Cochrane · systematic review · CD003406
Behavioural and cognitive‐behavioural interventions for outwardly directed aggressive behaviour in people with intellectual disabilities
Prior, D, Win, S, Hassiotis, A, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
24
current version
GRADE rated
11
No studies
13
Included studies
NR
No studies 13 · 54.2%Ungraded 0 · 0%Very low 7 · 29.2%Low 2 · 8.3%Moderate 2 · 8.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlySummary of findings table ‐ Anger management compared to wait‐list control for outwardly aggressive behaviour in people with intellectual disability
Population: outwardly aggressive behaviour in people with intellectual disability
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Aggressive behaviour: severity of incidents: Aberrant Behaviour Checklist (ABC – irritability subscale – key worker report – post‐treatment (Analysis 1.2.1) Summary of findings table ‐ Anger management vs wait‐list control | no estimate extracted | 1 study · 158 participants | Moderate Downgraded: imprecision |
Ability to control anger: Provocation Inventory (PI) – self‐report – post‐treatment (Analysis 1.17.1) Summary of findings table ‐ Anger management vs wait‐list control | no estimate extracted | 3 studies · 212 participants | Very low Downgraded: risk of bias, imprecision |
Adaptive functioning: Adaptive Behaviour Scale – Revised, Part II (ABS‐II) (Analysis 1.26) Summary of findings table ‐ Anger management vs wait‐list control | no estimate extracted | 1 study · 28 participants | Very low Downgraded: risk of bias, imprecision |
Mental state: psychiatric symptoms measured using the Brief Symptom Inventory (BSI) (Analysis 1.27) Summary of findings table ‐ Anger management vs wait‐list control | no estimate extracted | 1 study · 28 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life: Comprehensive Quality of Life Scale: Intellectual Disability (COMQoL‐ID) – post‐treatment (Analysis 1.32.1) Summary of findings table ‐ Anger management vs wait‐list control | no estimate extracted | 1 study · 129 participants | Very low Downgraded: imprecision |
Costs of service utilisation: Client Service Receipt Inventory (CSRI): cost per person per week of health and social care resource (in British pounds (GBP)) – Summary of findings table ‐ Anger management vs wait‐list control | no estimate extracted | 1 study · 133 participants | Very low Downgraded: imprecision |
Summary of findings table ‐ Positive behavioural support compared to treatment as usual for people with outwardly aggressive behaviour and intellectual disability
Population: people with outwardly aggressive behaviour and intellectual disability
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Aggressive behaviour: Aberrant Behaviour Checklist (ABC) Total – at 6 months (Analysis 2.1.1) Summary of findings table ‐ Positive behavioural support vs treatment | no estimate extracted | 2 studies · 275 participants | Moderate Downgraded: imprecision |
Ability to control anger ‐ not measured Summary of findings table ‐ Positive behavioural support vs treatment | no estimate extracted | NR | No studies |
Adaptive functioning ‐ not measured Summary of findings table ‐ Positive behavioural support vs treatment | no estimate extracted | NR | No studies |
Mental state: Common Mental Disorder (CMD) – at 6 months (Analysis 2.2.1) (CMD) Summary of findings table ‐ Positive behavioural support vs treatment | OR 1.44 [0.83, 2.49] | 1 study · 215 participants | Low Downgraded: imprecision |
Quality of life ‐ not measured Summary of findings table ‐ Positive behavioural support vs treatment | no estimate extracted | NR | No studies |
Costs of service utilisation: mean health and social care costs per participant – at 12 months (Analysis 2.7.2) (Cost of service utilisation) Summary of findings table ‐ Positive behavioural support vs treatment | no estimate extracted | 1 study · 225 participants | Very low Downgraded: imprecision |
Summary of findings table ‐ Meditation based on mindfulness compared to treatment as usual for people with outwardly aggressive behaviour and intellectual disability
Population: people with outwardly aggressive behaviour and intellectual disability
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Aggressive behaviour: frequency of incidents: number of incidents of physical aggression per week during treatment (12 weeks) – post‐treatment (Analysis 3.1) Summary of findings table ‐ Meditation based on mindfulness vs treatment | no estimate extracted | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision |
Ability to control anger ‐ not measured Summary of findings table ‐ Meditation based on mindfulness vs treatment | no estimate extracted | NR | No studies |
Adaptive functioning ‐ not measured Summary of findings table ‐ Meditation based on mindfulness vs treatment | no estimate extracted | NR | No studies |
Mental state ‐ not measured Summary of findings table ‐ Meditation based on mindfulness vs treatment | no estimate extracted | NR | No studies |
Quality of life ‐ not measured Summary of findings table ‐ Meditation based on mindfulness vs treatment | no estimate extracted | NR | No studies |
Cost of service utilisation ‐ not measured Summary of findings table ‐ Meditation based on mindfulness vs treatment | no estimate extracted | NR | No studies |
Summary of findings table ‐ Mindfulness based on positive behaviour support compared to positive behaviour support in outwardly aggressive behaviour in people with intellectual disability
Population: outwardly aggressive behaviour in people with intellectual disability
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Aggressive behaviour: aggressive events – carer reports – post‐training (Analysis 4.1) Summary of findings table ‐ Mindfulness based on positive behaviour support vs positive behaviour support | no estimate extracted | 2 studies · 128 participants | Low Downgraded: risk of bias, inconsistency |
Ability to control anger ‐ not measured Summary of findings table ‐ Mindfulness based on positive behaviour support vs positive behaviour support | no estimate extracted | NR | No studies |
Adaptive functioning ‐ not measured Summary of findings table ‐ Mindfulness based on positive behaviour support vs positive behaviour support | no estimate extracted | NR | No studies |
Mental state ‐ not measured Summary of findings table ‐ Mindfulness based on positive behaviour support vs positive behaviour support | no estimate extracted | NR | No studies |
Quality of life ‐ not measured Summary of findings table ‐ Mindfulness based on positive behaviour support vs positive behaviour support | no estimate extracted | NR | No studies |
Cost of service utilisation ‐ not measured Summary of findings table ‐ Mindfulness based on positive behaviour support vs positive behaviour support | no estimate extracted | NR | No studies |
Comparison
Population: People with learning disability and outwardly‐directed aggressive behaviour*
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Aggressive behaviour: Severity of incidents: Modified Overt Aggression Scale (MOAS) ‐ key worker report: Post‐treatment | no estimate extracted | 1 study · 158 participants | Moderate Downgraded: imprecision |
Ability to control anger: Provocation Inventory (PI) ‐ self report: Post‐treatment (scale range 0 to 75; higher scores indicate higher levels of aggression) | no estimate extracted | 1 study · 162 participants | Moderate Downgraded: imprecision |
Ability to control anger: Provocation Inventory (PI) ‐ key worker report: Post‐treatment (scale range 0 to75; higher scores indicate higher levels of aggression) | no estimate extracted | 1 study · 161 participants | Moderate Downgraded: imprecision |
Mental state: Depression: Post‐treatment (Glasgow Depression Scale for people with an Intellectual Disability (GDS‐ID); scale range 0 to 40; higher scores indicate more depressive symptoms) | no estimate extracted | 1 study · 157 participants | Moderate Downgraded: imprecision |
Mental state: Anxiety: Glasgow Anxiety Scale for people with an intellectual disability (GAS‐ID): Post‐treatment (scale range 0 to 54; higher score indicates more anxiety symptoms) | no estimate extracted | 1 study · 154 participants | Moderate Downgraded: imprecision |
Quality of life ‐ self reported: Comprehensive Quality of Life Scale: Intellectual Disability (COMQoL‐ID: Post‐treatment | no estimate extracted | 1 study · 129 participants | Moderate Downgraded: imprecision |
Cost of service utilisation: Client Service Receipt Inventory (CSRI): Cost per person per week of health and social care resource (in British Pounds):10‐month | no estimate extracted | 1 study · 133 participants | Moderate Downgraded: imprecision |
Comparison
Population: Participants with learning disabilities with outwardly‐directed aggressive behaviour
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Ability to control anger: Provocation Inventory (PI) ‐ Total score: Post‐treatment (higher scores indicate more aggression) | no estimate extracted | 1 study · 36 participants | Very low Downgraded: risk of bias, imprecision |
Ability to control anger: Ward Anger Rating Scale (WARS) ‐ staff report: Post‐treatment (higher scores indicate more anger) | no estimate extracted | 1 study · 36 participants | Very low Downgraded: risk of bias, imprecision |
Mental state: Depression; Mental state: Anxiety | no estimate extracted | NR | No studies |
Quality of life | no estimate extracted | NR | No studies |
Cost of service utilisation | no estimate extracted | NR | No studies |
Comparison
Population: Participants with learning disabilities and outwardly aggressive behaviour
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Ability to control anger: Role Play Test (RPT) of Anger Arising Situations: Post‐treatment (range of scale 5 to 35; higher score indicates better response) | no estimate extracted | 1 study · 28 participants | Low Downgraded: imprecision |
Ability to control anger: Problem‐Solving Task (PST): Post‐treatment (range of scale 0 to 100; higher scores indicate a better response) | no estimate extracted | 1 study · 28 participants | Low Downgraded: imprecision |
Mental state: Psychiatric symptoms: Brief Symptom Inventory (BSI): Post‐treatment (higher scores indicate more symptoms) | no estimate extracted | 1 study · 28 participants | Low Downgraded: imprecision |
Mental state: Psychological distress: Subjective Units of Distress Scale (SUDS): Post‐treatment (higher scores indicate more symptoms) | no estimate extracted | 1 study · 28 participants | Low Downgraded: imprecision |
Quality of life | no estimate extracted | 0 participants | Ungraded |
Cost of service utilisation | no estimate extracted | 0 participants | Ungraded |
Comparison
Population: Participants with learning disabilities and outwardly‐directed aggressive behaviour
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Aggressive behaviour: Frequency of incidents: Number of incidents of physical aggression per week during treatment (12 weeks): Post‐treatment | no estimate extracted | 1 study · 34 participants | Low Downgraded: risk of bias |
Aggressive behaviour: Frequency of incidents: Number of incidents of verbal aggression per week during treatment (12 weeks): Post‐treatment | no estimate extracted | 1 study · 34 participants | Low Downgraded: risk of bias |
Mental state: Depression; Mental state: Anxiety | no estimate extracted | 0 participants | Ungraded |
Quality of life | no estimate extracted | 0 participants | Ungraded |
Cost of service utilisation | no estimate extracted | 0 participants | Ungraded |
Comparison
Population: Participants with learning disability with outwardly‐directed aggressive behaviour
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Aggressive behaviour: Frequency of incidents: Number of incidents of all types of disruptive behaviour per person per 30 minutes of observation: Post‐treatment | no estimate extracted | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Aggressive behaviour: Frequency of incidents: Number of incidents of verbal disruptive behaviour per person per 30 minutes: Post‐treatment | no estimate extracted | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Mental state: Depressive; Mental state: Anxiety | no estimate extracted | 0 participants | Ungraded |
Quality of life | no estimate extracted | 0 participants | Ungraded |
Cost of service utilisation | no estimate extracted | 0 participants | Ungraded |