BACKGROUND:Children with intellectual disabilities can display behaviours that challenge, often associated with poor outcomes. Despite national policy commitment to co-production, little evidence is available on how such services deliver co-produced activity. METHODS:Qualitative data were collected from three services that reported co-producing Positive Behaviour Support introductory workshops. Participants' experiences and perceptions of these workshops were described through individual semi-structured interviews conducted with staff and family carers (n = 24) and analysed using a Framework approach. RESULTS:Two main themes were represented in the initial framework. Positives of Co-production included the advantages of obtaining and combining theoretical and practical knowledge, including personal and professional development for those delivering the intervention. Challenges to Implementation included the time and effort required to build a collaborative way of working, barriers to organisational support and family carers' history with services. CONCLUSIONS:Support, funding and resources need to be made available and protected to make co-production activities meaningful.
BACKGROUND:Children with developmental disabilities show a high prevalence of behaviours that challenge (BtC). Thus, harnessing known risk markers to target early intervention to children at the greatest risk of BtC is essential. In this study, machine learning techniques were used to develop prediction models of risk (no, low and high severity behaviour) for different BtC (self-injurious behaviour, aggression, property destruction, 'any BtC'). A secondary aim was to assess the external validation of these models to predict future behaviour. METHOD:Caregivers of individuals with developmental disabilities completed the Self-injury, Aggression and Destruction Screening Questionnaire. One dataset (n = 778) was used to train and test models to establish internal validation. Algorithms were created using random forest classifiers, K-nearest neighbours, multiple logistic regressions and Gaussian mixture models (GMM) for each type of behaviour. External validation utilising a second dataset of caregivers (n = 121) completing the SAD-SQ at baseline and 12 months later was then conducted. OUTCOMES:Across internal and external validation, the random forest classifiers and GMM algorithms for any BtC showed the highest number of correct classifications with fair to good recall and precision, with 83.5% of people at risk of BtC correctly predicted. Predictions of persistence and incidence of behaviour over 12 months was also good (83.5% and 83.3%, respectively). INTERPRETATION:The novel prediction models showed the ability to predict BtC for children with developmental disabilities. Such models have applicability to clinical practice to inform provision of early preventative interventions for BtC.
Due to the high burden of cardiovascular diseases in obesity, there is a growing need for structured, risk-adapted treatment strategies. Obesity amplifies classical cardiovascular risk factors, such as arterial hypertension, type 2 diabetes and dyslipidemia and additionally exerts effects on the cardiovascular system independent of the body mass index (BMI) through inflammatory and metabolic mechanisms. Visceral obesity in particular is closely linked to the development and progression of cardiovascular diseases, including coronary artery disease, heart failure (especially heart failure with preserved ejection fraction, HFpEF), cardiac arrhythmias, valvular heart disease, pulmonary hypertension and sleep-related breathing disorders. This consensus paper of the German Cardiac Society (DGK) provides a structured overview of pathophysiological principles, diagnostic characteristics and therapeutic options in the management of cardiovascular disease in obesity. The aim is to provide evidence-based, consensus-supported and practice-oriented recommendations for risk-adapted and multimodal care. The paper outlines an integrated treatment concept combining lifestyle interventions, modern pharmacotherapy, particularly incretin-based substances and bariatric procedures. It also addresses sex-specific aspects, peri-interventional challenges and the importance of structured rehabilitation and cross-sectoral care. The document is intended as a consensus-based clinical guide and does not replace formal evidence-based guidelines.
Abstract Background Children with intellectual disability are at a higher risk of presenting with behaviours that challenge. Video Interaction Guidance (VIG) is a brief, personalised, strengths-based therapy that focuses on improving the parent–child relationship and interactions. A strong parent–child relationship may reduce the risk of behaviours that challenge. Access to support is difficult for families of children with intellectual disability. Remotely delivered support may enhance access to therapy for those who might otherwise struggle to access support. To date, no definitive effectiveness trial of VIG, or remotely delivered VIG, has been conducted, including in intellectual disability. Methods A feasibility randomised controlled trial (RCT) aimed to recruit 50 parents of a child with intellectual disability (aged 6–12) referred to specialist mental health services. Participants were randomised on a 1:1 basis to VIG plus treatment as usual (TAU) or just TAU. Measures were collected remotely at baseline, 3-month, and 6-month follow-up. A parallel economic study explored the feasibility of a future economic evaluation, while an embedded process evaluation explored feasibility and acceptability through qualitative interviews. A survey investigated TAU in specialist mental health services. A Parent Carer Advisory Group of 10 parents of children with intellectual disability worked with the research team on design, recruitment, data analysis and interpretation. Results Forty-four parents consented to participate in the study and 40 were randomised to the RCT. Of those, 75% remained in the study at 6-month follow-up, and 70% of the VIG-arm participants completed at least 3 cycles of VIG. At 6-month follow-up, between 83.3% and 100% of parent-completed questionnaires were completed, including the Developmental Behaviour Checklist (DBC2 at 86.7% completion rate). The acceptability of VIG was high among parents and practitioners. Parents identified few barriers to participation when VIG was delivered remotely. The cost of VIG was calculated at £153.35 per session and £306.70 per cycle. Video-feedback interventions are not typically part of TAU: just 15% of 66 specialist mental health services reported offering any video-feedback intervention to parents of children with intellectual disability. Conclusions Findings supported the feasibility and acceptability of a definitive trial of remotely delivered VIG to parents of children with intellectual disability referred for support to specialist mental health services. Adaptations will be needed to enhance recruitment and align some of the study outcomes and processes more closely to parent preferences. Trials registration ISCTRN 13171328, Registration date 28 December 2022.
Purpose This study aims to remind readers of the intended meaning behind the term “challenging behaviour”, consider criticisms of its use and to restate its continued utility. Design/methodology/approach This review paper adopts a historical perspective to explore the usage of a widely used term in the field of intellectual disabilities and to identify how it has become corrupted and extended beyond original intentions. It then seeks to revisit its intended meaning and to clarify how it remains important in current times. Findings While any favoured term is likely to become subject to criticism over time, current disapproval of “challenging behaviour” is based on highly inaccurate interpretations of its intended meaning. Currently suggested alternatives lack any clear definition and risk working against the needs of those the authors support. While the wish to develop better terminology is an entirely appropriate objective and continuing endeavour, the authors have not as yet discovered a better alternative. Practical implications Being able to accurately describe the challenging behaviours evidenced by a minority of people with intellectual disability both aids understanding and underpins the case for sophisticated intervention and support. Originality/value The authors contend that this an original and important contribution to the importance of language and terminology in the field.
