Peter McGill

Support for family carers of children and young people with developmental disabilities and challenging behaviour: What stops it being helpful?

BACKGROUND Many family carers find the support they receive in respect of their childs challenging behaviour unhelpful. This study sought to identify carer perceptions of the ways in which support is unhelpful and how it could be more helpful. METHODS Thirteen mothers, caring for a child with intellectual disability and challenging behaviour, were interviewed. Parental perceptions and concerns regarding support received were investigated. Transcribed interviews were analysed using interpretive phenomenological analysis. RESULTS Parents reported problems with generic disability services including accessing good services, obtaining relevant information, working relationships with professionals and issues with respite provision. Concerns were also expressed about challenging behaviour-specific provision including ineffective strategies being suggested, an apparent lack of expertise, insufficient input and their childs exclusion from services. CONCLUSIONS More preventative approaches, more widespread adoption of effective behaviour management and improved partnership between professionals and families appear needed. Increasing family support may be ineffective if not accompanied by greater insight into the factors related to effectiveness and recognition of the role of informal support.

Severe Learning Disabilities and Challenging Behaviours: Designing high quality services.

The size of the problem - H Qureshi Understanding challenging behaviour - G Murphy Conceptualizing service provision - E Emerson, J Mansell and P McGill Ordinary housing for people with severe learning disabilities and challenging behaviours - E Emerson, J Mansell, F Beasley and P McGill Vocational services - D Allen Intervention and support services - J McBrien Part III: Determinants of quality Introduction - P McGill, E Emerson and J Mansell Values and staff culture - E Emerson, P McGill and S Barrett Service organization and staff support - P McGill, S Toogood and C McCool Supporting local service placements - J Mansell, P McGill and H Hughes Disseminating good practice - J Mansell, E Emerson and P McGill Assessing costs and benefits - J Mansell and M Knapp Part IV: Implications for future services.

Incorporating “Motivation” Into the Functional Analysis of Challenging Behavior: On the Interactive and Integrative Potential of the Motivating Operation

Sensitivity theory attempts to account for the variability often observed in challenging behavior by recourse to the “aberrant motivation” of people with intellectual and developmental disabilities. In this article, we suggest that a functional analysis based on environmental (challenging environments) and biological (challenging needs) motivating operations provides a more parsimonious and empirically grounded account of challenging behavior than that proposed by sensitivity theory. It is argued that the concept of the motivating operation provides a means of integrating diverse strands of research without the undue inference of mentalistic constructs. An integrated model of challenging behavior is proposed, one that remains compatible with the central tenets of functional analysis.

Maintaining local residential placements

A characteristic of community-based residential services set up to replace institutions is the breakdown of some placements and the re-admission of individuals to institutional care. The most commonly cited reason for placement breakdown given in studies of community services is challenging behaviour (Pagel and Whitling, 1978; Sutter et al, 1980; Thiel, 1981; Intagliata and Willer, 1982). Breakdown incurs costs for service agencies in finding new placements, often at short notice, as well as in dealing with the crisis and its aftermath. Alternative placements are usually hospitals, which impose costs on the individual person with learning disabilities in terms of fewer opportunities for meaningful activity, less staff help available and greater restrictiveness (Felce et al., 1980a, b; 1986; see also Chapter 1) as well as the practical and emotional disruption involved. Family members and staff may also experience placement breakdown as failure.

Values, attitudes and service ideology

The role played by social values and cultural ideologies in shaping the form of services for people with disabilities has received extensive attention over the past two decades (e. g., Wolfensberger, 1972; 1975; 1980). Indeed, it nowadays appears to be accepted as something of a truism that such a ‘value base’ underpins the very existence of welfare services and exerts a pervasive and powerful influence upon their everyday practice.

An Indirect Examination of the Function of Problem Behavior Associated with Fragile X Syndrome and Smith-Magenis Syndrome

Fragile X syndrome (FXS) and Smith-Magenis syndrome (SMS) are associated with a number of specific topographies of problem behavior. Very few studies have examined the function served by problem behavior in these groups. Using the Questions About Behavioral Function scale Matson and Vollmer (User’s guide: questions about behavioral function (QABF). Scientific Publishers Inc., Baton Rouge, LA, 1995) the current study examined group differences in the function of problem behavior displayed by children with FXS and SMS, in comparison to a control group of children with non-specific intellectual and developmental disabilities. Between-group analyses showed children with SMS were more likely to display problem behavior related to physical discomfort. Both within- and between-group analyses showed children with FXS were less likely to display attention-maintained problem behavior. These findings hold implications for the assessment, treatment and prevention of problem behavior associated with both FXS and SMS.

A tutorial on the concept of the motivating operation and its importance to application.

Motivating operations (MOs) exert a powerful influence over operant relations and hold significant implications for those working in applied settings. In this paper, we describe the concept of the MO and provide “real world” examples. Particular emphasis is given to the concept of the conditioned MO (CMO). Implications for intervention are discussed. It is hoped that this endeavour will encourage the utilization of the full conceptual system of the MO.

Staff Reports of Setting Events Associated With Challenging Behavior

This study sought to identify the setting events reported by care staff as more and less likely to be associated with the challenging behaviors of people with intellectual disabilities. Sixty-five staff working with 22 individuals were interviewed using an inventory of putative setting events. Findings were collated to allow identification of those events reported to be associated with increased and decreased likelihood of challenging behavior. Some events were reported as strongly associated with the occurrence of challenging behavior, some as strongly associated with its absence, some as largely “inert,” and many as idiosyncratically associated with occurrence, absence, or inertness. Different categories of setting events contributed different relative amounts to reported variation in challenging behavior. The use of the inventory described here, or modified versions, may be a useful way of identifying relationships between setting events and challenging behaviors, which suggest ways in which routine service provision might be modified to help prevent challenging behavior.

Normalization and Applied Behaviour Analysis: Values and Technology in Services for People with Learning Difficulties

It is argued that normalization and applied behaviour analysis represent the most significant developments of the past two decades in approaches to the design of services for people with learning difficulties. Problems in translating these approaches into practice have been compounded by an apparent conflict between them. The nature of this conflict is examined and suggestions for a rapprochement are made.

Functional Analysis of the Early Development of Self-Injurious Behavior: Incorporating Gene-Environment Interactions

The analysis of the early development of self-injurious behavior (SIB) has, to date, reflected the wider distinction between nature and nurture. Despite the status of genetic factors as risk markers for the later development of SIB, a model that accounts for their influence on early behavior-environment relations is lacking. In the current paper we argue that the investigation of gene-environment interactions (GxE) and other forms of gene-environment interplay could potentially enhance current approaches to the study of self-injury. A conceptual model of the early development of SIB based explicitly on such relations is presented. The model is consistent with the basic tenets of functional analysis. Implications for research and the assessment, treatment, and prevention of SIB are discussed.