'Key skills' building in schools as a possible approach to reducing and preventing challenging behaviour.

BACKGROUND: Building 'key skills' may help prevent the development of challenging behaviour in children with an intellectual disability. The aim of this paper was to extend the current limited evidence in this area. METHOD: We undertook two studies with children with an intellectual disability in school settings: (1) a cross-sectional replication study exploring the relationship between 'key skills' and challenging behaviour. (2) a longitudinal study follow-up exploring change in 'key skill' levels and challenging behaviour. RESULTS: The replication study recruited 74 participants, those scoring lowest in 'key skill' had a 94% chance of having challenging behaviour; those with the highest scores had a 6% chance. The follow-up study recruited 39 participants, we found a significant increase in children's 'key skill' level (p < .001) and a decrease in their challenging behaviour (p = .046). CONCLUSION: Building 'key skills' in children with an intellectual disability may help reduce or prevent challenging behaviour.

Interventions addressing challenging behaviours in Arab children and adults with intellectual disabilities and/or autism: A systematic review.

BACKGROUND: Arabs with intellectual disabilities and/or autism may exhibit challenging behaviour that affects them and their caregivers. Early, appropriate intervention may reduce these effects. This review synthesised and critically appraised challenging behaviour intervention research for this population. METHODS: All published empirical research on challenging behaviour interventions for Arabs with intellectual disabilities and/or autism was included. In September 2022, 15 English and Arabic databases yielded 5282 search records. Studies were appraised using the MMAT. Review findings were narratively synthesised. RESULTS: The 79 included studies (n = 1243 participants) varied in design, intervention, and evaluation method. Only 12.6% of interventions were well-designed and reported. Arab interventions primarily targeted children, were applied collectively on small samples, lacked individualised assessment, and were based on an inconsistent understanding of challenging behaviour. CONCLUSION: The evidence base on interventions for Arabs with intellectual disabilities and/or autism and challenging behaviour needs strengthening. Attention should be given to culturally relevant adaptations.

Exploring the Use of the Picture Exchange Communication System (PECS) in Special Education Settings.

The Picture Exchange Communication System (PECS) is an Augmentative and Alternative Communication (AAC) system which is widely used to support children with developmental disabilities. In the present study, we surveyed individuals responsible for implementing PECS in special educational settings in the United Kingdom (N=283). We explored knowledge of and adherence to the  intervention, with a view to identifying training and support needs. Specifically, we examined participants' knowledge, implementation accuracy, training experiences, access to resources, and attitudes towards PECS. We developed hierarchical logistic regression models to explore the association between training experience and both knowledge and use of PECS. We pre-registered our methods, predictions and the analysis plan on the Open Science Framework (OSF).We found considerable variation in practitioner knowledge and implementation of PECS. Formal training predicted greater knowledge and more accurate implementation when practitioner role and the degree of setting support were accounted for. While PECS was rated by a large majority to be effective and practical, many participants identified that time and the availability of resources were barriers to implementation. We also found that the purpose of PECS was not always fully understood by practitioners, and we identified some consistent gaps in knowledge and implementation.  This study contributes new information regarding the real-world  use of PECS in educational settings and offers new insights for supporting practitioners.

Short report: Correlates of behaviours that challenge in children with intellectual disability in special education settings.

BACKGROUND: Understanding the correlates of behaviours that challenge (CB) can help in both identifying children with intellectual disabilities (ID) at risk of developing CB and designing support programmes and interventions. AIMS: This study explores the correlates of CB exhibited by children with ID in special educational settings in the UK. METHODS AND PROCEDURES: Data on behaviours that challenge were provided by educators of 71 children with ID. Additional measures of adaptive and pro-social behaviours, maternal anxiety, depression, and stress, and demographic variables were included in the cross-sectional binary logistic regression analyses. OUTCOMES AND RESULTS: Results showed that pro-social behaviours of children with ID were associated negatively with overall CB (OR=0.72, 95% CI [0.62, 0.84], p < 0.001), stereotyped (OR=0.81, 95% CI [0.70, 0.94], p = 0.005), self-injurious (OR=0.80, 95% CI [0.70, 0.90], p < 0.001), and aggressive/destructive behaviours (OR=0.79, 95% CI [0.69, 0.90], p < 0.001). Stereotyped behaviours were associated with lower adaptive skills (OR=0.95, 95% CI [0.91, 0.99], p = 0.026) and male gender (OR=9.20, 95% CI [1.07, 79.44], p = 0.044). Aggressive/Destructive behaviours were associated with maternal stress (OR=0.82, 95% CI [0.70, 0.97], p = 0.022), and increased maternal anxiety (OR=1.21, 95% CI [1.00, 1.47], p = 0.050) was a marginally significant predictor of self-injurious behaviours. CONCLUSIONS AND IMPLICATIONS: The findings of this study emphasise the potential role of pro-social and adaptive behaviours, gender of children with ID, and maternal stress, as factors associated with CB in special education settings. Therefore, the present study contributes to extending the literature on correlates of CB for children with ID in special education settings while adopting an evidence-informed methodology for defining and measuring CB that facilitates replicability and allows for comparisons across findings of studies that explore CB thus increasing a more coherent evidence-base regarding assessment of CB.

Positive behavioural support for children and young people with developmental disabilities in special education settings: A systematic review.

BACKGROUND: Positive behavioural support (PBS) can be effective in supporting children and young people (CYP) with developmental disabilities. This systematic review focused on describing the components and nine characteristics of PBS that have been used with CYP with developmental disabilities in special education settings, and the evidence for PBS effectiveness in these settings. Additionally, facilitators and barriers to PBS implementation, and experiences of stakeholders, were investigated. METHOD: Systematic searches followed a registered protocol, and 30 studies were identified, narratively synthesised, and critically appraised. RESULTS: From the 30 studies included, 10 reported the presence of all 9 PBS characteristics, 17 reported on 8 PBS characteristics, and 3 reported on 7 characteristics. Overall, 28 studies demonstrated significant decreases in behaviours that challenge and increases in alternative behaviours, if increasing alternative behaviours was part of the interventions. CONCLUSIONS: There was a lack of evidence on facilitators and barriers, and a lack of qualitative studies exploring experiences of stakeholders with PBS in special education settings. The available evidence suggested that not all studies reported on all PBS characteristics when describing the approach followed. In addition, available evidence suggested that most studies demonstrated effectiveness of PBS regarding the measured outcomes. Implications and future directions are discussed.

The READ-IT study protocol for a feasibility randomised controlled trial of using a support worker/family carer mediated online reading programme to teach early reading skills to adults with intellectual disabilities.

BACKGROUND: Many individuals with intellectual disability (ID) have not learnt basic reading skills by the time that they reach adulthood, potentially limiting their access to critical information. READ-IT is an online reading programme developed from the Headsprout® Early Reading (HER®) intervention and supplemented by support strategies tailored for adults with ID. HER® has been successfully used to teach adults with ID to read in a forensic setting by trained staff. The aim of this study is to assess the feasibility of delivering READ-IT to adults with ID by family carers/support workers and will assess whether it would be feasible to conduct a later definitive randomised controlled trial (RCT) of the effectiveness of the programme. The study will aim to contribute to the evidence base on improving outcomes for adults with ID and their caregivers. METHODS: This study is a feasibility RCT, with embedded process evaluation. Forty-eight adults with ID will be recruited and allocated to intervention: control on a 1:1 basis. Intervention families will be offered the READ-IT programme immediately, continuing to receive usual practice and control participants will be offered the opportunity to receive READ-IT at the end of the trial follow-up period and will continue to receive usual practice. Data will be collected at baseline and 6 months post-randomisation. DISCUSSION: The results of this study will inform a potential future definitive trial, to evaluate the effectiveness of READ-IT to improve reading skills. Such a trial would have significant scientific impact internationally in the intellectual disability field. TRIAL REGISTRATION: ISRCTN11409097.

Common approaches to intervention for the support and education of children with autism in the UK: an internet-based parent survey.

There is a distinct lack of research identifying the interventions used by parents for the support and education of children with autism in the UK. This internet-based survey is the first to report exclusively on data from a UK sample of 160 parents. We sought to identify and describe the interventions used currently and in the past, and explored associations between parent and child characteristics and interventions used. We found that visual schedules, speech and language therapy, and Applied Behavior Analysis (ABA) were currently most in use, and that the majority of parents reported using more than one intervention concurrently. Younger children were more likely to be currently using at least one intervention, and current use of ABA was found to be associated with higher parental educational level. The findings highlight the need for further research into the factors that underlie decision-making in respect to interventions used.