Behavioural Supports For Parents of Children With An Intellectual Disability and Problem Behaviours 2002

Journal of Intellectual & Developmental Disability,
Vol. 27, No. 1, pp. 31–55, 2002
Behavioural supports for parents of children

with an intellectual disability and problem
behaviours: an overview of the literature
SUSANA GAVIDIA-PAYNE1
J Intellect Dev Dis Downloaded from informahealthcare.com by Stanford University on 11/18/14
Victorian Parenting Centre
ALAN HUDSON
RMIT University
For personal use only.
A considerable body of knowledge that allows for the design of effective

interventions with problem behaviour in children with an intellectual disability
is now in existence. The development of behavioural supports for parents, in
particular, has taken momentum in the last few years. The purpose of this paper
is to provide an overview of research on the supports provided to parents in the
assessment of and intervention with the problem behaviour of their children
with an intellectual disability. It is concluded that while research in the area
has made considerable advances, gaps in research on the development of
practical applications of “parent friendly” programmes are still evident.
Problem behaviour is one of the most enduring and pervasive challenges experi-
enced by children with an intellectual disability , families, professionals , and the
community at large. Fortunately, our current state of knowledge is such that we are
able to design effective supports, in particular for parents, as they are the children ’s
most immediate and influential environment. While many would argue that
literature on the topic is abundant, it is spread throughout a number of fields of
knowledge and research, including parenting, disability, and assessment and inter-
ventions with challenging behaviour. Thus, it is the purpose of the present paper to
integrate information and research findings underlying the development of be-
havioural supports for parents of children with an intellectual disability and
problem behaviour, as depicted in the various knowledge areas.
1
Address for correspondence : Susana Gavidia-Payne, Victorian Parenting Centre, 24 Drummond Street, Carlton, VIC
3053, Australia. E-mail: vpc@vicparenting.com.a u
ISSN 1366-8250 print/ISSN 1469-953 2 online/02/010031-25

Ó 2002 Australian Society for the Study of Intellectual Disability Inc.
DOI: 10.1080/1366825012010919 6
32 Gavidia-Payne & Hudson
Specifically, we address our current understandings of the most commonly

known dimensions of challenging behaviour that are at the crux of its various
definitions among children with an intellectua l disability . Also discussed are the
significant changes and refinements in our knowledge base regarding the assess-
ment of, and intervention s for, challenging behaviours in children with develop-
mental disability . A review of the more technical aspects of effective behavioural
supports, and recent research that attests to the importance of the inclusion of
family variables from the outset when developing supports for dealing with
children ’s difficult behaviour, are also included.
Current research findings emphasise interventions that are proactive, positive ,
and strengthenin g of parents’ and children’s skills in natural settings. In this way,
the present paper focuses on the various family characteristics that enhance
effective intervention , and the adjunctive strategies that may in turn be required.
Specific behavioural strategies are referred to in the context of parent training
models, which have generally provided the most consistent body of knowledge.
Also included in this section is a discussion of professional and systemic factors
that may have an impact on the success of behavioural parenting interventions. The
final segment provides a review of existing resources and materials that address the
management of challenging behaviours in children with an intellectua l disability .
Studies that examine the comparative effectiveness of different parent training
formats are also reviewed and evaluated.
Challenging behaviours in people with an intellectual disability

Definition
Challenging behaviours is a term that has been in existence for approximately 10
years in the intellectua l disability field. Previously, terms such as “aberrant
behaviour” (Forehand & Baumeister, 1976), “excess behaviour” (Meyer & Evans,
1989) and others have often been used to describe problematic behaviour. The
change in focus from “problem behaviour” to “challenging behaviour” was made
to emphasise a shift away from seeing problems as inherent qualities in people with
an intellectua l disability (Qureshi, 1994). One of the most commonly known
definitions is provided by Emmerson, Cummings, Barrett, Hughes, McCool and
Toogood (1988), who defined challenging behaviours as:
… behaviours of such intensity, frequency or duration that the physical safety
of the person or others is placed in serious jeopardy, or behaviour which
seriously limits the person’s access to ordinary settings, activities, services, and
experiences.
More recently, in describing the conceptualisatio n of treatment of challenging

behaviours, Risley (1996) asserted that:
… a behaviour is called challenging because it is seen as dangerous, or
disruptive by those who live and work with the consumer.
Regardless of the definition used, it is evident that challenging behaviours are

Behavioural supports for parents 33
characterised by particular features in their occurrence, such as frequency, duration

or intensity. In addition, these behaviours place the individual and others at risk of
serious harm to their physical and psychologica l well-being. Finally, the occurrence
of challenging behaviour prevents the person and his caregivers from having
ordinary experiences like the rest of individual s in the community.
Prevalence and aetiology of challenging behaviour

Despite the recognised impact of problem behaviours as sources of further
handicap, not much information regarding the prevalence of challenging behaviour
among children with an intellectua l disability is available (Einfeld & Tonge, 1996).
It is evident, however, that problem behaviours are more prevalent in children and
adolescents with an intellectua l disability than their counterparts without a disabil-
ity. This was demonstrated in a study by Floyd and Phillippe (1993) who found that
children with an intellectual disability displayed higher base rates of non-compliant
behaviours than a comparison group of children without an intellectual disability .
Quine (1986), who studied behaviour problems in 200 children with a recognised
intellectual disability, found that the prevalence of mild and severe behaviour
problems was 45%.
A more recent Australian study by Einfeld and Tonge (1996) of an epidemiolog-

ically derived population in a multi-centre study in New South Wales, suggests that
40.7% of those with an intellectua l disability and aged between 4 and 18 years
could be classified as having severe emotional and behaviour disorders. The study
also generated information regarding the relationship between the level of intellec-
tual disability and the presence of problems in a number of behavioural dimensions.
More specifically, it was found that disruptive and antisocial behaviours, as
measured by the Developmental Behaviour Checklist (Einfeld & Tonge, 1992),
were more prominent in the group with mild intellectua l disability ; whereas,
self-absorbed and autistic behaviours were more frequently found in those children
with a severe level of intellectual disability . These latter findings coincide with
those of Emerson and Bromley (1995) who also suggested that severe challenging
behaviours were shown by people with more severe disability , with a significant
number (44%) of people showing more than one form of challenging behaviour.
It appears that certain topographies of behaviour are more frequent than others
among children with an intellectual disability. In a study conducted by Dunlap,
Robbins and Darrow (1994), parents reported a high frequency of challenging
behaviour, including self-stimulation , destructive behaviours (i.e., self-injury, ag-
gression, destruction of property, and pica), withdrawing, and tantrums. These
behaviours occurred more frequently than once per day. When considering the
various age groups, interesting patterns were found in the frequency of these
behaviours. It was observed that destructive behaviours were reported more
frequently in the 12–17 years age group and least frequently in the 5–11 years age
group. On the other hand, self-stimulation was reported to occur most frequently in
the pre-school (birth to 4 years) age group. Withdrawing was the most frequently
reported behaviour problem in the adolescent group, and tantrums in the pre-school
group. Other studies have also found clusters of behaviours such as self-injurious
and aggressive behaviours (Emerson & Bromley, 1995) and hyperactivity and
irritability (Chung, Bickerton, Cumella & Winchester, 1996).
The prevalence of challenging behaviour in children with specific disability types
has also been examined. Several categories of problem behaviour have been
defined according to the causes or aetiology of particular disability types (Meyer
& Evans, 1989). In a study of 43 children with Prader–Willi syndrome compared
with matched children with Down syndrome and with non-specific intellectual
disability , Dykens and Kasari (1997) found that the Prader–Willi group showed
more frequent and severe internalisin g and externalising , and total behaviour
problems on the Child Behaviour Checklist (Achenbach & Edelbrock, 1983). Some
problem behaviours were elevated in all groups, and several behaviours (e.g., skin
picking, obsessions , compulsions , talking too much, etc.) were significantl y elev-
ated in the Prader–Willi syndrome group relative to the comparison groups. Dykens
and Kasari concluded that there is a unique Prader–Willi behavioural phenotype. In
a study of parent behaviours and child compliance, Lemanek, Stone and Fishel
(1993) found that a group of autistic children presented the highest frequency of
non-compliance compared with the behaviour of children without an intellectual
disability , children with an intellectual disability, or language impairment.
Evidence suggesting that specific disability groups have unique behavioural

phenotypes is, however, inconclusive . Clarke and Boer (1998) demonstrated, in
their assessment of behaviours in samples of people with chromosome deletion
disorders (i.e., Prader–Willi, Cri du Chat, and Smith Magenis), that each deletion
disorder is associated with a relatively characteristic constellatio n of problem
behaviours, but with some of the behaviours occurring in association with more
than one disorder. For example, oppositiona l behaviour was exhibited by all
groups, whereas inactivity was particularly related to Prader–Willi, odd bizarre
behaviour to the Smith Magenis, and overactivity to the Cri du Chat syndrome
group.
Brief historical overview of intervention s with challenging behaviour

Intervention approaches with children with an intellectual disability and challeng-
ing behaviour have evolved significantly, keeping in line with significant changes
that have occurred in psychology and related fields (Lutzker & Campbell, 1994;
Morris & Midgley, 1990). Concerted and continuing efforts have been made to
develop, refine, and extend methods of treating behaviour problems among people
with disability (Favell & Reid, 1988).
During the 1960s and early 1970s, the use of behavioural techniques proved
fruitful in the treatment of children with severe challenging behaviours such as
phobias (Greer, Rainey & Anderson, 1976), stereotypie s (Favell, 1976) and other
behaviours. Interestingly , however, it was argued at the time that applied behaviour
analysts were analysing too narrow a range of responses and stimuli [Edwin
Willems (1974) cited by Morris and Midgley (1990)]. It was observed that the
person’s concurrent and sequential response–response covariations were being

overlooked, along with the broader physical and social systems in which those
covariations were embedded. In addition, as Lutzker and colleagues (Lutzker, 1992;
Lutzker & Campbell, 1994) have suggested, behaviour therapy techniques were
also criticised for their rather mechanical and artificial use of procedures and
outcomes generated. It was not until the late 1970s that those issues were
acknowledged to include the examination of as many variables (i.e., settings,
parents, teachers, and peers) as practical when observing and treating the challeng-
ing behaviour of children with an intellectual disability (Lutzker & Campbell,
1994). The idea was to use natural reinforcers and natural teaching strategies in the
contexts where the behaviour occurred. This represented a clear deviation from the
more clinical model that had been prevalent at the time, and which eventually led
to the birth of a more encompassing approach that carried through the 1980s and
1990s. During these years, the need to acknowledge the wider family system in the
treatment of children ’s challenging behaviour was demonstrated in various research
studies [see Singer and Irvin (1989)]. Inevitably, this meant that methods used for
gathering information about the behaviour and its context required expansion to
include direct (i.e., direct observation) as well as indirect (i.e., caregiver self-report)
methods. Assessments of the acceptability of behavioural intervention s by people
with an intellectua l disability, and general consumer satisfaction (Miltenberg, Suda,
Lennox & Lindeman, 1991) began to be part of this trend.

Despite the considerable changes and progress made, several methodologica l and
conceptual challenges in the effective implementation of intervention s with chil-
dren with developmental disability and challenging behaviours still exist (Vyse &
Mulick, 1990). Perhaps one of the most discussed limitations relates to practi-
tioners’ ability to effect pervasive, durable improvement in problem behaviour
(Carr et al., 1999; Favell & Reid, 1988). Current approaches to intervention appear
to be addressing these concerns as noted in our following discussion .
The eco-behavioural approach to intervention : emphasis on prevention

The consideration of increasingly diverse variables in the development of interven-
tions for people with challenging behaviours has given rise to an approach that is
commonly known as the eco-behavioural model (Lutzker, 1992). Recent studies
suggest that the adoption of an eco-behavioural approach, which acknowledges the
role of social–ecological factors in the development and maintenance of challeng-
ing behaviours, is critical in the prevention of challenging behaviours (Albin,
Lucyshyn, Horner & Flannery, 1996; Lutzker, 1992). The “eco” in eco-behavioural
refers to the consideration of the natural family social ecology in the examination
of parent–child relationships , and in the development of effective intervention s
(Lucyshyn, Albin & Nixon, 1997). The “behavioural” part implies the use of an
applied behaviour analysis methodology such as the operationalisatio n of behaviour
and the use of direct observations of behaviour in situ. This means observing and
treating the behaviour in the settings where the challenging behaviours occur
(Lutzker & Campbell, 1994; Lutzker, Huynen & Bigelow, 1998).
In addition to the consideration of the family ecology and behavioural methodol-

ogy, Lutzker and Campbell (1994) state that developmental variables also consti-
tute vital elements of the eco-behavioural approach. That is, intervention strategies
must both match the developmental skill level of the individual and be functional
in terms of the skills being taught (i.e., skills will be useful to the child in managing
and controlling the environment). Finally, the eco-behavioural model emphasises
active programming for generalisation across time, behaviours, and settings.
Thus, incidental teaching, family planned activities, and identificatio n of skills
are essential ingredients in the development of, and planning for, parent training
initiative s and their generalisation effects. Recent studies have in fact provided
evidence for the inclusion of these elements in behaviour intervention support
efforts for parents. Fox, Benito and Dunlap (in press) reported a decreased level of
tantrums in a young child with autism following an intervention that focused both
on the embedding of behavioural strategies in family routines and on support
provided to families to go through this process successfully. The intervention also
included the teaching of replacement skills that served as a functional equivalent to
the problem behaviour. Similarly, Moes and Frea (2000) demonstrated reductions
in challenging behaviours and increased on-task behaviour within a contextualise d
treatment phase that included an assessment of family context and teaching
methods that fitted with the family’s ongoing routine and interaction goals.
Assessment of challenging behaviour

The assessment of challenging behaviour(s) is a key task to accomplish in the
provision of behavioural support to families. A comprehensive functional assess-
ment of child problem behaviour and his environment is an integral and logical step
before intervention s take place. Complementary to functional assessment is an
evaluation of the family contexts where intervention s will be embedded. Both of
these elements, functional assessment and assessment of family contexts, are
described below in detail.
Assessment of behaviour and environmental events: functional assessment

It is now widely acknowledged that problem behaviour is typically purposeful. The
procedure used to ascertain the purpose/function of the behaviour is known as
functional assessment in the scientific literature (Carr, Levin, McConnachie,
Carlson, Kemp & Smith, 1994). The importance of this process in the development
of effective behavioural support is reflected in the adoption of American laws and
regulations stipulatin g the need for functional assessment (O’Neill, Horner, Albin,
Sprague, Storey & Newton, 1997). Furthermore, functional assessment has become
a professiona l standard for numerous practitioners involved in the delivery of
support to people with challenging behaviour. Empirical evidence linking func-
tional assessments to effective intervention s is abundant [see Repp and Horner
(1999) for a review].
Functional assessments allow practitioners to hypothesis e about the meaning of
problem behaviours in terms of their communicative function (Lucyshyn et al.,

1997), which, in turn, meets a specific need for the child (Frea & Hepburn, 1999).
What are the essential components of a thorough functional assessment? According
to O’Neill et al. (1997), the five primary outcomes of a functional assessment
process are as follows: (a) a clear description of the problem behaviours, including
classes or sequences of behaviour that frequently occur together; (b) identificatio n
of the events, times, and situations that predict when the problem behaviours will
and will not occur across the full range of typical daily routines; (c) identificatio n
of the consequences that maintain the problem behaviours, that is, what functions
the behaviours appear to serve for the person; (d) development of one or more
summary statement or hypothesis that describes specific behaviours, a specific type
of situation in which they occur, and the outcomes or reinforcers maintaining them
in that situation; (e) collection of direct observation data that support the summary
statements that have been developed.
O’Neill and his colleagues further suggest that the processes used in conducting
a functional assessment can take many forms and have many levels of precision,
often depending on the complexity of the problem behaviour. It follows, then, that
the methods of gathering information will vary accordingly, from interviews with
the individual and significant others, to more systematic observations of behaviour
in typical daily routines. Questionnaires such as the Motivation Assessment Scale
(Durand & Crimmins, 1988) and the Aberrant Behaviour Checklist (Sigafoos,
Pittendreigh & Pennell, 1997) have been used in Australia with good results with
parents. Some other authors (e.g., Sigafoos, Kerr, Roberts & Couzens, 1993)
suggest that it may also be necessary to use direct observation to verify findings
generated by questionnaire s and interviews. Overall, recent research (Moes & Frea,
2000) demonstrates that family involvement in the implementation of functional
assessments can be successful in generating and testing hypotheses about the
function of the problem behaviour of their children.
Another much more precise and rigorous strategy to gather functional assessment
information has been termed functional analysis (O’Neill et al., 1997). This
procedure involves the experimental manipulation of specific variables that are or
are not associated with the problem behaviour, and allows for the testing of
hypotheses regarding events maintaining a particular behaviour. In this way, brief
analogue conditions are set up in which a child is provided with reinforcers
contingent on the occurrence of problematic behaviour. The utility of functional
analyses has been amply demonstrated and recommended in parent-implemented
intervention s (Derby et al., 1997; Wacker, Peck, Derby, Berg & Harding, 1996).
Regardless of the chosen method for gathering information, the most important
concept to understand is that problem behaviours occur for a reason; that is, why
do problem behaviours occur? O’Neill et al. (1997) suggest that there are several
distinctiv e reasons why children and adults with disability engage in problem
behaviours, namely: (a) to obtain internal stimulation ; (b) to obtain attention; (c) to
obtain activities or objects; (d) to escape/avoid internal stimulation ; (e) to escape/
avoid attention; and (f) to escape/avoid task activities.
In discussing the various purposes which challenging behaviour serve, it has also
been demonstrated that in real-life situations, children may use the same problem
behaviour to achieve many different functions. This is clearly illustrated in a study
cited by Carr et al. (1994), of a 5-year-old girl with brain damage. She engaged in
self-biting, hitting others, and screaming in order to escape a vocabulary develop-
ment task. She used the same problem behaviours to gain her teacher’s attention
whenever the teacher failed to pay sufficient attention to her. The importance of
these dynamics cannot be emphasised enough in terms of their implications for
intervention . Given that problem behaviour can serve many different purposes,
intervention s may also have to include a number of different components to address
the various purposes of the behaviour.
While the notion of functional assessment has been researched and practised for
a number of years (Carr, 1977), its relevance in family environments has only been
recently acknowledged. Furthermore, numerous researchers consider functional
assessments in the family context to be essential in the systematic prevention and
management of challenging behaviour (Koegel, Koegel, Kellegrew & Mullen,
1996; Wacker et al., 1996). It has been argued that functional assessment plays a
critical role in the design of individualised , multi-component, intervention s that are
integrated within family contexts. Lucyshyn and his colleagues (1997) demon-
strated the usefulness of functional assessment with the family of a 14-year-old girl
with severe disability and severe problem behaviours. A multiple-baseline design
across family routines assessed the functional relationship between parent im-
plementation of a component intervention, improvement in child behaviour, and
successful completion of routines. The results indicated durable improvements in
child behaviour and routine completion, generalised improvements in child behav-
iour, and enhanced activity patterns. These findings corroborate other research
findings reported in the literature about the importance of the links between
functional assessments and family ecology variables (Lutzker & Campbell, 1994;
Sanders & Dadds, 1982; Singer, Irvine & Irvin, 1989). The need to conduct
functional assessments in conjunction with evaluations of the family environment
is thus evident for the purpose of developing successful interventions .
Family assessment
As suggested earlier, family assessment is another critical element in the develop-
ment of sound behavioural family interventions, where one of the major goals is to
ensure goodness of contextual fit (Albin et al., 1996; Egel & Powers, 1989). Albin
and his colleagues define contextual fit as “… the congruence or compatibilit y that
exists between specific features and components of a behavioural support plan and
a variety of relevant family variables” (p. 82). In order to obtain “good” contextual
fit, family-focused assessment activities are conducted with the aim of identifying
and understandin g family characteristics and family values and goals, around which
families have constructed their routines. More specifically, the authors emphasise
the need to gain the following information: (a) family members’ ideas and reactions
regarding hypothese s as to the function(s) of problem behaviours; (b) current ways
in which the family has structured its daily living patterns and routines; (c) the
family’s use of successful strategies and accommodations to address problem

behaviours; (d) the family’s future goals; (c) potential support strategies; (d) issues
for programme implementation and contextual fit.
Family interviews and discussion s are important parts of the information gather-
ing process. Albin et al. (1996), for example, have used an interview protocol that
specifically includes items related to three areas: (a) family characteristics (i.e.,
sources of stress, informal and formal resources, goals for child and family); (b)
family social construction of child activity settings (i.e., home routines and
community activities) ; and (c) family vision of successful activity settings. Overall,
this information then becomes the basis on which the intervention plan is imple-
mented, and within which family members are coached and supported as required.
Albin et al. (1996) indicate that while the family interview is a useful clinical tool,
further research is needed to provide evidence of its use in relation to the
“contextual fit” notion.
Intervention strategies for challenging behaviour

The application of specific behaviour change strategies constitutes another key
element in the development of behavioural supports. As discussed earlier, our
current understanding of this task suggests that we give consideration to interven-
tions that are both child and family centred, and which are concerned not only with
problem behaviours, but also with the strengths and lifestyle of the child and
family. The following sections address various levels of intervention as reported in
the behavioural intervention literature. For the purpose of this paper, an explicit
distinctio n has been made between interventions that are seen as preventative
compared with those that require an increasingly complex use of behavioural
procedures.
Incidental teaching and positive programming

The role of parents in the prevention of problem behaviour has long been
acknowledged (Altman & Mira, 1983), given their enormous influence in shaping
and maintaining particular interactions with their children. Moreover, it has been
consistently demonstrated that parents are instrumental in maximising learning and
minimising delay through the application of behavioural procedures in a variety of
settings (Egel & Powers, 1989). The teaching of skills is central to preventative
efforts by strengthenin g the child’s repertoire that allows for positive interactions
with the immediate environment. As Risley (1996) suggests, in implementing
positive behavioural interventions , the key issue is to develop new skills in an effort
to provide prosocial alternatives for the child to practice. In this context, asking
questions such as, “What should or could the child be doing instead of the problem
behaviour?” and “How can we ensure those alternative actions are practised, used,
and acknowledged?” become of ultimate importance.
As noted earlier, the building of skill repertoires is a common characteristic of
positive approaches that aim to prevent the occurrence of problem behaviour.
Dunlap, Johnson and Robbins (1990) contend that prevention of behaviour prob-
lems can be accomplished through the development of functional skills, preferably
at an early age. Put simply, it is suggested that instead of emphasising specific
consequences to apply when problem behaviours occur, interventions focus on
what to do in those situations when the behaviour does not occur. A number of
studies illustrate the effectiveness of this approach in preventing behaviour prob-
lems, particularly, by teaching language and social interaction skills between
parents and their children (Koegel & Koegel, 1996; Wacker et al., 1996). Huynen,
Lutzker, Bigelow, Touchette and Campbell (1998), using a multi-probe design,
demonstrated the effectiveness of incidental teaching with a set of mothers of
children with disability in the context of planned activities training. Following
intervention , the mothers increased co-operative mother–child interactions and

decreased non-compliance and off-task behaviour.
The teaching of skills to children with an intellectual disability can essentially
occur at two different levels, depending on the degree of structure and arrange-
ments made to impart the desired skills. One level of instruction is what is known
as incidental teaching, a term first coined by Hart and Risley in 1975, and often
employed to strengthen prosocial alternatives to problem behaviours (Risley, 1996).
Incidental teaching has been mainly used to teach language skills (Hemmeter, Ault,
Collins & Meyer, 1996; McGee, Krantz & McClannahan, 1985; Miranda-Linne &
Melin, 1992). During incidental teaching, interactions between an adult and a child
arise naturally and in an unstructured situation such as free play (Warren & Kaiser,
1986). These interactions are used systematically by the adult to transmit new
information or give the child practice in developing a communication skill. In this
context, adults do not try to elicit responses by means of questions, prompts or
gestures, but rather wait for the learner to initiate an interaction. Incidental teaching
episodes are brief, positive, and oriented towards communication rather than
language teaching per se; thus, very much resembling teaching that naturally occurs
in mother–child dyadic interactions.
According to Lutzker et al. (1998), the basic principle of incidental teaching in
the context of preventing problem behaviour is awareness. That is, when a child
initiates a conversation by looking at something, playing with something, or talking
about something, the parent notices. Once the child has shown an interest in
something, parents can further the child’s learning and involvement. The parent can
enhance the interaction by asking further questions or talking about an item the
child has noticed.
One of the most important points about the use of incidental teaching in the
prevention of challenging behaviour is its role in the development of communi-
cation skill repertoires. As these have been recognised as essential in creating
positive alternatives to challenging behaviours (Durand, 1990), incidental teaching,
as a strategy, offers an effective medium for the reinforcement of alternative
behaviours within relatively unstructured environments such as those offered in
family settings. Parents are natural incidental teachers, and can thus be used
successfully in preventing their children ’s problem behaviour.
At a second level, a more structured and directed approach than incidental
teaching is proposed. Positive programming is defined as the use of longitudinal ,

instructiona l programmes designed to give the individua l greater skills and compe-
tencies for the purpose of controlling or eliminating problem behaviour (LaVigna,
Willis & Donnellan, 1989). Moreover, positive programming teaches more effec-
tive and socially acceptable ways of getting one’s needs met and of coping with the
realities of the physical environment in which the person has to act and interact.
LaVigna et al. (1989) describe five variations of positive programming: (a) general
skill development, which teaches general skills in various developmental areas; (b)
teaching alternative, functionally equivalent skills; (c) independenc e training which
involves teaching a person to satisfy his/her own needs independently , which would
in turn reduce the motivation for problem behaviour; (d) teaching alternative,
functionally related skills which are not necessarily functionally equivalent to the
behaviour to be decreased (e.g., choice making, schedule building, introducing
contingency specific stimuli, and establishin g stimulus control); (e) teaching coping
and tolerance.
Numerous studies with children with an intellectual disability and challenging
behaviour indicate that general increases in competent performance will be associ-
ated with decreases in occurrence of problem behaviour. This is, in turn, essential
in producing durable intervention effects (Dunlap & Fox, 1996; Koegel & Koegel,
1996; LaVigna et al., 1989). In family contexts, parents have been found to be
effective teachers of their children across a range of skill domains, and in different
situations . Thus, given the powerful influence of parents on their children ’s
behaviours, positive programming, together with incidental teaching, is a viable
strategy that can be effectively used to support parents in preventing their child’s
problem behaviour.
Parent training and support

It is recognised that in order for parents to fulfil their role effectively, a series of
supports may need to be in place. Parent training is one form of support that has
been consistentl y researched for the last 20 years, and which has generated a solid
body of knowledge (Polster & Dangel, 1984). It has also been argued that some
families may require additional intervention s in order to enhance the effectiveness
of parent training (Singer & Irvin, 1989). The sections below address both parent
training and the adjunctive supports that are known to have demonstrated effective-
ness.
Parent training. The recognition of parental influence on child behaviour has

given way to a variety of interventions . These have demonstrated that through
altering parent behaviour, children can be assisted in developing adaptive
behaviours (Lowry & Whitman, 1989). Parent training strategies, in particular,
have been used to treat a variety of problem behaviours in both typically
developing children and children with disability (Lutzker et al., 1998). Parent
training, as a generic term, is based on the principles of applied behaviour analysis
and social learning theory which aim to investigate variables that influence
behaviour and to demonstrate the functional relationship s between them (Lutzker &
Steed, 1998).
The notion of parent training has evolved over the last few years in an attempt
to optimise interventions and generate positive child and family outcomes. The
need to produce generalisation of behaviours across settings and people has also
constituted a significant prompt to expand the parameters of parent training. As per
our earlier discussion of the eco-behavioural approach, current parent training
approaches emphasise the consideration of the family ecology, within which the
child behaviour is embedded. These intervention s can also be conceptualised within
the broader positive behaviour support paradigm espoused by Carr et al. (1999).
The authors strongly advocate the use of “typical” support agents, such as families,
which in turn enhances the maintenance of effects across a range of situations. In
addition, recent parent training approaches have focused on antecedents and
consequences that are carefully considered through a functional assessment of the
behaviour, and prior to intervention . Subsequently , outcomes of this functional
assessment will determine the emphasis on antecedents, consequences, or both
during intervention .
According to Lutzker et al. (1998), there have been three broad approaches to
parent training which have shown considerable promise in obtaining positive
outcomes for children and their families. First, contingenc y management training,
which focuses on teaching parents to apply consistent consequences and use clear
commands. This approach has been primarily used with non-compliant children,
and for the most part is based on the seminal work of Forehand and McMahon
(1981). During several sessions, parents are taught a series of techniques such as
attending, ignoring, providing rewards, delivery of appropriate commands, and use
of time-out (Breiner, 1989). Second, planned activities training, which emphasises
the structuring of antecedents to increase engagement in activities and prevent
problem behaviour, rather than simply focusing on consequences as with contin-
gency management training. Third, errorless compliance training or behavioural
momentum, where parents are first taught to request behaviour from their children
to which instruction following is almost certain. Then, requests with low probabil-
ity of being followed are gradually given. The efficacy of this intervention has been
demonstrated for serious non-compliance in children with disability (Ducharme,
Pontes, Guger, Crozier, Lucas & Popynick, 1994).
It can be concluded that behavioural parent training, whether the focus is on
antecedents, consequences, or both, is effective in both producing and generalising
changes in child and parent behaviour. It must also be noted that a series of
procedures based on an applied behaviour analysis technology has also been used
with families. These procedures include the use of differential reinforcement of
incompatible behaviour, differential reinforcement of other behaviour, time-out,
and extinction (LaVigna and Donellan, 1986). In their discussion of positive
behaviour support strategies, Carr et al. (1999) characterise this category of
intervention s as non-positive behaviour support intervention s in that they are
reactive rather than proactive. It is beyond the scope of this review to describe these
techniques in detail. However, the reader is referred to LaVigna and Donellan

(1986) for a detailed review.
Adjunctive supports. In line with the eco-behavioural approach to supporting

parents of children with an intellectual disability and problem behaviour, it is
important to implement additional programmes that enhance the effect of parent
training strategies. It has been argued that the inclusion of these supports may
address problems such as treatment adherence, side-effects, lack of generalisation
across settings and behaviours, and loss of maintenance, that have been found in
parent training situations (Lucyshyn et al., 1997; Singer et al., 1989). Indeed,
several studies demonstrate the importance of including the context of parent–child

interactions in the practical implementation of behavioural intervention s (Baker,
Landen & Kashima, 1991; Singer et al., 1989). Baker et al. (1991) found in their
study of the effects of parent training, that while the parent training intervention
had good social validity and increased parental skill acquisition , families with
characteristics such as lack of employment, stress, and poor marital adjustment
made the least gains. Other authors have reported similar results (Dadds, Schwartz
& Sanders, 1987; Webster-Stratton, 1985).
Furthermore, in explaining the challenges faced in dealing with their children
with problem behaviour, parents often report significant stress and difficulty in
maintaining healthy interactions in a number of family life areas (Turnbull &
Ruef, 1996). It has been reported that parents of school-age children with a
disability experience a disproportionatel y greater level of stress relating to their
children than do parents of children without a disability (Dyson, 1997). Similarly,
in a study conducted with an Australian sample of families of children with a
disability , Gavidia-Payne, Richdale, Francis and Cotton (1997) found that the
severity of the problem behaviour was associated with the parents’ experience of
greater stress in relation to their child, dealing with others within and outside the
family environment, and their own personal well-being. Other areas of family
functioning also seem to be affected by the characteristics of the child with a
disability . For example, in examining the associations between the marital relation-
ship and adjustment in parents of children with a disability, Bristol, Gallagher and
Schopler (1988) showed that the strongest predictor of adjustment was marital
harmony.
In view of evidence suggesting the impact of family context factors on
parental behaviour and on the implementation of parent training, specific pro-
grammes have been developed, especially for those parents who may experience
stressors that may impinge on their morale and relationship s with others. While it
is acknowledged that not all families experience these problems (Turnbull, Patter-
son, Behr, Murphy, Marquis & Blue-Banning, 1993), there is sufficient evidence to
suggest that family caregiving for people with disability does exact a toll on
families in the absence of adequate formal and informal support (Singer & Irvin,
1991). The following is a review of the main areas reportedly used as complemen-
tary interventions.
Stress management. Numerous approaches exist in the treatment of stress and

depression, namely parent counselling , reflective group therapy, and behavioural
stress management (Hawkins & Singer, 1989). Stress management strategies based
on behavioural/educational principles have been particularly researched and evalu-
ated through controlled outcome studies. Reviews of these intervention s conclude
that they are efficacious (Cotton, 1990) in the treatment of individual s with stress
and depression. Further, several of these procedures have been employed effec-
tively with parents of children with an intellectua l disability and challenging
behaviour (Hawkins & Singer, 1989). Typically, critical elements of behavioural–
cognitive intervention s include, for this population : (a) identificatio n of stressors
through self-monitoring; (b) relaxation training and its application to natural
settings; (c) modification of cognitive responses to difficult situations ; and (d)

evaluation of, and an increase in support of, other people (Hawkins & Singer,
1989). These strategies contrast those used in a psychodynami c approach, which for
the most part centres on an individual ’s private thoughts and feelings (Singer, Irvin,
Irvine, Hawkins, Hegreness & Jackson, 1993).
Marital therapy. Of particular interest in interventions with couples with children

with a disability is behavioural marital therapy (Lichtenstein, 1993), which is
essentially a skills-based approach. Lichtenstein (1993) states that behavioural

marital therapy offers the application of a specific scientific methodology to the
treatment of distressed couples, with theoretical underpinning s derived from social
exchange and social learning theory. Internal events or perceptions about one’s
partner and one’s relationship are central in the formulation of social exchange
theory; whereas, social learning theory examines the ratio of rewarding and
punishing behaviours that determine the quality of people’s daily lives.
Behavioural marital therapy intervention s generally contain several components:
(a) behavioural exchange techniques, which create an increase in positive marital
exchanges and builds on the rewarding/reinforcing experiences that the couple
share; and (b) communication and problem-solving training, which focus on
teaching process-interaction skills, particularly those involved in conflict resolution.
Evaluations of behavioural marital therapy as a composite intervention have
generated positive outcomes for couples who are experiencing relationship diffi-
culties and who have children with a disability (Lichtenstein, 1993).
Problem-solving training. Problem-solving skills are essential components of

parents’ repertoires in that they enable parents to perform their caregiving role
effectively. Problem-solving training has been useful in working with parents of
children with a disability in a variety of situations (Singer & Irvin, 1991).
Generally, problem-solving training includes the following steps (Hawkins, Singer
& Nixon, 1993; Lutzker & Campbell, 1994): (a) identifying problems; (b) generat-
ing and evaluating solutions to problems; (c) implementing the solution; (d)
reinforcement; and (e) promoting generalisation .
In summary, it appears that a series of adjunctive intervention s can enhance the

effectiveness of parent training. Singer et al. (1993) have developed an approach
that in addition to combining the interventions cited earlier, includes other supports.
More notably are the use of respite care, community volunteers, self-help groups,
and community volunteers. The authors conclude that the combination of all these
elements appears to hold considerable promise for improving quality of life in
families of children with a disability.
Factors affecting intervention : characteristic s of staff

As noted earlier, several authors have highlighte d the importance of considering the
role of a range of variables, particularly family-related variables, in order to
produce more effective intervention s (Lucyshyn et al., 1997; Lutzker & Steed,
1998). Another recent body of research also indicates that in implementing positive
intervention s in the real world, the characteristics of the staff involved in delivering
these programmes to people with problem behaviour and their families are also
critical (Emerson, Hastings & McGill, 1994). Carr, Reeve and Magito-McLaughlin
(1996) called these staff influences one type of “durational” event or a category of
setting events. In a study by Touchette, MacDonald and Langer (1985; cited by
Carr et al., 1996) it was found that when a certain staff member was present, the
level of self-injury of one individual diagnosed with autism was high. With a
different staff member, problem behaviour was low. These differences occurred in
spite of the fact that the two staff members were implementing the same educa-
tional programmes. Carr et al. (1996) observe that staff presence may constitute a
continuous , ongoing, and complex event; thus, it is contextual in nature rather than
discrete, where it is not clear why a staff member was associated with high levels
of problem behaviour, and another was not.
In examining more closely the effect of staff-related variables, Emerson et al.
(1994) suggest that staff attitudes have a powerful effect on the quality of services
provided to people with a disability and problem behaviour. More specifically,
according to the authors, the response of a staff member to a particular episode of
problem behaviour can be influenced by the following: (a) the staff’s subjective
evaluation of the likely consequences of possible courses of action; (b) the value
staff place on potential outcomes; (c) the staff’s beliefs about how others may react
to the possible courses of action open to the staff member; and (d) the extent to
which the staff are motivated by the reactions of others.
In a study by Hastings (1996), it was found that staff have a diversity of views
on the reasons for the occurrence of challenging behaviour. These ranged from
medical/biological determinants to the seeking of attention and communication
difficulties. Most respondents reported that challenging behaviours are, to some
extent, intentional . The staff also reported that they tended to stop challenging
behaviours by intervening verbally or physically rather than by encouraging other
behaviours, or ignoring incidents. It has also been suggested that staff with negative
attitudes about interventions with people with a disability and challenging be-
haviours will be less likely to implement them. Corrigan, Williams, McCraken,

Kommana, Edwards and Brunner (1998) investigated the specific pathways that
lead to these negative attitudes. The findings revealed that burnout and insufficient
collegial support leads to negative attitudes, while experience with behavioural
intervention s leads to positive attitudes. Other authors report similar findings
(Watts, Reed & Hastings, 1997).
Staff competencies and supervision required in conducting optimal intervention s
with children with a disability and problem behaviour have also received some
attention in the literature (Bernstein, 1982; Favell & Reid, 1988). It has been
suggested that staff need to learn skills in teaching, treating, generalising, and
maintaining improvements in their client’s behaviour (Favell & Reid, 1988). In
their description of in-service training for staff working with young children with
a disability and problem behaviour, Reichle et al. (1996) state that training in
developing positive behaviour support plans requires instruction in three essential
areas: (a) recognising that challenging behaviours may serve a variety of functions;
(b) being familiar with assessment activities that can be used to determine the
function of challenging behaviour; and (c) identifying intervention options avail-
able to address challenging behaviour, ranging from intervention s that establish
functionally equivalent responses to intervention s that promote self-regulation.
Serious threats to the prevention and reduction of challenging behaviour, through
the attainment of the above staff competencies, are variability and drift in staff
performance. In order to overcome these potential problems, effective supervisory
practices at both individual and group levels are required to be in place. These may
include frequent, on-site monitoring of clearly specified dimensions of staff
performance followed by differential positive and corrective feedback (Favell &
Reid, 1988). Anderson, Russo, Dunlap and Albin (1996) provide an innovative
team training model that addresses these issues through the provision of multi-level
training that encourages team coaching and careful delineation of a training
curriculum.
Unlike, the work conducted in the disability and challenging behaviour areas,
investigatio n into staff-related characteristics in parenting intervention s has been
scarce (Graziano & Diament, 1992; Kazdin, 1997). Nevertheless, Lutzker and
Campbell (1994) point out that in working with parents of children with a disability
and problem behaviour, the skill training of staff requires a combination of
theoretical knowledge, role-playing, feedback, supervision , and independent per-
formance. All of these strategies are employed to teach skills to trainees across a
range of interventions .
In summary, there is a dearth of research related to the impact of staff variables
on the delivery of programmes for parents of children with a disability and
challenging behaviour. Nevertheless, the attitudes, training and supervision of staff
play a critical role in the development of effective interventions . Various staff
competency areas have been identified, including establishment of the functions of
behaviour, assessment of behaviour and environments, and multi-level interven-
tions. Clearly, the need to conduct further research in the area of staff and family
partnerships is urgently needed.
Parenting resource materials: characteristics and effectiveness

A variety of resource materials exists for families of children with an intellectual
disability . These range from advocacy information to more skill-oriented packages
to assist children and families on an everyday basis (Turnbull & Turnbull, 1990).
As for specific resource materials in dealing with problem behaviour, while there
has been a burgeoning of materials for parents of children without disability , the
same has not occurred for parents of children with a disability (Breiner, 1989). A
review of the parenting literature produced over the last 25 years suggests that the
majority of research conducted on the development of parent training models and
resources in the disability area took place during the late 1970s and 1980s. Most
of these resource materials are based on behavioural models that have proven
effectiveness in reducing problem behaviour.
Generally, practitioners in the past have tended to use a variety of resources,
teaching methods, and settings for parent training. Manuals and curriculum guides,
as well as videos and films, have been used extensively (Altman & Mira, 1983;
Baker, 1989; Bass, Dube, Foster & Munson, 1987). In regard to teaching strategies
used in parent training packages, role-playing, modelling, and behavioural rehearsal
have been shown to be effective in generating positive learning outcomes (Fore-
hand & McMahon, 1981; Hudson, 1982). A range of settings is also represented in
the use of parenting resources and programmes, from training carried out in the
home (Anderson, Avery, DiPietro, Edwards & Christian, 1987) to clinic-based
interventions . Overall, these resources have been pivotal in assisting parents in
reducing their children ’s problem behaviours.
Of particular note is the programme developed by Baker, Brightman, Blacher,
Heifetz, Hinshaw & Murphy (1989). Studies underpinnin g this programme have
focused on parents learning strategies to teach their children skills such as self-help,
toilet training, play, independent living, including behaviour management skills
(Alvey & Aeschleman, 1990; Baker, 1989; Baker & Brightman, 1984; Baker &
Heifetz, 1976). Subsequent to Baker’s work, scarce attention has been given to the
development and evaluation of resources in the form of manuals, training guides,
or other audio-visual materials. In response to this state of affairs, Baker (1989)
embarked on a comprehensive research agenda that answered a number of ques-
tions regarding the effectiveness of certain parent training approaches over others.
Baker’s basic interest was in demonstrating the feasibility of effective alternatives
to long-term, individualised , clinic intervention s with families. To this end, Baker
and his colleagues conducted several studies that tested a series of questions
through the random assignment of training participants to intervention and control
conditions.
In one particular study (Baker & Heifetz, 1976), the research question posed
was, how effectively could parents of children with an intellectua l disability learn
behavioural teaching strategies and teach their children when their only training
was from self-instructiona l materials? Parents were assigned to one of four
conditions which involved increasing professional contact: (a) manuals only, where
all contacts were by mail, including provision of teaching materials, child assess-
ment measures, and teaching log books; (b) telephone consultations , where manual
materials were supplemented by biweekly scheduled telephone calls to parents; (c)
group conditions , during which parents received manuals plus group training
following a parents as teachers curriculum; and (d) group visits, similar to the
group conditions plus six biweekly consultatio n visits. The study revealed that
while all the intervention conditions were associated with greater gains than the
control group, the manuals only condition produced the greatest parental knowl-
edge and child gains, whereas the least gains were made in the telephone condition.
Baker points out that the results are encouraging in terms of the potential usefulness
of instructiona l manuals for parent training. However, as far as the treatment of
problem behaviour is concerned, caution should be exercised before concluding
that training parents could best proceed through manuals alone. One reason is
that the group conditions showed some superiority in the management of
problem behaviours. Although all the families were given the manual, the families
in the group conditions were significantly more likely to carry out a programme
than were the manuals only and telephone families. As for the change in child
behaviour, only the group visits condition was superior to the control families, and
this condition was significantly superior to the other three training conditions
combined. The salience of group intervention s found in Baker’s study is consistent
with findings reported by other researchers and practitioners in the area (Baker &
Heifetz, 1976; Brightman, Baker, Clark & Ambrose, 1982; Heifetz, 1977; Ito et al.,
1992).
In line with the original study, Baker and his colleagues (Baker, 1989) conducted
other studies that tested the effectiveness of individual training versus group parent
training. The findings indicated that group and individua l training produced
indistinguishabl e results, suggesting that perhaps the strong reliance upon written
and visual media in both training formats and the use of a standardised curriculum
served to minimise the difference between formats. In a subsequent study
(Kashima, Baker & Landen, 1988), self-instructiona l materials (i.e., standardised
media) and group training were combined into one condition and compared with a
live-led training group. It was found that in both knowledge and implementation of
the programmes at home, both media-based and live-trained families improved
significantly , and differed significantl y from the control families, who did not
change. On the other hand, the live-trained families improved significantl y more
than the media-trained families in knowledge acquired, while in the implementation
measure the training groups did not differ.
Overall, it was concluded that when different formats were used, the outcomes
did not vary significantly . Furthermore, less cost-effective formats, such as training
by manuals, or groups, or by media, can be employed with similar effectiveness.
The findings as they relate to the usefulness of these various formats in the
management of problem behaviour point to group parent training as one powerful
approach to use. However, the question remains as to who benefits the most
from parent training in light of subsequent research concerned with the prevention
of problem behaviour and generalisation of parental skills (Dunlap et al.,
1990). The answer to this question brings the discussion back into the arena of
family-embedded interventions , which regardless of the format or package, high-

light the importance of considering the family ecology.
In sum, effective parent training programmes and packages for parents of
children with a disability who have problem behaviour are few. It appears that
actual practice is considerably lagging behind current research findings that
highlight the importance of multi-element family interventions . A review of the
published literature suggests that the programmes in current use still tend to draw
heavily from a parent training technology developed 15 years ago for the treatment
of problem behaviour (Breiner,1989; Czyzewski, Christian & Norris, 1984; Dangel
& Polster, 1984; Derby et al., 1997). While this is seen as a positive sign in terms
of the consolidatio n of our knowledge base and technical intervention , the chal-
lenge to incorporate into practice evidence yielded in recent studies, still remains.
One notable exception to this is the recent work conducted in Western Australia in
the development of a parent training package for young children with disability and
problem behaviour, called Stepping Stones: Positive Parenting Program (Sanders,
Markie-Dadds, Mazzucchelli & Studman, 1997). This programme is based on
learning theory principles and incorporates adjunctive intervention s for parents
under a clinician ’s guidance. The application of the programme across a range of
families of children with disability is currently being evaluated.
General conclusions
Our knowledge about the elements of successful supports for people with an
intellectual disability who have difficult behaviour has come a long way. The
implementation of behavioural assessments before intervening in family contexts is
clearly founded on extensive research that attests to the importance of doing it in
a thorough and systematic manner. It is evident that the level of sophisticatio n of
such assessments will vary as a function of the complexities around the child
behaviour, the characteristics of the family context, and the circumstances external
to them. In this sense, families have become instrumenta l agents in the gathering
of valuable information about their children ’s behaviour and the environmental
events associated with it.
In order to determine the reasons behind the occurrence of problematic behav-
iour, current literature also supports the execution of functional assessments as a
critical step prior to intervention . However, practical knowledge about the ways to
conduct functional assessments effectively within family environments, either by
clinicians or families themselves, is limited. Notable exceptions are the works of
Albin et al. (1996), Koegel et al. (1996), and Arndorfer, Miltenberger, Woster,
Rortvedt and Gaffaney (1994). Arndorfer et al. (1994) demonstrated that parents
successfully implemented functional assessments in natural settings; whereas
Koegel et al. (1996) reported that parents typically were able to identify the
function of the behaviour quite rapidly. Nevertheless, further research in the
development and testing of “friendly” practical packages of assessment information
for parents to use within home environments is clearly needed. Investigatio n of the
supports required so that families are able to do so successfully and effectively is
another imperative in making behavioural supports accessible to and usable by

families.
As for the use of intervention strategies, Carr and his colleagues clearly remind
us that a consistent body of knowledge about behavioural supports that are effective
and practical is still emerging and evolving. The most salient feature of this
evolving set of premises is the emphasis on implementation of behaviour support
procedures by natural support agents (Carr et al., 1999). It is in this broader context
that parent training intervention models that enable parents, as natural agents, to
teach skills to their children through the use of natural routines, are particularly
salient. The use of both antecedent and consequence strategies embedded in the
family context also offers the greatest promise of success when working with
families. The “goodness of fit” notion (i.e., how well the intervention fits the family
context) adequately summarises all the above elements.
The challenge remains in terms of making the knowledge we have more
available to families and to those working with them. The development of resource
materials is sound progress in the right direction, but the resources still need to be
tested, and subsequentl y to be “out there” in the field. Thus, the problems of
testing, dissemination , and usability of knowledge seem to be the next challenges
to overcome. In addition, we may also need, as Carr and colleagues suggest (Carr
et al., 1999), to adopt a new applied science where the needs of consumers (i.e.,
parents and children) are addressed more systematically and frequently, and where
the environments, systems, and contexts where they operate are as thoroughly
addressed as is the behaviour of individuals with intellectual disability.
Acknowledgement
The development of this paper was supported by funding provided by the
Department of Human Services (Victoria), Disability Services Program.
The authors also thank their colleagues Jan Matthews (RMIT University), Christine
Cameron (Victorian Parenting Centre), Robyn Mildon (Victorian Parenting Centre),
and Karen Nankervis (RMIT University) for their support in the development of the
manuscript.
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Behavioural Supports For Parents of Children With An Intellectual Disability and Problem Behaviours 2002

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Journal of Intellectual & Developmental Disability,

Vol. 27, No. 1, pp. 31–55, 2002

Behavioural supports for parents of children

Victorian Parenting Centre

A considerable body of knowledge that allows for the design of effective

ISSN 1366-8250 print/ISSN 1469-953 2 online/02/010031-25

Specifically, we address our current understandings of the most commonly

formats are also reviewed and evaluated.

Challenging behaviours in people with an intellectual disability

More recently, in describing the conceptualisatio n of treatment of challenging

Regardless of the definition used, it is evident that challenging behaviours are

characterised by particular features in their occurrence, such as frequency, duration

Prevalence and aetiology of challenging behaviour

A more recent Australian study by Einfeld and Tonge (1996) of an epidemiolog-

Evidence suggesting that specific disability groups have unique behavioural

Brief historical overview of intervention s with challenging behaviour

person’s concurrent and sequential response–response covariations were being

Lennox & Lindeman, 1991) began to be part of this trend.

The eco-behavioural approach to intervention : emphasis on prevention

In addition to the consideration of the family ecology and behavioural methodol-

Assessment of challenging behaviour

Assessment of behaviour and environmental events: functional assessment

problem behaviours in terms of their communicative function (Lucyshyn et al.,

family’s use of successful strategies and accommodations to address problem

Intervention strategies for challenging behaviour

Incidental teaching and positive programming

intervention , the mothers increased co-operative mother–child interactions and

teaching is proposed. Positive programming is defined as the use of longitudinal ,

Parent training and support

Parent training. The recognition of parental influence on child behaviour has

techniques in detail. However, the reader is referred to LaVigna and Donellan

Adjunctive supports. In line with the eco-behavioural approach to supporting

several studies demonstrate the importance of including the context of parent–child

Stress management. Numerous approaches exist in the treatment of stress and

settings; (c) modification of cognitive responses to difficult situations ; and (d)

Marital therapy. Of particular interest in interventions with couples with children

essentially a skills-based approach. Lichtenstein (1993) states that behavioural

Problem-solving training. Problem-solving skills are essential components of

In summary, it appears that a series of adjunctive intervention s can enhance the

Factors affecting intervention : characteristic s of staff

haviours will be less likely to implement them. Corrigan, Williams, McCraken,

Parenting resource materials: characteristics and effectiveness

family-embedded interventions , which regardless of the format or package, high-

another imperative in making behavioural supports accessible to and usable by

Association on Mental Retardation.

Psychology, 22, 68–77.

disabilities. Belmont, CA: Brookes/Cole Publishing.

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