、孩童或成人,以隨機或半隨機的方式,分配到接受介入或標準治療/列在觀察名單兩組的試驗。

資料收集與分析

以電腦搜尋相關文獻,由兩名獨立的回顧審閱者,使用納入標準來檢驗參考書目,以及私人的聯繫。

主要結論

有三篇針對成人學習障礙的試驗,符合納入標準,但是只有兩篇的資料,是適合統合分析 (metaanalysis) 的形式。直接使用認知行為方法 (包括修飾過的放鬆法、自信心與問題解決的訓練、憤怒管理) 為介入方式,在減低侵略性行為上頭,在治療尾聲有著某些影響,但在後續追蹤上 (6個月之內) ,經個案和照顧者評估後,其影響並未再出現。

作者結論

認知行為與行為介入,對於學習障礙者其外顯的侵略性行為之效果,現有的證據仍很薄弱。方法學完整的臨床試驗仍欠缺。因為此類行為影響個案、照護者,及提供醫療服務者,有效的介入方式是必須的。去探討現有治療模式的花費效益也是很重要的。我們建議,以標準化的量表,評估以 ‘減少外顯的侵略性行為’ 、 ‘改善生活品質’ 、和 ‘花費效益’ 作為初級結果,具有足夠效力的隨機分配試驗是需要的。

翻譯人

本摘要由成功大學附設醫院紀美宏翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

挑釁性的行為,是造成學習障礙 (又稱為智能障礙) 者社交孤立的重要原因。對於何種介入仍沒有有力的證據顯示具療效。在這篇回顧中,我們比較行為、和行為認知介入,對於外顯侵略性,這種充滿挑釁性或問題性的行為,其介入的治療效果。

Plain language summary

More research is needed for people with learning disabilities and challenging behaviour

Challenging behaviour is a significant cause of social exclusion for people with learning disabilities. ('Learning disabilities' is also known as ' intellectual disabilities'). There is no firm evidence as yet about which interventions help people with learning disabilities most with their challenging behaviour. In this review we assess the efficacy of behavioural and cognitive behavioural interventions for a specific type of challenging or 'problem' behaviour, that is, outwardly-directed aggression.

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