Categorizing evidence set in The Matrix of Psychological Therapies in relation to people with intellectual disabilities who also have challenging behaviour: NHS Education for Scotland

Martin Campbell

Research output: Book/ReportCommissioned report


In December 2008 the Scottish Government published The Matrix - A Guide to delivering evidence-based Psychological Therapies in Scotland. The Matrix was produced to help NHS Boards in Scotland to timeously deliver the range, volume and quality of Psychological Therapy required for the effective treatment of common mental health problems.
The Scottish Government, in conjunction with NHS Education for Scotland have now commissioned a review of effective psychological therapies in relation to people with intellectual disabilities. One part of this is a review of psychological therapies for people with intellectual disabilities who also have challenging behaviour, which is the subject of this paper.
Challenging behaviours are more prevalent in individuals with intellectual disability, and likelihood of challenging behaviours increases with the severity of the disability, (Borthwick-Duffy 1994; Cormack et al. 2000; Janssen et al. 2002; McIntyre et al. 2002). Typical examples of challenging behaviour in people with intellectual disabilities include physical aggression, disruptive or antisocial behaviour, stereotyped and repetitive behaviour and self-injurious behaviour. These behaviours reduce a person’s quality of life, present barriers to obstacles to community and social integration and have resource implications for specialist accommodation and therapeutic services.
There is a growing body of evidence on the effectiveness of psychological therapies for people with a learning disability and challenging behaviour. An evidence based approach aims to transfer research findings into practice, on the basis of their effectiveness, safety and ethical acceptability. The most recent best practice guidelines produced by the Royal College of Psychiatry and the British Psychological Society (A Unified Approach, 2007) references reviews and meta-analyses of the evidence for the effectiveness of psychodynamic, cognitive-behavioural and cognitive therapies. Generally the evidence supports the effectiveness of these therapies for adults with mild learning disabilities and, in much smaller numbers, for people with more severe learning disabilities. These therapies are defined thus:
“Psychological interventions are defined as attempts to make changes in people, their behaviour, the systems around them or their interpersonal relationships, using methods derived from a psychological knowledge and understanding of individuals and their world.” (p. 69, BPS 2004)

This paper reports on a systematic review of the peer-reviewed literature published between 1980-2010, to identify the evidence base for therapeutic interventions used with people who have intellectual disabilities and challenging behaviour. A search was conducted using the databases ERIC, PsycINFO, PsycARTICLES, Web of Science and Cochrane Library. Applied key terms were intellectual disability, mental retardation, learning difficulty, learning disability, challenging behaviour. The literature identified in this search was then further interrogated for articles specific to intervention charac¬teristics and intervention effects.
The available evidence was then categorized as far as possible using standards set in The Matrix of Psychological Therapies for people with common mental health problems
Academic and research practitioner colleagues on the Psychological Therapies Sub-group were consulted as to relevance and accuracy of the evidence base
Original languageEnglish
PublisherNHS Education for Scotland
Number of pages10
Publication statusPublished - 1 Mar 2011


  • Challenging behaviour, evidence base


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