Treatment methods for destructive and aggressive behaviour in people with severe developmental and intellectual disabilities

Introduction People with severe developmental intellectual disabilities (ID) are increasingly being supported in community living programmes. Adequate community support involves effectively treating such behavioural difficulties as property destruction, aggression and self-injurious behaviour. The treatment of aggressive and destructive behaviour in these people has resulted in greater emphasis being placed on understanding the causes of such behaviours in any particular individual. Behavioural, medical and neuropsychiatric knowledge has developed rapidly, as have psychopharmacologic treatments. Progress is being made on integrating information from diverse fields such as genetics, neurology, medicine, and behavioural psychology (Schroeder et al ., 2002). Effective team models are being developed to promote collaboration from medical and behavioural professions (Freeman et al ., 2005; Koegel et al ., 1996; Singh et al ., 2002). In this chapter we propose an integrated team approach for assessment and treatment of destructive and aggressive behaviour in people with severe ID. We will begin the chapter by first identifying some of the often-missed physical illnesses and neuropsychiatric conditions that can precipitate or worsen destructive and aggressive behaviour. The treating clinician is dependent on observations made in this regard by care givers of the person. Clinicians need to take a thorough medical, medication and neuropsychiatric history. Second, behavioural assessment and treatment for destructive and aggressive behaviour are reviewed. We emphasize that researchers and clinicians using the behavioural approach are joining forces with medical and neuropsychiatric professionals in this field.