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Randomized Controlled Trial
. 2020 Apr 15;20(1):161.
doi: 10.1186/s12888-020-02577-1.

Clinical and cost effectiveness of staff training in the delivery of Positive Behaviour Support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial

Andre Strydom  1   2   3 , Alessandro Bosco  4 , Victoria Vickerstaff  5 , Rachael Hunter  6 ; PBS study group; Angela Hassiotis  7   8
Collaborators, Affiliations
Randomized Controlled Trial

Clinical and cost effectiveness of staff training in the delivery of Positive Behaviour Support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial

Andre Strydom et al. BMC Psychiatry. .

Abstract

Background: Although Positive Behaviour Support (PBS) is a widely used intervention for ameliorating challenging behaviour (CB), evidence for its use in adults with intellectual disability (ID) and comorbid autism (ASD) is lacking. We report a planned subsidiary analysis of adults with both ASD and ID who participated in a randomised trial of PBS delivered by health professionals.

Methods: The study was a multicentre, cluster randomised trial conducted in 23 community ID services in England, participants were randomly allocated to either the delivery of PBS (n = 11 clusters) or to treatment as usual (TAU; n = 12). One-hundred and thirteen participants (46% of all participants in the trial) had a diagnosis of ID, autism spectrum disorder and CB (ASD+); (47 allocated to the intervention arm, and 66 to the control). CB (primary outcome) was measured with the Aberrant Behaviour Checklist total score (ABC-CT). Secondary outcomes included mental health status, psychotropic medication use, health and social care costs and quality adjusted life years (QALYs) over 12 months.

Results: There were no statistically significant differences in ABC-CT between ASD+ groups randomised to the two arms over 12 months (adjusted mean difference = - 2.10, 95% CI: - 11.3 7.13, p = 0.655) or other measures. The mean incremental cost of the intervention per participant was £628 (95% CI -£1004 to £2013). There was a difference of 0.039 (95% CI - 0.028 to 0.103) for QALYs and a cost per QALY gained of £16,080.

Conclusions: Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions.

Trial registration: ClinicalTrials.gov: NCT01680276.

Keywords: Autism spectrum disorder; Challenging behaviour; Intellectual disability; Positive behaviour support.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of Mini PAS-ADD scores b
Fig. 2
Fig. 2
ABC-CT scores over 12 months for the ASD+ group
See this image and copyright information in PMC

References

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    1. Elsabbagh M, Divan G, Koh YJ, Kim YS, Kauchali S, Marcin C, et al. Global prevalence of autism and other pervasive developmental disorders. Autism Res. 2012;5:160–179. doi: 10.1002/aur.239. - DOI - PMC - PubMed
    1. Baxter AJ, Brugha TS, Erskine HE, Scheurer RW, Vos T, Scott JG. The epidemiology and global burden of autism spectrum disorders. Psychol Med. 2015;45:601–613. doi: 10.1017/S003329171400172X. - DOI - PubMed
    1. Autism and Developmental Disabilities Monitoring Network US, 2010 . Morbidity and mortality weekly report: prevalence and characteristics of autism spectrum disorder among children aged 8 years Centers for Disease Control and Prevention (CDC) 2014. - PubMed
    1. American Association on Intellectual Developmental Disabilities . Intellectual disability: definition, classification, and systems of supports. Washington, DC: AAIDD; 2010.

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