Behavioural, psychiatric and psychosocial factors associated with aggressive behaviour in adults with intellectual disabilities: A systematic review and narrative analysis.
Natalie van den Akker, Marieke Kroezen, Jannelien Wieland and 2 others
PMID 33073443WHAT IT FOUND
No behavioural, psychiatric or psychosocial factor was consistently associated with aggression across 38 studies of adults with intellectual disabilities.
Aggression types often co-occurred. Use individual functional assessment rather than assuming a diagnosis or skill deficit causes aggression.
Key findings
01Psychiatric factors showed inconsistent associations with aggression; some studies reported an association and others reported no association for the same disorder or symptom.
02Different topographies of aggressive behaviour often co-occurred.
03The only consistently positive association found was between self-injurious behaviour and aggression in general.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
The 38 studies used many different definitions and instruments; 27 different tools were used to assess aggressive behaviour. Study populations and settings varied widely, from mild to profound intellectual disability and from residential, forensic, community and mixed settings. Only 16 of the 38 studies were rated high quality; 22 were rated low quality. Sample sizes ranged from n = 24 to n = 4,069 adults, so small studies could overestimate or underestimate associations. Most studies used cross-sectional or retrospective designs, so they cannot show what causes aggression. Verbal and sexual aggression were studied less often than self-injurious behaviour.
Declared interests
The authors declared no potential conflict of interest. The review was funded by the Dutch Ministry of Health, Welfare and Sport and was part of developing Dutch multidisciplinary guidelines for challenging behaviour.
The easy way to misread this
Do not conclude that a psychiatric diagnosis, communication deficit or living situation causes aggression. The review found inconsistent associations and no factor all studies agreed on, so these are possible contributors to assess individually, not proven causes.