Nice | Challenging behaviour and learning disabilities

learning disabilitiesThis is a new guideline from Nice on managing challenging behaviour in people with learning disabilities. Most of it is fairy obvious. I've highlighted a few points.

Behaviours may be to communicate, to provide sensory stimulation, to avoid demands or to attract attention.

Consider the patient's environment, relationships and medications among other things. Look for any recent changes in these.

For early initial intervention, specialised parenting classes should be considered.

In adults, psychological interventions should be considered.

Consider antipsychotic medication only if:

  • other interventions haven't helped.
  • any mental or physical health problems have been addressed.
  • there is risk of serious harm to themselves or others.

Where medication is used, review at 3 - 4w and stop it if there's been no benefit by 6w.

Sleep problems. These should initially be addressed with behavioural methods - e.g. structured bedtime routines. Medication should only be used after consultation with a specialist. Where medication is used, melatonin should be considered.

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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