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Challenging behaviour and learning disabilities: prevention and interventions for children with learning disabilities whose behaviour challenges: NICE guideline 2015
  1. Manjari Tanwar,
  2. Benjamin Lloyd,
  3. Priscilla Julies
  1. Department of Paediatrics, Royal Free Hospital NHS Trust, London, UK
  1. Correspondence to Dr Manjari Tanwar, Department of Paediatrics, Royal Free Hospital NHS Trust, Pond street, London NW3 2QG, UK; manjari.tanwar{at}nhs.net

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Information about current guideline

In May 2015, the National Institute for Health and Care Excellence (NICE) published guidance entitled ‘Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges’.1 The guideline concerns children (aged 12 years or younger) and young adults (13–17 years) covering principles of management.

Previously published guidance

The British Psychological Society published a report entitled ‘Challenging behaviour: a unified approach’ in 2007.2 This guideline was developed for clinical psychologists working mainly within the child and adolescent mental health services. To our knowledge, the NICE guideline1 is the first to provide guidance to paediatricians and general practitioners working in this field.

Key terminology

Learning disability: This guideline highlights that ‘Learning disability’ is the most widely and accepted term in the UKdefined by three core criteria:

1. Lower intellectual ability (IQ <70)

2. Significant impairment of social adaptive functioning

3. Onset in childhood

‘Behaviour that challenges’ is not a diagnosis and is used in this guideline to indicate that although difficult behaviour may be a challenge to services, family members or carers, it may serve a purpose for the person with a learning disability and often indicates an unmet need.

The terminology in intellectual disability is a contentious issue. In this guideline, the term ‘Behaviour that challenges’ is used rather than ‘challenging behaviour’ to highlight that an individual with challenging behaviour is not the only one requiring treatment and to therefore ensure that other elements such as the environment, skills, attitudes of carers/staff and service capabilities are simultaneously assessed and are also the focus of intervention.

It is relatively common for people with a learning disability to develop behaviour that challenges (5%–15%), acknowledging that objective assessment is often difficult.

Key points

Assessment

  1. Pre-assessment: Early identification of behaviour that challenges is the key. Everyone involved in caring for and supporting children and young adults …

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