The present thesis focuses on challenging behaviours exhibited by people with an intellectual disability and the effects of Active Support, a potential environmental intervention, on the challenging behaviour and quality of life for people with an
intellectual disability (ID). Challenging behaviours are frequent among people with ID and, in the absence of effective intervention, highly persistent. Findings from an 11-year longitudinal investigation of challenging behaviours in 58 adults with ID highlighted the chronicity of serious challenging behaviours (Chapter 2). Participants who exhibited severe physical attacks, self-injurious or stereotyped behaviours were more likely (by about 200%) to still exhibit these behaviours at severe levels 11 years later. An environmental broad antecedent intervention (Active Support) is proposed as one alternative approach to individualised behavioural interventions, which are rarely available in services for people with ID and challenging behaviours. Active Support is a multi-component person-focused model which aims to improve the quality of life of people with ID living in residential settings, by putting in place a system that ensures opportunities for daily participation in meaningful activities and receipt of staff support. The evidence pertaining to the effectiveness of the model in improving the quality of life for people with ID was reviewed and a theoretical description of the model's potential to act as a proactive intervention for challenging behaviours was put forward (Chapter 3).
Evaluation of Interactive Training for Active Support, the training component hypothesised to produce more immediate effects on residents' challenging behaviours, showed no overall group-level increase in activity participation or any decrease in challenging behaviours for 21 adults with ID, while observational evidence suggested that quality of staff support improved immediately after Interactive Training (Chapter 4). Despite the absence of a group-level change in resident behaviours, there was some evidence that Interactive Training had an immediate effect on the engagement levels of individuals with more frequent aggressive and destructive behaviours. In the final study reported in this thesis (Chapter 5), 37 staff in ID services who had received Interactive Training were interviewed about their training experience, and, also, their views on the Active Support model which they had been using for a period of about two years. While the majority of staff viewed Interactive Training as a positive experience which had an impact on the way they worked, they suggested that successful implementation of the whole Active Support model is complicated by residents' challenging behaviours and lack of managerial support. The Active Support model may be most effective when both training components- workshops and Interactive Training- are offered to staff in community services. Our understanding of the effects of Active Support on challenging behaviour would benefit from further research which focuses more specifically on people with ID and challenging behaviours.