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. 2015 Apr 7;2015(4):CD003406.
doi: 10.1002/14651858.CD003406.pub4.

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

Afia Ali  1 , Ian Hall, Jessica Blickwedel, Angela Hassiotis
Affiliations

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

Afia Ali et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Outwardly-directed aggressive behaviour is a significant part of problem behaviours presented by people with intellectual disabilities. Prevalence rates of up to 50% have been reported in the literature, depending on the population sampled. Such behaviours often run a long-term course and are a major cause of social exclusion. This is an update of a previously published systematic review (see Hassiotis 2004; Hassiotis 2008).

Objectives: To evaluate the efficacy of behavioural and cognitive-behavioural interventions on outwardly-directed aggressive behaviour in people with intellectual disabilities when compared to standard intervention or wait-list controls.

Search methods: In April 2014 we searched CENTRAL, Ovid MEDLINE, Embase, and eight other databases. We also searched two trials registers, checked reference lists, and handsearched relevant journals to identify any additional trials.

Selection criteria: We included studies if more than four participants (children or adults) were allocated by random or quasi-random methods to either intervention, standard treatment, or wait-list control groups.

Data collection and analysis: Two review authors independently identified studies and extracted and assessed the quality of the data.

Main results: We deemed six studies (309 participants), based on adult populations with intellectual disabilities, suitable for inclusion in the current version of this review. These studies examined a range of cognitive-behavioural therapy (CBT) approaches: anger management (three studies (n = 235); one individual therapy and two group-based); relaxation (one study; n = 12), mindfulness based on meditation (one study; n = 34), problem solving and assertiveness training (one study; n = 28). We were unable to include any studies using behavioural interventions. There were no studies of children.Only one study reported moderate quality of evidence for outcomes of interest as assessed by the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We judged the evidence for the remaining studies to be of very low to low quality. Most studies were at risk of bias in two or more domains: one study did not randomly allocate participants and in two studies the process of randomisation was unclear; in one study there was no allocation concealment and in three studies this was unclear; blinding of assessors did not occur in three studies; incomplete outcome data were presented in one study and unclear in two studies; there was selective reporting in one study; and other biases were present in one study and unclear in four studies.Three of the six studies showed some benefit of the intervention on improving anger ratings. We did not conduct a meta-analysis, as we considered the studies too heterogeneous to combine (e.g. due to differences in the types of participants, sample size interventions, and outcome measures).Follow-up data for anger ratings for both the treatment and control groups were available for two studies. Only one of these studies (n = 161) had adequate long-term data (10 months), which found some benefit of treatment at follow-up (continued improvement in anger coping skills as rated by key workers; moderate-quality evidence).Two studies (n = 192) reported some evidence that the intervention reduces the number of incidents of aggression and one study (n = 28) reported evidence that the intervention improved mental health symptoms.One study investigated the effects of the intervention on quality of life and cost of health and social care utilisation. This study provided moderate-quality evidence, which suggests that compared to no treatment, behavioural or cognitive-behavioural interventions do not improve quality of life at 16 weeks (n = 129) or at 10 months follow-up (n = 140), or reduce the cost of health service utilisation (n = 133).Only one study (n = 28) assessed adaptive functioning. It reported evidence that assertiveness and problem-solving training improved adaptive behaviour.No studies reported data on adverse events.

Authors' conclusions: The existing evidence on the effectiveness of behavioural and cognitive-behavioural interventions on outwardly-directed aggression in children and adults with intellectual disabilities is limited. There is a paucity of methodologically sound clinical trials and a lack of long-term follow-up data. Given the impact of such behaviours on the individual and his or her support workers, effective interventions are essential. We recommend that randomised controlled trials of sufficient power are carried out using primary outcomes that include reduction in outward-directed aggressive behaviour, improvement in quality of life, and cost effectiveness.

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Conflict of interest statement

Dr Afia Ali ‐ none known. Dr Ian Hall ‐ is employed as a consultant psychiatrist in the United Kingdom's (UK) National Health Service (NHS), and receives fees for giving expert testimony in civil cases in the English Courts. He receives expense payments in relation to study leave and activities connected with his employment. Dr Hall does unremunerated work for the Royal College of Psychiatrists leading and supporting psychiatrists, and setting standards in psychiatry. Jessica Blickwedel ‐ none known. Professor Angela Hassiotis ‐ is the author of an academic publication Hassiotis 2009 that was excluded from this review. Although she was not directly involved in the decision making regarding the paper, she has an overview of the work completed for this document. She declares that at no point has she attempted to influence her co‐authors' decisions about this paper. Professor Hassiotis's institution has grants pending with the National Institute for Health Research (NIHR) for Research for Patient Benefit and Health Technology Assessment (HTA) programmes, and the Bailey Thomas Charitable Foundation. Professor Hassiotis occasionally receives payment for lecture honoraria by academic institutions as an invited speaker/workshop leader and author of commissioned articles.

Figures

1
1
Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
1.1
1.1. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 1 Aggressive behaviour: Severity of incidents: Aberrant Behaviour Checklist (ABC) ‐ Hyperactivity subscale ‐ key worker report.
1.2
1.2. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 2 Aggressive behaviour: Severity of incidents: ABC ‐ Irritability subscale ‐ key worker report.
1.3
1.3. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 3 Aggressive behaviour: Severity of incidents: ABC ‐ Hyperactivity subscale ‐ home carer report.
1.4
1.4. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 4 Aggressive behaviour: Severity of incidents: ABC ‐ Irritability subscale ‐ home carer report.
1.5
1.5. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 5 Aggressive behaviour: Severity of incidents: MOAS ‐ key worker report.
1.6
1.6. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 6 Aggressive behaviour: Severity of incidents: Modified Overt Aggression Scale (MOAS) ‐ home carer report.
1.7
1.7. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 7 Aggressive behaviour: Severity of incidents: Controllability Beliefs Scale (CBS) ‐ key worker report.
1.8
1.8. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 8 Ability to control anger: Provocation Inventory (PI) ‐ self report.
1.9
1.9. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 9 Ability to control anger: PI ‐ carer report.
1.10
1.10. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 10 Ability to control anger: Novaco Anger Scale (NAS) ‐ self report.
1.11
1.11. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 11 Ability to control anger: NAS ‐ carer report.
1.12
1.12. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 12 Ability to control anger: Profile of Anger Coping Skills (PACS) ‐ self report.
1.13
1.13. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 13 Ability to control anger: PACS ‐ key worker report.
1.14
1.14. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 14 Ability to control anger: PACS ‐ home carer report.
1.15
1.15. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 15 Mental state: Depression: Glasgow Depression Scale for people with an Intellectual Disability (GDS‐ID).
1.16
1.16. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 16 Mental state: Anxiety: Glasgow Anxiety Scale for people with an Intellectual Disability (GAS‐ID).
1.17
1.17. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 17 Self esteem: Rosenberg Self Esteem Scale (SES).
1.18
1.18. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 18 Quality of Life: Comprehensive Quality of Life Scale: Intellectual Disability (ComQoL‐ID).
1.19
1.19. Analysis
Comparison 1 Anger management versus wait‐list control group (community sample), Outcome 19 Costs of service utilisation: Client Service Receipt Inventory (CSRI): Cost per person per week of health and social care resource (in British pounds).
2.1
2.1. Analysis
Comparison 2 Anger management versus wait‐list control group (forensic sample), Outcome 1 Aggressive behaviour: Severity of incidents: NAS ‐ Total score.
2.2
2.2. Analysis
Comparison 2 Anger management versus wait‐list control group (forensic sample), Outcome 2 Aggressive behaviour: Severity of incidents: NAS ‐ Cognitive subscale.
2.3
2.3. Analysis
Comparison 2 Anger management versus wait‐list control group (forensic sample), Outcome 3 Aggressive behaviour: Severity of incidents: NAS ‐ Arousal subscale.
2.4
2.4. Analysis
Comparison 2 Anger management versus wait‐list control group (forensic sample), Outcome 4 Aggressive behaviour: Severity of incidents: NAS ‐ Behavioral subscale.
2.5
2.5. Analysis
Comparison 2 Anger management versus wait‐list control group (forensic sample), Outcome 5 Ability to control anger: PI ‐ Total score.
2.6
2.6. Analysis
Comparison 2 Anger management versus wait‐list control group (forensic sample), Outcome 6 Ability to control anger: PI ‐ Disrespect subscale.
2.7
2.7. Analysis
Comparison 2 Anger management versus wait‐list control group (forensic sample), Outcome 7 Ability to control anger: PI ‐ Unfairness subscale.
2.8
2.8. Analysis
Comparison 2 Anger management versus wait‐list control group (forensic sample), Outcome 8 Ability to control anger: PI ‐ Frustration subscale.
2.9
2.9. Analysis
Comparison 2 Anger management versus wait‐list control group (forensic sample), Outcome 9 Ability to control anger: PI ‐ Annoying traits subscale.
2.10
2.10. Analysis
Comparison 2 Anger management versus wait‐list control group (forensic sample), Outcome 10 Abiity to control anger: PI ‐ Irritations subscale.
2.11
2.11. Analysis
Comparison 2 Anger management versus wait‐list control group (forensic sample), Outcome 11 Ability to control anger: Spielberger's State ‐ Trait Anger Expression Inventory ‐ Anger Expression subscale (STAXI ‐ AX).
2.12
2.12. Analysis
Comparison 2 Anger management versus wait‐list control group (forensic sample), Outcome 12 Ability to control anger: STAXI ‐ Anger control subscale.
2.13
2.13. Analysis
Comparison 2 Anger management versus wait‐list control group (forensic sample), Outcome 13 Ability to control anger: Ward Anger Rating Scale (WARS).
3.1
3.1. Analysis
Comparison 3 Assertiveness and problem‐solving versus no‐treatment control group, Outcome 1 Ability to control anger: Problem‐Solving Task (PST).
3.2
3.2. Analysis
Comparison 3 Assertiveness and problem‐solving versus no‐treatment control group, Outcome 2 Ability to control anger: Role Play Test of Anger Arising Situations (RPT).
3.3
3.3. Analysis
Comparison 3 Assertiveness and problem‐solving versus no‐treatment control group, Outcome 3 Adaptive functioning: Adaptive Behaviour Scale ‐ Revised, Part II (ABS‐II).
3.4
3.4. Analysis
Comparison 3 Assertiveness and problem‐solving versus no‐treatment control group, Outcome 4 Mental state: Psychiatric symptoms: Brief Symptom Inventory (BSI).
3.5
3.5. Analysis
Comparison 3 Assertiveness and problem‐solving versus no‐treatment control group, Outcome 5 Mental state: Psychological distress: Subjective Units of Distress Scale (SUDS).
4.1
4.1. Analysis
Comparison 4 Meditation based on mindfulness versus wait‐list control group, Outcome 1 Aggressive behaviour: Frequency of incidents: Number of incidents of physical aggression per week during treatment (12 weeks).
4.2
4.2. Analysis
Comparison 4 Meditation based on mindfulness versus wait‐list control group, Outcome 2 Aggressive behaviour: Frequency of incidents: Number of incidents of verbal aggression per week during treatment (12 weeks).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

McPhail 1989 {published data only}
    1. McPhail CH, Chamove AS. Relaxation reduces disruption in mentally handicapped adults. Journal of Mental Deficiency Research 1989;33(5):399‐406. - PubMed
Nezu 1991 {published data only}
    1. Nezu CM, Nezu AM, Arean P. Assertiveness and problem‐solving training for mildly mentally retarded persons with dual diagnoses. Research in Developmental Disabilities 1991;12(4):371‐86. - PubMed
Singh 2013 {published and unpublished data}
    1. Singh NN, Lancioni GE, Karazsia BT, Winton ASW, Myers RE, Singh ANA, et al. Mindfulness‐based treatment of aggression in individuals with mild intellectual disabilities: a waiting list control study. Mindfulness 2013;4(2):158‐67.
Taylor 2005 {published data only}
    1. Taylor JL, Novaco RW, Gillmer BT, Robertson A, Thorne I. Individual cognitive‐behavioural anger treatment for people with mild‐borderline intellectual disabilities and histories of aggression: a controlled trial. British Journal of Clinical Psychology 2005;44(3):367‐82. - PubMed
Willner 2002 {published data only}
    1. Nezu CM, Nezu AM, Arean P. Assertiveness and problem‐solving training for mildly mentally retarded persons with dual diagnoses. Research in Developmental Disabilities 1991;12(4):371‐86. - PubMed
    1. Willner P, Jones J, Tams R, Green G. A randomised controlled trial of the efficacy of a cognitive‐behavioural anger management group for clients with learning disabilities. Journal of Applied Research in Intellectual Disabilities 2002;15(3):224‐35.
Willner 2013 {published and unpublished data}
    1. Willner P, Rose J, Jahoda A, Kroese BS, Felce D, Cohen D, et al. Group‐based cognitive‐behavioural anger management for people with mild to moderate intellectual disabilities: cluster randomised controlled trial. British Journal of Psychiatry 2013;203(4):288‐96. - PubMed
    1. Wilner P, Rose J, Jahoda A, Stenfert Kroese B, Felce D, MacMahon P, et al. A cluster randomised controlled trial of a manualised cognitive‐behavioural anger management intervention delivered by supervised lay therapists to people with intellectual disabilities. Health Technology Assessment 2013;17(21):1‐173. [DOI: 10.3310/hta17210] - DOI - PMC - PubMed

References to studies excluded from this review

Amerikaner 1982 {published data only}
    1. Amerikaner M, Summerlin ML. Group counseling with learning disabled children: effects of social skills and relaxation training on self‐concept and classroom behaviour. Journal of Learning Disabilities 1982;15(6):340‐3. - PubMed
Bagner 2007 {published data only}
    1. Bagner DM, Eyberg SM. Parent child interaction therapy for disruptive behavior in children with mental retardation: a randomized controlled trial. Journal of Clinical Child and Adolescent Psychology 2007;36(3):418‐29. - PubMed
Baker 1971 {published data only}
    1. Baker BL, Ward MH. Reinforcement therapy for behavior problems in severely retarded children. American Journal of Orthopsychiatry 1971;41(1):124‐35. - PubMed
Bearss 2013 {published data only}
    1. Bearss K, Johnson C, Handen B, Smith T, Scahill L. A pilot study of parent training in young children with autism spectrum disorders and disruptive behavior. Journal of Autism and Developmental Disorders 2013;43(4):829‐40. - PubMed
Benson 1986 {published data only}
    1. Benson BA, Rice CJ, Miranti SV. Effects of anger management training with mentally retarded adults in group treatment. Journal of Consulting and Clinical Psychology 1986;54(4):728‐9. - PubMed
Bird 2000 {published data only}
    1. Bird FL, Luiselli JK. Positive behavioural support of adults with developmental disabilities: assessment of long‐term adjustment and habilitation following restrictive treatment histories. Journal of Behaviour Therapy and Experimental Psychiatry 2000;31(1):5‐19. - PubMed
Bornstein 1980 {published data only}
    1. Bornstein PH, Bach PJ, McFall ME, Friman PC, Lyons PD. Application of a social skills training program in the modification of interpersonal deficits among retarded adults: a clinical replication. Journal of Applied Behavior Analysis 1980;13(1):171‐6. - PMC - PubMed
Brightman 1982 {published data only}
    1. Brightman RP, Baker BL, Clark DB, Ambrose SA. Effectiveness of alternative parent training formats. Journal of Behaviour Therapy and Experimental Psychiatry 1982;13(2):113‐7. - PubMed
Brookman‐Frazee 2012 {published data only}
    1. Brookman‐Frazee LI, Drahota A, Stadnick N. Training community mental health therapists to deliver a package of evidence‐based practice strategies for school‐age children with autism spectrum disorders: a pilot study. Journal of Autism and Developmental Disorders 2012;42(8):1651‐61. - PMC - PubMed
Carr 2006 {published data only}
    1. Carr EG, Blakeley‐Smith A. Classroom intervention for illness‐related problem behavior in children with developmental disabilities. Behavior Modification 2006;30(6):901‐24. - PubMed
Clement 1967 {published data only}
    1. Clement PW, Milne DC. Group play therapy and tangible reinforcers used to modify the behavior of 8‐yr‐old boys. Behavior Research and Therapy 1967;5(4):301‐12.
Durand 2013 {published data only}
    1. Durand M, Hieneman M, Clarke S, Wang M, Rinaldi ML. Positive family intervention for severe challenging behavior I: A multisite randomized clinical trial. Journal of Positive Behavior Interventions 2013;15(3):133‐43.
Edmonson 1983 {published data only}
    1. Edmonson B, Han SS. Effects of socialization games on proximity and prosocial behaviour of aggressive mentally retarded institutionalised women. American Journal of Mental Deficiency 1983;87(4):435‐40. - PubMed
Eikeseth 2007 {published data only}
    1. Eikeseth S, Smith T, Jahr E, Eldevik S. Outcome for children with autism who began intensive behavioral treatment between ages 4 and 7: a comparison controlled study. Behavior Modification 2007;31(3):264‐78. - PubMed
Eikeseth 2012 {published data only}
    1. Eikeseth S, Klintwall L, Jahr E, Karlsson P. Outcome for children with autism receiving early and intensive behavioral intervention in mainstream preschool and kindergarten settings. Research in Autism Spectrum Disorders 2012;6(2):829‐35.
Eldevik 2006 {published data only}
    1. Eldevik S, Eikeseth S, Jahr E, Smith T. Effects of low intensity behavioral treatment for children with autism and mental retardation. Journal of Autism and Developmental Disorders 2006;36(2):211‐24. - PubMed
Fava 2011 {published data only}
    1. Fava L, Strauss K, Valerie G, D'Elia L, Arima S, Vicari S. The effectiveness of a cross‐setting complementary staff‐and parent‐mediated early intensive behavioral intervention for young children with ASD. Research in Autism Spectrum Disorders 2011;5(4):1479‐92.
Feldman 2002 {published data only}
    1. Feldman M, Condillac RA, Tough S, Hunt S, Griffiths D. Effectiveness of community positive behavioral intervention for persons with developmental disabilities and severe behavior disorders. Behavior Therapy 2002;33(3):377‐98.
Gates 2001 {published data only}
    1. Gates B, Newell R, Wray J. Behaviour modification and gentle teaching workshops: management of children with learning disabilities exhibiting challenging behaviour and implications for learning disability nursing. Journal of Advanced Nursing 2001;34(1):86‐95. - PubMed
Gresham 1982 {published data only}
    1. Gresham FM, Gresham GN. Interdependent, dependent and independent group contingencies for controlling disruptive behaviour. Journal of Special Education 1982;16(1):102‐10.
Grey 2007 {published data only}
    1. Grey IM, McClean B. Service user outcomes of staff training in positive behaviour support using person‐focused training: a control group study. Journal of Applied Research in Intellectual Disabilities 2007;20(1):6‐15.
Hagiliassis 2005 {published data only}
    1. Hagiliassis N, Gulbenkoglu H, Marco M, Young S, Hudson A. The Anger Management Project: a group intervention for anger in people with physical and multiple disabilities. Journal of Intellectual and Developmental Disability 2005;30(2):86‐96.
Hall 1973 {published data only}
    1. Hall HV, Price B, Shinedling M, Peizer SB, Massey RH. Control of aggressive behaviour in a group of retardates using positive and negative reinforcement procedures. The Training School Bulletin 1973;70(3):179‐86. - PubMed
Hassiotis 2009 {published data only}
    1. Hassiotis A, Robotham D, Canagasabey A, Romeo R, Langridge D, Blizard R, et al. Randomized, single‐blind, controlled trial of a specialist behavior therapy team for challenging behavior in adults with intellectual disabilities. American Journal of Psychiatry 2009;166(11):1278‐85. - PubMed
Koenig 2010 {published data only}
    1. Koenig K, White SW, Pachler M, Lau M, Lewis M, Klin A, et al. Promoting social skill development in children with pervasive developmental disorders: a feasibility and efficacy study. Journal of Autism and Developmental Disorders 2010;40(10):1209‐18. - PubMed
Leblanc 1995 {published data only}
    1. Leblanc LA, Matson JL. A social skills training programme for preschoolers with developmental delays: generalization and social validity. Behaviour Modification 1995;19(2):234‐46. - PubMed
Lindsay 2004 {published data only}
    1. Lindsay WR, Allan R, Parry C, Macleod F, Cottrell J, Overend H, et al. Anger and aggression in people with intellectual disabilities: treatment and follow‐up of consecutive referrals and a waiting list comparison. Clinical Psychology and Psychotherapy 2004;11(4):255‐64.
Lovaas 1987 {published data only}
    1. Lovaas IO. Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology 1987;55(1):3‐9. - PubMed
Lowe 1996 {published data only}
    1. Lowe KD, Felce D, Blackman D. Challenging behaviour: the effectiveness of specialist support teams. Journal of Intellectual Disability Research 1996;40(4):336‐47. - PubMed
Mate‐Kole 1999 {published data only}
    1. Mate‐Kole CC, Danquah SA, Twum M, Danquah AO. Outcomes of a nonaversive behavior intervention in intellectually impaired individuals using goal attainment scaling. Nursing Research 1999;48(4):220‐5. - PubMed
Murphy 1978 {published data only}
    1. Murphy MJ, Zahm D. Effect of improved physical and social environment on self‐help and problem behaviors of institutionalized retarded males. Behavior Modification 1978;2(2):193‐210.
Reitzel 2013 {published data only}
    1. Reitzel J, Summers J, Lorv B, Szatmari P, Zwaigenbaum L, Georgiades S, et al. Pilot randomized controlled trial of a Functional Behavior Skills Training program for young children with Autism Spectrum Disorder who have significant early learning skill impairments and their families. Research in Autism Spectrum Disorders 2013;7(11):1418‐32.
Rickards 2009 {published data only}
    1. Rickards AL, Walstab JE, Wright‐Rossi RA, Simpson J, Reddihough DS. One‐year follow‐up of the outcome of a randomized controlled trial of a home‐based intervention programme for children with autism and developmental delay and their families. Child: Care, Health and Development 2009;35(5):593‐602. - PubMed
Roberts 2006 {published data only}
    1. Roberts C, Mazzucchelli T, Studman L, Sanders MR. Behavioral family intervention for children with developmental disabilities and behavioral problems. Journal of Clinical Child & Adolescent Psychology 2006;35(2):180‐93. - PubMed
Roeden 2014 {published data only}
    1. Roeden JM, Maaskant MA, Curfs LMG. Processes and effects of Solution‐Focused Brief Therapy in people with intellectual disabilities: a controlled study. Journal of Intellectual Disability Research 2014;58(4):307‐20. - PubMed
Rose 2000 {published data only}
    1. Rose J, West C, Clifford D. Group intervention for anger in people with intellectual disabilities. Research in Developmental Disabilities 2000;21(3):171‐81. - PubMed
Rose 2005 {published data only}
    1. Rose J, Loftus M, Flint B, Carey L. Factors associated with the efficacy of a group intervention for anger in people with intellectual disabilities. British Journal of Clinical Psychology 2005;44(3):305‐17. - PubMed
Rose 2009 {published data only}
    1. Rose J, O'Brien A, Rose D. Group and individual cognitive behavioural interventions for anger. Advances in Mental Health and Learning Disabilities 2009;3(4):45‐50.
Schnitzer 2007 {published data only}
    1. Schnitzer G, Andries C, Lebeer J. Usefulness of cognitive behavioral intervention programmes for socio‐emotional behavioural problems in children with learning disabilities. Journal of Research in Special Educational Needs 2007;7(3):161‐71.
Shechtman 2005 {published data only}
    1. Shechtman Z, Pastor R. Cognitive–behavioral and humanistic group treatment for children with learning disabilities: a comparison of outcomes and process. Journal of Counseling Psychology 2005;52(3):322–36.
Smith 1997 {published data only}
    1. Smith T, Eikeseth S, Klevstrand M, Lovaas OI. Intensive behaviour treatment for preschoolers with severe mental retardation and pervasive developmental disorders. American Journal on Mental Retardation 1997;102(3):238‐49. - PubMed
Strauss 2012 {published data only}
    1. Strauss K, Vicari S, Valeri G, D'Elia L, Arima S, Fava L. Parent inclusion in Early Intensive Behavioral Intervention: the influence of parental stress, parent treatment fidelity and parent‐mediated generalization of behavior targets on child outcomes. Research in Developmental Disabilities 2012;33(2):688‐703. - PubMed
Tavormina 1975 {published data only}
    1. Tavormina JB. Relative effectiveness of behavioural and reflective group counseling with parents of mentally retarded children. Journal of Consulting and Clinical Psychology 1975;43(1):22‐31. - PubMed
Taylor 2002 {published data only}
    1. Taylor JL, Novaco RW, Gillmer B, Thorne I. Cognitive‐behavioural treatment of anger intensity among offenders with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities 2002;15(2):151‐65.
To 2000 {published data only}
    1. To MYF, Chan S. Evaluating the effectiveness of progressive muscle relaxation in reducing the aggressive behaviours of mentally handicapped patients. Archives of Psychiatric Nursing 2000;14(1):39‐46. - PubMed
Wacker 1998 {published data only}
    1. Wacker DP, Berg WK, Harding JW, Derby KM, Asmus JM, Healey A. Evaluation and long‐term treatment of aberrant behaviour displayed by young children with disabilities. Journal of Developmental and Behavioral Pediatrics 1998;19(4):260‐6. - PubMed
Wiggs 1999 {published data only}
    1. Wiggs L, Stores G. Behavioural treatment for sleep problems in children with severe learning disabilities and challenging daytime behaviour: effect on day time behaviour. Journal of Child Psychology and Psychiatry 1999;40(4):627‐35. - PubMed
Willner 2007 {published data only}
    1. Willner P, Tomlinson S. Generalization of anger‐coping skills from day‐service to residential settings. Journal of Applied Research in Intellectual Disabilities 2007;20(6):553‐62.

References to studies awaiting assessment

Collada‐Castillo 2011 {published data only}
    1. Collado‐Castillo CJ. Comparison of a cognitive re‐appraisal approach and a problem solving approach to improve social cognition in adults with intellectual disabilities who exhibit aggressive behaviour. Disseration Abstracts International Section A: Human and Social Sciences 2011; Vol. 71:3324.

Additional references

Allen 2005
    1. Allen D, James W, Evans J, Hawkins S, Jenkins R. Positive behavioural support: definition, current status and future directions. Tizard Learning Disability Review 2005;10(2):4‐11.
Aman 1991
    1. Aman MG. Review and evaluation of instruments for assessing emotional and behavioural disorders. Australian and New Zealand Journal of Developmental Disabilities 1991;17(2):127‐45.
APA 2000
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM‐IV‐TR). 4th Edition. Washington DC: American Psychiatric Association, 2000.
APA 2013
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM IV). 5th Edition. Washington DC: American Psychiatric Association, 2013.
Bishop 2004
    1. Bishop S, Lau M, Shapiro S, Carlson LE, Anderson ND, Carmody J, et al. Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice 2004;11(3):230‐41.
Borthwick‐Duffy 1994
    1. Borthwick‐Duffy SA. Prevalence of destructive behaviors. A study of aggression, self‐injury, and property destruction. In: Thompson T, Gray DB editor(s). Destructive Behavior in Developmental Disabilities. Thousand Oaks, California: Sage Publications, 1994. [ISBN: 0803955820]
Cooper 2009
    1. Cooper SA, Smiley E, Jackson A, Finlayson J, Allan L, Mantry D, et al. Adults with intellectual disabilities: prevalence, incidence and remission of aggressive behaviour and related factors. Journal of Intellectual Disability Research 2009;53(3):217–32. - PubMed
Crocker 2006
    1. Crocker AG, Mercier C, Lachapelle Y, Brunet A, Morin D, Roy M‐E. Prevalence and types of aggressive behaviour among adults with intellectual disabilities. Journal of Intellectual Disability Research 2006;50(9):652‐61. - PubMed
Didden 1997
    1. Didden R, Duker, PC, Korzilius H. Meta‐analytic study on treatment effectiveness for problem behaviours with individuals who have mental retardation. American Journal of Mental Retardation 1997;101(4):387‐99. - PubMed
Didden 2006
    1. Didden R, Korzilius H, Oorsouw W, Sturmey P. Behavioral treatment of challenging behaviors in individuals with mild mental retardation: meta‐analysis of single‐subject research. American Journal on Mental Retardation 2006;111(4):290‐8. - PubMed
DOH 2012
    1. Department of Health. Transforming care: a national response to Winterbourne View Hospital: Department of Health review final report. http://bit.ly/1GKOq1G (accessed 16 February 2015).
Emerson 1995
    1. Emerson C. Challenging Behaviour: Analysis and Intervention in People with Learning Difficulties. Cambridge: Cambridge University Press, 1995.
Emerson 2001
    1. Emerson E, Kiernan C, Alborz A, Reeves D, Mason H, Swarbrick R, et al. The prevalence of challenging behaviours: a total population study. Research in Developmental Disabilities 2001;22(1):77–93. - PubMed
Gamble 2005
    1. Gamble C, Hollis S. Uncertainty method improved on best‐worst case analysis in a binary meta‐analysis. Journal of Clinical Epidemiology 2005;58(6):579‐88. [DOI: 10.1016/j.jclinepi.2004.09.013] - DOI - PubMed
Heyvaert 2010
    1. Heyvaert M, Maes B, Onghena P. A meta‐analysis of intervention effects on challenging behaviour among persons with intellectual disabilities. Journal of Intellectual Disability Research 2010;54(7):634‐49. - PubMed
Heyvaert 2012
    1. Heyvaert M, Maes B, Noortgate W, Kuppens S, Onghena P. A multilevel meta‐analysis of single‐case and small‐n research on interventions for reducing challenging behavior in persons with intellectual disabilities. Research in Developmental Disabilities 2012;33(2):766‐80. - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook of Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Jones 2008
    1. Jones S, Cooper SA, Smiley E, Allan L, Williamson A, Morrison J. Prevalence of, and factors associated with, problem behaviours in adults with intellectual disabilities. Journal of Nervous and Mental Disease 2008;196(9):678‐86. - PubMed
Kiernan 1994
    1. Kiernan C, Kiernan D. Challenging behaviour in schools for pupils with severe learning difficulties. Mental Handicap Research 1994;7(3):177‐201.
Lundgvist 2013
    1. Lundgvist L‐O. Prevalence and risk markers of behaviour problems among adults with intellectual disabilities: a total population study in Örebro County, Sweden. Research in Developmental Disabilities 2013;34(4):1346‐56. - PubMed
McClintock 2003
    1. McClintock K, Hall S, Oliver C. Risk markers associated with challenging behaviours in people with intellectual disabilities: a meta‐analytic study. Journal of Intellectual Disability Research 2003;47(6):405–16. - PubMed
Meinhold 1990
    1. Meinhold PM, Mulick JA. Counter‐habilitative contingencies in institutions for people with mental retardation: ecological and regulatory influences. Mental Retardation 1990;28(2):67‐75. - PubMed
Nezu 2000 [pers comm]
    1. Nezu C. Confirming method of sequence generation was by coin‐tossing [personal communication]. Email to: A Hassiotis and J Dennis 23 September 2000.
Nicoll 2013
    1. Nicoll M, Beail N, Saxon D. Cognitive behavioural treatment for anger in adults with intellectual disabilities: a systematic review and meta‐analysis. Journal of Applied Research in Intellectual Disabilities 2013;26(1):47‐62. - PubMed
Novaco 1994
    1. Novaco RW. Anger as a risk factor for violence among the mentally disordered. In: Monahan J, Steadman HJ editor(s). Violence and Mental Disorder: Developments in Risk Assessment. Chicago: University of Chicago Press, 1994:21‐59.
Novaco 2003
    1. Novaco RW. Novaco Anger Scale and Provocation Inventory (NAS‐PI). Los Angeles: Western Psychological Services, 2003.
Poppes 2010
    1. Poppes P, Putten AJJ, Vlaskamp C. Frequency and severity of challenging behaviour in people with profound intellectual disability and multiple disabilities. Research in Developmental Disabilities 2010;31(6):1269–75. - PubMed
Rana 2013
    1. Rana F, Gormez A, Varghese S. Pharmacological interventions for self‐injurious behaviour in adults with intellectual disabilities. Cochrane Database of Systematic Reviews 2013, Issue 4. [DOI: 10.1002/14651858.CD009084.pub2; Art. No.: CD009084] - DOI - PMC - PubMed
RCPsych 2001
    1. Royal College of Psychiatrists. DC‐LD: Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation. Occasional Paper OP 48. London: Gaskell, 2001.
RCPsych 2007
    1. Royal College of Psychiatrists. Challenging Behaviour: A Unified Approach. College Report 2007; Vol. CR144.
Schünemann 2008
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, et al. Chapter 12: Interpreting results and drawing conclusions In: Higgins JPT, Green S (editors). Cochrane Handbook of Systematic Reviews of Interventions. Version5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Scotti 1991
    1. Scotti JR, Evans IM, Meyer LH, Walker P. A meta‐analysis of intervention research with problem behavior: treatment validity and standards of practice. American Association on Mental Retardation 1991;96(3):233‐56. - PubMed
Singh 2003
    1. Singh NN, Wahler RG, Adkins AD, Myers RE, Mindfulness Research Group. Soles of the Feet: a mindfulness‐based self‐control intervention for aggression by an individual with mild mental retardation and mental illness. Research in Developmental Disabilities 2003;24(3):158‐69. - PubMed
Skuse 2002
    1. Skuse DH. Behavioural phenotypes. Psychiatry 2002;1(7):98‐102.
Smiley 2007
    1. Smiley E, Cooper S‐A, Finlayson J, Jackson A, Allan L, Mantry D, et al. Incidence and predictors of mental ill‐health in adults with intellectual disabilities: prospective study incidence and predictors of mental ill‐health in adults with intellectual disabilities. British Journal of Psychiatry 2007;191(4):313‐19. - PubMed
Spielberger 1996
    1. Spielberger CD. State‐Trait Anger Expression Inventory Professional Manual. Lutz, Florida: Psychological Assessment Resources, 1996.
Taylor 2007 [pers comm]
    1. Taylor J. Concerning randomisation and allocation concealment [personal communication]. Email to: A Hassiotis 4 September 2007.
Turner 2012
    1. Turner RM, Davey J, Clarke MJ, Thompson SG, Higgins JPT. Predicting the extent of heterogeneity in meta‐analysis, using empirical data from the Cochrane Database of Systematic Reviews. International Journal of Epidemiology 2012;41(3):818‐27. - PMC - PubMed
Vereenooghe 2013
    1. Vereenooghe L, Langdon PE. Psychological therapies for people with intellectual disabilities: a systematic review and meta‐analysis. Research in Developmental Disabilities 2013;34(11):4085‐102. - PubMed
WHO 1993
    1. World Health Organization. International Classification of Disease and Related Disorders (ICD‐10). Geneva: World Health Organization, 1993.
Willner 2005
    1. Willner P, Brace N, Phillips J. Assessment of anger coping skills in individuals with intellectual disabilities. Journal of Intellectual Disability Research 2005;49(5):329‐39. - PubMed

References to other published versions of this review

Hassiotis 2001
    1. Hassiotis A, Hall I. Behavioural and cognitive‐behavioural interventions for outwardly‐directed aggressive behaviour in people with learning disabilities. Cochrane Database of Systematic Reviews 2001, Issue 4. [DOI: 10.1002/14651858.CD003406; Art. No.: CD003406] - DOI - PubMed
Hassiotis 2004
    1. Hassiotis A, Hall I. Behavioural and cognitive‐behavioural interventions for outwardly‐directed aggressive behaviour in people with learning disabilities. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD003406.pub2; Art. No.: CD003406] - DOI - PubMed
Hassiotis 2008
    1. Hassiotis AA, Hall I. Behavioural and cognitive‐behavioural interventions for outwardly‐directed aggressive behaviour in people with learning disabilities. Cochrane Database of Systematic Reviews 2008, Issue 3. [DOI: 10.1002/14651858.CD003406.pub3] - DOI - PubMed

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