Randomized, single-blind, controlled trial of a specialist behavior therapy team for challenging behavior in adults with intellectual disabilities

Am J Psychiatry. 2009 Nov;166(11):1278-85. doi: 10.1176/appi.ajp.2009.08111747. Epub 2009 Aug 17.


Objective: Community-based specialist behavior therapy teams may be helpful in managing challenging behavior, but evidence of their effectiveness is limited. This study was designed to examine the effectiveness and costs associated with treatment by a specialist behavior therapy team.

Method: This was a parallel-group, randomized, single-blind controlled trial carried out in an intellectual disabilities service in England. Participants were 63 male and female service users with mild to severe intellectual disability who presented with challenging behavior. The interventions were standard treatment plus applied behavioral analysis (N=32) and standard treatment only (N=31). The primary outcome measure was challenging behavior, as measured by total and subscale scores on the Aberrant Behavior Checklist 3 and 6 months after randomization. Secondary outcome measures were psychiatric comorbidity assessed at 3 and 6 months using the Psychiatric Assessment Schedule for Adults With a Developmental Disability Checklist (PAS-ADD) and total costs recorded at 6 months. Multilevel modeling was used to compare square root transformations of Aberrant Behavior Checklist scores.

Results: Significant differences were found in the transformed total scores on the Aberrant Behavior Checklist (difference=-0.89, 95% CI=-1.74 to -0.04) and transformed lethargy and hyperactivity subscale scores (common intervention effect=-0.56, 95% CI=-0.97 to -0.15). Standard care participants fared worse on the PAS-ADD comorbid organic disorder subscale. There was a clear trend for lower overall costs of the intervention.

Conclusions: Use of a specialist behavior therapy team in addition to standard treatment appears to be more effective in improving challenging behavior and may have financial advantages over standard treatment.

Publication types

  • Case Reports
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Behavior Therapy / economics
  • Behavior Therapy / methods*
  • Child
  • Comorbidity
  • Developmental Disabilities / diagnosis
  • Developmental Disabilities / epidemiology
  • Developmental Disabilities / therapy*
  • England / epidemiology
  • Female
  • Health Care Costs
  • Humans
  • Intellectual Disability / therapy*
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology
  • Mental Disorders / therapy
  • Outcome Assessment, Health Care / methods
  • Patient Care Team / economics
  • Personality Inventory
  • Psychiatric Status Rating Scales
  • Severity of Illness Index
  • Single-Blind Method
  • Specialization / economics
  • Surveys and Questionnaires
  • Treatment Outcome