Evidence-based practices in intellectual disability and behaviour disorders Ian M. Grey a and Richard P. Hastings b Purpose of review To critically review the most recently published studies on the treatment of challenging behaviours/behaviour disorders for individuals with intellectual disability. Recent findings Literature published in the review period was from three traditions: applied behaviour analysis, psychopharmacology, and service evaluation. Applied behaviour analysis treatments have a large evidence base, and recent research has focused on refining issues such as dealing with low rate behaviours, improving generalization, the effects of choice-making, and setting event variables that may affect treatment outcomes. Recent interest in risperidone as a treatment for behaviour disorder has dominated the literature on pharmacological interventions. Several empirical studies support the use of risperidone in children, although a recent review is more sceptical of the quality of the evidence to date. A small number of service evaluation studies suggest in particular that applied behaviour analysis technologies can be scaled up to benefit large numbers of patients. Summary Applied behaviour analysis methods for the assessment and treatment of behaviour disorders continue to be the focus of research, and continue to result in positive outcomes. Recent data show the value of using applied behaviour analysis technologies as a service model for people with behaviour disorders. Pharmacological treatments, especially risperidone, also have a developing evidence base despite a lack of understanding of their mechanisms of action. A number of questions about behaviour disorders remain unanswered, especially whether early intervention may be effective and their putative relationship with psychiatric conditions. Keywords applied behaviour analysis, behaviour disorders, challenging behaviour, pharmacological treatment, service models Curr Opin Psychiatry 18:469–475. ß 2005 Lippincott Williams & Wilkins. a KARE, Newbridge, Co. Kildare and Department of Psychology, Trinity College, Dublin, Ireland and b School of Psychology, University of Wales, Bangor, UK Correspondence to Ian Grey PhD D Clin Psych BCBA, KARE Lecturer in Intellectual Disabilities, Department of Psychology, Trinity College, Dublin 2, Ireland Tel: +353 1 608 1886; fax: +353 1 671 2006; e-mail: igrey@tcd.ie Current Opinion in Psychiatry 2005, 18:469–475 Abbreviations ABA applied behaviour analysis FCT functional communication training N-CBRF Nisonger Child Behavior Rating Form NCE noncontingent escape PCP person-centred planning PDD pervasive developmental disorder ß 2005 Lippincott Williams & Wilkins 0951-7367 Introduction The purpose of the present review is to consider recent evidence on interventions for behaviour disorders in chil- dren and adults with intellectual disabilities. We have included studies published during 2004 and the first few months of 2005, and used a broad definition of behaviour disorder. Thus, we have included studies of classic ‘chal- lenging behaviour’ (such as self-injury, aggression towards others or the environment, stereotyped/repetitive beha- viours), studies of general problem behaviours in indivi- duals with intellectual disabilities, and behaviour problems labelled with common psychiatric terminology (especially conduct disorder, attention deficit hyper- activity disorder (ADHD)/hyperactivity). The main sections of the review focus on evidence for interventions using methods derived from applied behaviour analysis (ABA), pharmacological interventions, and also a number of service delivery models. However, the literature review also identified a number of general issues that have implications for our understanding and treatment of beha- viour disorders in intellectual disability and it is to these that we turn first. General issues on behaviour disorders and intellectual disability Behaviour disorders in individuals with intellectual dis- abilities clearly constitute a significant clinical concern. A 3-year longitudinal study of 13 preschool children by Green and colleagues [1] suggests that behaviour disorders can emerge early and are highly persistent. When beha- viour disorders are not treated, they can develop into serious, life-threatening actions once children develop physically and enter adolescence and young adulthood. Many psychological intervention studies of adults with intellectual disabilities are focused on cases when beha- viour disorders are likely to have been present for many years, posing significant challenges for intervention. Early intervention for behaviour disorders is thus clearly 469