Variability in staff reports of the frequency of challenging behavior☆
Introduction
Natural variability in the occurrence of challenging behavior is more common than not. Such variability has been explained as a result of variations in the occurrence of setting events Carr et al 1996, Gardner et al 1986, antecedent events that evoke challenging behavior McGill 1999, Smith and Iwata 1997, the application of reinforcement contingencies (Iwata et al., 1994b), and biological factors (Carr, 1994). Such variability has, therefore, been of particular interest to those responsible for assessing challenging behavior, and this process of assessment can essentially be seen as one of hypothesizing the factors responsible for such variability either indirectly through questionnaires (e.g., Durand and Crimmins 1988, Matson et al 1999) or interviews (e.g., O’Neill, 1997), or more directly through observation (e.g., Emerson, Thompson, Reeves, Henderson, & Robertson, 1995). The most complex approaches to such assessment have relied not on naturally occurring variability but on the imposed variability (Sidman, 1960) that arises when an individual is exposed to specially designed settings intended as analogs to the natural environment (Iwata, Dorsey, Slifer, Bauman, & Richman, 1994a).
This pragmatic approach to variability may have diverted attention from the phenomenon itself. Thus, in general, we can conclude very little about the range of variability that is likely to be found in an individual’s behavior, about the extent to which variability can be uniformly expected across individuals, or about its relationship with the topography of challenging behavior. Such knowledge (which, in part, might be derived from a re-analysis of previously published studies containing single case data) is important for a number of reasons. First, an interest in variability naturally leads to an interest in why challenging behavior sometimes occurs at high rates/intensities and sometimes at low or zero rates/intensities, and to the investigation of factors correlated with this variation. Of course, a good functional assessment might be expected to provide this information in respect of an individual, but cannot provide this information across individuals. Knowledge about the variability of the challenging behavior of many individuals is required before we can identify correlated factors of potentially general relevance (cf., Iwata et al., 1994b). Second, information about variability may help to promote a parametric analysis of its correlated factors, drawing attention to those factors that should receive most effort both in intervening with individuals and larger-scale prevention. Third, information about variability may direct attention to the development of interventions that seek to increase the occurrence of the factors associated with low rates of challenging behavior. Such approaches have been described only rarely in the literature (e.g., Touchette, MacDonald, & Langer, 1985) but may avoid some of the implementation (Hastings & Remington, 1993), maintenance (Ager, 1991) and generalization (Stokes & Baer, 1977) difficulties frequently reported with more traditional behavioral interventions. Fourth, information about variability may promote a view of challenging behavior as partly under the control of the services provided to the person (Emerson, McGill, & Mansell, 1994). That is, the demonstration of variability may constitute a demonstration of both the service’s success (at times of low or zero occurrence) and the service’s failure (at times of high occurrence) that directs attention to the scope for, and the nature of, improvements in the service’s performance (cf., Gilbert, 1978).
One particular location of variability may be the people supporting or caring for the individual. Wing and Gould (1978) reported that parents described their children with developmental disabilities/autism as displaying more stereotyped and aggressive or difficult behavior than the children’s teachers or child care workers. They concluded that there were real differences in the children’s behavior in the presence of different informants. Holmes, Shah and Wing (1982), in a study of residents in a developmental disability hospital, found similar differences in the reports of nurses and day care workers and reached a similar conclusion, also noting that genuine differences in individual behavior could be found within the same setting. Differences within the same setting were, indeed, reported by the multiple raters used by Rojahn (1984) in his study of self-injurious behavior in an institution and by Touchette, MacDonald and Langer (1985), whose data included an individual recorded as displaying self-injury at high rates only when one member of staff was on duty. Touchette et al’s study included a reversal in which staff changed their shifts, with the rate of self-injury changing in parallel. None of these studies have set out to specifically investigate variability in challenging behavior so that the generality of conclusions drawn from them may be questioned. The phenomenon they have identified, however, is not specific to developmental disability (see, for example, Graham & Rutter, 1970) and is consistent with the established notion of situation specificity. This literature provides grounds, therefore, for supposing that challenging behavior may commonly vary across the presence of different staff or caregivers.
In the study described here, variability in the reported occurrence and frequency of challenging behavior in the presence of different staff was investigated directly, with a view to estimating the extent of variability, the extent to which variability can be uniformly expected across individuals, and its relationship with the topography of challenging behavior. Additionally, relationships with the status, role and gender of reporters were investigated.
Section snippets
Settings
Data were gathered in 18 residential service settings, 13 provided by private agencies, 3 by voluntary organizations, 1 by the NHS and 1 by a Local Education Authority (a residential school). Settings varied widely in size having on average 10 clients (range: 2–27) and 14 staff (range: 5–26). Some settings were parts of larger units (e.g., a bungalow in a village community) while some were completely independent of other services.
Participants
Data were gathered on 22 people with developmental
Results
On the 88 completed BPIs respondents reported an average of 10.3 (range: 1–22) problem behavior topographies including 4.0 self-injurious behaviors (range: 0–12), 4.4 aggressive/destructive behaviors (range: 0–9) and 1.8 stereotyped behaviors (range: 0–5). Frequency ratings were converted to numerical scores for each item (from 0 = “never” to 6 = “more than hourly”). The average total frequency score was 31.8 (range: 4–89), 11.6 for self-injury (range: 0–42), 12.6 for aggressive/destructive
Discussion
Conventionally, differences between staff in their reports of challenging behavior have been treated as a matter of reliability. The central proposition of this paper has been that such differences may reflect valid (rather than unreliable) differences in staff experience. The main findings of the study can be summarized as follows. Staff reports of the occurrence and frequency of challenging behaviors displayed by people with developmental disabilities were highly correlated but widely
References (34)
- et al.
Descriptive analysis of multiple response topographies of challenging behavior across two settings
Research in Developmental Disabilities
(1995) - et al.
A validity study on the Questions About Behavioral Function (QABF) scalePredicting treatment success for self-injury, aggression, and stereotypies
Research in Developmental Disabilities
(1999) Effecting sustainable change in client behaviourThe role of the behavioural analysis of service environments
- et al.
A descriptive analysis of nursing staff behaviors in a teaching nursing homeDifferences among NAs, LPNs, and RNs
The Gerontologist
(1990) Emerging themes in the functional analysis of problem behavior
Journal of Applied Behavior Analysis
(1994)- Carr, E. G., Reeve, C. E., & Magito-McLaughlin, D. (1996). Contextual influences on problem behavior in people with...
A coefficient of agreement for nominal scales
Educational and Psychological Measurement
(1960)Weighted kappaNominal scale agreement with provision for scaled disagreement or partial credit
Psychological Bulletin
(1968)- et al.
Prevalence of stereotypy among institutionalized nonambulatory profoundly mentally retarded people
American Journal of Mental Deficiency
(1987) - et al.
Identifying the variables maintaining self-injurious behavior
Journal of Autism and Developmental Disorders
(1988)
Reducing aggression in individuals with developmental disabilitiesAn expanded stimulus control, assessment, and intervention model
Education and Training in Mental Retardation
Human competenceEngineering worthy performance
The selection of children with psychiatric disorder
“Is there anything on…why ‘good’ behavioural programmes fail?” A brief review
Clinical Psychology Forum
A renaissance in residential behavior analysis? A historical perspective and a better way to help people with challenging behavior
The Behavior Analyst
The Disability Assessment ScheduleA brief screening device for use with the mentally retarded
Psychological Medicine
Cited by (13)
Analysis of staff reports on the frequency of challenging behaviour in people with severe or profound intellectual disabilities
2009, Research in Developmental DisabilitiesAutism spectrum disorders in adults with intellectual disability and comorbid psychopathology: Scale development and reliability of the ASD-CA
2008, Research in Autism Spectrum DisordersAssessing challenging behaviors in children with autism spectrum disorders: A review
2007, Research in Developmental DisabilitiesFunctional grouping in residential homes for people with intellectual disabilities
2003, Research in Developmental DisabilitiesSleep–behaviour relationship in children with autism spectrum disorder: methodological pitfalls and insights from cognition and sensory processing
2019, Developmental Medicine and Child NeurologyDistress and Psychological Growth in Parenting an Adult Child with Autism Spectrum Disorder and Aggression
2017, Advances in Neurodevelopmental Disorders
- ☆
This research was funded by a grant from the NHS National Research and Development Programme for People with Physical and Complex Disabilities. We are very grateful to the people with developmental disabilities, staff members and services that gave their consent and cooperation for the conducting of this study. David Hughes is now at Cumbria Care Services. Kerry Teer is now at Department of Psychological Medicine, University of Glasgow. Lynne Rye is now at East Kent Community NHS Trust and the Tizard Centre.