Background: Stress and burnout is often reported within the ‘human service’ professions. A systematic review aimed to ascertain the prevalence of stress and burnout within clinical psychologists, and the coping strategies utilised by members of this profession. Specifically, the role of clinical psychologists that work with people with intellectual disabilities and behaviour that challenges may, arguably, be particularly challenging, given the risks inherent in behaviour that challenges. Previous work has found that paid and family carers for this population experience substantial levels of stress. However, little is known about the experiences of clinical psychologists who may play a pivotal role in the multi-disciplinary team supporting individuals and their carers. Methods: The systematic review explores the prevalence of stress, burnout and coping in clinical psychologists. An electronic review and hand search of the literature was completed. The quality of all eligible articles was assessed, and themes within the findings were discussed using a narrative synthesis approach. The subsequent empirical article explores the perspectives of 14 female clinical psychologists. Thematic analysis was utilised to derive themes from their interview transcripts. Results: Eight studies met inclusion criteria for the review; findings suggest that a large proportion of clinical psychologists experience symptoms of stress and burnout. Nevertheless, most psychologists also experience high levels of personal achievement in their role. Within the empirical study, two overarching themes were apparent across participants. These included difficult and positive experiences. Participants reported barriers to influencing change and feelings of stress, worry, anxiety, self-doubt and frustration within the role. However, supervision and support from colleagues appeared to moderate difficult emotions. All conveyed a sense of reward within their role. Conclusions: Comparable to other ‘human service’ professionals, clinical psychologists experience symptoms of stress and burnout. With regard to clinical psychologists working with people with intellectual disabilities and behaviour that challenges, it appears that supervision and support from colleagues is key in managing difficult emotions. Based on the findings, provisions that are believed to improve clinical psychologists’ experiences are considered.

This thesis explored attachment in individuals with intellectual disability (ID). It investigated the role attachment may have in presenting difficulties such as challenging behaviour, which is an area much researched within other populations. It also considered parental well-being in the early years following diagnosis and the implications this may have for attachment development. Paper 1 describes a systematic review of the literature on parental response and adaptation to a child’ diagnosis of an ID in the early years. The news of a child’s diagnosis can be met with a range of intense emotions however, existing research reports conflicting outcomes regarding the nature of parental reactions and the psychological impact that may result. 12 studies were reviewed with one study demonstrating a strong methodology. The review found that the comparison groups used within studies had an important bearing on how effectual parental response and adaptation appeared. Due to the limited literature available and the methodological variation within the reviewed studies, no clear conclusions could be drawn. Paper 2 describes an empirical study which investigated the contribution of attachment behaviour to engagement in challenging behaviour, whilst considering other variables, in adults with ID. 22 service staff completed assessment questionnaires which examined service user attachment behaviour, level of adaptive ability, challenging behaviour and other variables. The relationships between particular variables were analysed. Results showed that level of adaptive ability was significantly related to attachment behaviour and challenging behaviour. Attachment behaviour was also significantly related to challenging behaviour, particularly social withdrawal and lethargy. However, when adaptive behaviour was controlled for the significance of these relationships disappeared. Therefore attachment behaviour did appear to contribute to challenging behaviour but less significantly than level of adaptive ability. The nature of the interaction between these three key variables is unclear and requires further research. Findings support the implementation of effective attachment based interventions alongside evidence based behavioural strategies. This would be particularly important for those at high risk of attachment and behavioural difficulties, which current and previous findings suggest may be those with ASD and those with lower levels of ability. Paper 3 describes the strengths and limitations of the systematic review and empirical paper. The research process, findings and clinical implications from each of the previous papers are discussed and reflected upon.

Första linjechefer inom LSS-bostäder ansvarar enligt arbetsmiljölagen, 1977:1160(AML) för att säkerställa arbetsmiljön för medarbetare, samtidigt som de skasäkerställa att insatser enligt lag 1993:387, om stöd och service för vissafunktionshindrade (LSS) är av god kvalité och möter stödanvändares behov.Detta, tillsammans med förekomst av utmanande beteende hos de boende, antyderatt första linjechefer har en komplex arbetssituation. Syftet med studien var därföratt undersöka hur första linjechefer inom LSS-bostäder, där det förekommerutmanande beteende, upplever relationen mellan arbetsmiljöåtgärder och detpedagogiska arbetet. Studiens fokus var att identifiera faktorer som verkarfrämjande respektive hindrande i arbetsmiljöarbete och pedagogiskt arbete.Empiri för studien samlades in med hjälp av semistrukturerade intervjuer med sjuförsta linjechefer. Genom tematisk analys har två huvudteman identifierats:upplevelser av yrkesrollen och upplevelsen av relationen mellan arbetsmiljö ochpedagogik. Resultatet har analyserat utifrån Michael Lipsky teori, Street-levelBureaucrats. Resultatet visar att praktiknära ledarskap upplevs centralt för attupprätthålla god kvalité i det pedagogiska arbetet, som i sin tur bidrog till bättrearbetsmiljö. Studien identifierar komplexitet och utmaningar i relationen mellanarbetsmiljöarbetet och det pedagogiska arbetet inom tre kategorier: (1)organisatoriska faktorer; (2) första linjechefens yrkesroll; och (3) bristandekunskap hos personalen. Vidare forskning kan därför behövas om hur praktiknäraledarskap påverkar kunskapsnivån i verksamheten och bemötandet avstödanvändare, samt hur det påverkar både arbetsmiljön och första linjechefersyrkesroll och arbetsuppgifter. / Frontline managers for LSS-housing are responsible according to the WorkEnvironment Act, 1977: 1160 (AML) to ensure adequate the workingenvironment for employees, and at the same time ensure the work provided are ofgood quality and meets the needs of the clients according to Act 1993: 387concerning Support and Service for Persons with Certain Functional Impairments(LSS). This, together with the presence of challenging behavioramong residents, this is suggested to be complex work situation for frontlinemanagers. The purpose of the study was therefore to investigate how frontlinemanagers for LSS-housing, where challenging behavior occur, experience therelation between work environment and the pedagogical work. The focus of thestudy was to identify factors that appear to promote and obstruct the efforts toensure adequate work environment and pedagogical work. The empirical data forthe study were collected using semi-structured interviews with seven frontlinemanagers. Through thematic analysis, two main themes have been identified:experiences of the professional role and the experience of the relation betweenwork environment and pedagogy. The result has been analyzed with MichaelLipsky theory, Street-level Bureaucrats. The result shows that practice leadershipis perceived as being vital to maintain good quality in the pedagogical work,which in turn contributed to a better working environment. The study identifiescomplexity and challenges in the relation of work environment and pedagogicalwork in three categories: (1) organizational factors, (2) frontline managersprofessional role; and (3) lack of knowledge of the staff. Further research istherefore needed on how practice leadership influences the level of knowledge inthe organization and how it affects the support work with the clients, as well as itaffects, the work environment and the frontline managers professional role andduties.

This study aims to contribute to a deeper understanding of the CPS model in the perspectives of special education discourse.The purpose of this study is to analyze how Ross Greenes way of describing students with challenging behavior in the CPS-model are interpreted by special education teachers and correlated with special education discourse. The studies questions are:•How does Ross Greene describe students with challenging behavior in the CPS-model?•How do special education teachers interpret these descriptions?•How do these descriptions correlative with perspectives of special education discourse?This study uses discourse theory as a framework, and Faircluoghs (1992, 2001) model which highlights how text, discursive practice and social practice altogether create social change as the method for the discourse analysis. Four special education teachers were interviewed and the ALSUP guide (Assessment of lagging skills and unsolved problems) and the Plan B Cheat Sheet, both important texts in the CPS model, were used for the discourse analysis.This study concludes that the categorical medical discourse is salient in CPS. It seems as this way of describing students with challenging behavior in the model has made a great impact on the special education teacher way of talking about the students. The pathogenic perspective dominates the discussions around the ALSUP-guide and the informants talk more about how to deal with students challenging behavior and solving their problems, than how to create a school organized for meeting all students learning needs by supporting teachers in their daily educational work. This creates dilemmas. The categorical way of describing the students seem to challenge teacher’s authoritarian way of describing students though, and that is considered by the informants in this study as a good thing. Plan B is a humanistic way of talking to students with challenging behavior and addresses both teachers and students concerns. It makes the special education teachers talk about students with challenging behavior from a relational perspective.The study implies that special education teachers need to be critical to the way they use models based on the medical discourse, so that their working practice includes both students, teachers and the school as a system with its norms and values.

No / . Challenging behaviours (behaviour difficulties) represent a problem of considerable clinical significance for learning disability nurses, and a source of much human distress. Gentle teaching is a relatively new approach to dealing with behavioural difficulties, and has been received with enthusiasm by clinicians, but has so far received little empirical support. The current study attempted to compare gentle teaching with a well-established alternative (behaviour modification) and a control group. Objectives. To examine the comparative effectiveness of gentle teaching, behaviour modification and control interventions for challenging behaviour amongst children with learning disabilities. Design. Nonrandomized controlled trial. Setting. Service users¿ homes in East Yorkshire. Participants. Seventy-seven children who presented with learning disabilities and challenging behaviour (behaviour difficulties) and their parents. Procedure. One-day workshops in were offered by recognized authorities in either behaviour modification or gentle teaching that were not otherwise involved with the research project. Forty-one participants were recruited to the gentle teaching condition; 36 to behaviour modification; 26 to the control group. Random allocation was not possible, because of the slow uptake by interested parents. Measures was preintervention, and at assessment points up until 12 months following intervention. Analysis. Quantitative analysis of pre¿post differences between the groups, using t-test. Results. In general, no significant differences were found between the treatment groups and controls. Significant improvements were found for both gentle teaching and behaviour modification children over controls on the AAMR ABS XVII (social engagement) subscale. Controls had more contact with medical practitioner (GP) services than behaviour modification children and less than gentle teaching children. Conclusion. Although very few differences were found between the three groups, those that did exist generally favoured behaviour modification. Implications for service provision and learning disability nursing practice are described.

Studiens syfte är att undersöka och förstå hur ett antal lärare resonerar kring sina möten med elever i behov av särskilt stöd. Fokus på studien ligger på undervisning i helklass och inte i mindre undervisningsgrupper. Mina frågeställningar utgår ifrån hur lärare beskriver pedagogiska situationer när de blir som bäst och när de känner att de lyckas i sina möten med elever i behov av särskilt stöd. Vad lärare upplever som utmaningar i möten inom klassrumsmiljön och vad inkludering av elever i behov av särskilt stöd betyder för lärare. Metoden för studien är en kvalitativ innehållsanalys med sex genomförda semistrukturerade intervjuer på två olika låg-och mellanstadieskolor. Resultatet presenteras i form av rubriker som skapats i analysen av intervjuer genom kodord och kategorier: Lärares syn på inkludering, Pedagogiska metoder och Samverkan och nätverk. Resultatet lyfter fram att lärarna i studien beskriver vikten av att kunna stödja enskilda elever så att de blir en del av gruppen. Lärarna anser att det är avgörande att lära känna eleven och skapa en relation. Resurspersoner är även en viktig förutsättning för elevers inkludering. Ett hinder kan vara tidsbrist för att klara av att ge både enskilda och övriga elever tillräckligt med stöd. Självreflektion är en gynnande pedagogisk metod och även samarbete med framför allt föräldrar och övriga professioner. Att skapa struktur och tydlighet genom förhållningssätt, anpassat material och miljö är mycket betydelsefullt för barn i behov av särskilt stöd. Min studie har visat att det behövs en medvetenhet om vad som påverkar inkludering. Att möta elever med ett utmanande beteende är någonting som ger upphov till olika uppfattningar och förhållningssätt hos lärare. Går det som lärare att skapa ett förtroende hos föräldrar ökas inkluderingsmöjligheterna stort.

The diagnosis of children with Attention Deficit Hyperactivity Disorder (ADHD) has increased over the last few years in Australia. ADHD is currently understood largely through a medical perspective, and in that context, the treatment recommended is stimulant medication. ADHD is a mental health label given to children who exhibit challenging behaviour. These children are diagnosed according to the categories stated in the Diagnostic Statistical Manual (DSM) – IV. To date, there is no medical test children can undertake to show that they ‘have’ ADHD. This research focuses on an alternative view of ADHD. Focussing upon families’ experience of ADHD, and the medicalisation of children’s behaviour, it argues that behaviour is socially influenced and constructed. It is because insufficient attention has been given to the family experience and the social implications of ADHD, that the child is often seen as ‘the problem’. The gap in our understanding of ADHD is situated in our understanding of the broader social context. To challenge this I will explore perceptions of the ‘good child’, ‘good mothers’ and the social consequences of inappropriate behaviour. Each family was interviewed five times every three months over a two-year period. Their stories and experiences are presented in this thesis.

No / This paper considers the situation of people with dementia who are living in long-term care from two rarely-applied theoretical perspectives. The first, Agamben’s theory of biopolitical life versus bare life, demonstrates that the situation of people with dementia living in care homes or hospitals approximates to that of prisoners, internees and refugees, deprived of full citizenship or biopolitical life. In popular imagery people with dementia are frequently referred to, first in terms of numbers, as a ‘rising tide’, in a way that has historically been used to justify discrimination and social exclusion. In many, care environments it is, moreover, still the case that people with dementia are reduced to a condition of ‘bare life’ only: given little choice, having few rights, lacking freedom of movement, and subjected to almost constant surveillance. In other contexts, such treatment is known to cause or exacerbate many of the problems which – following a biomedical model – are constructed as ‘symptoms of dementia’, such as disorientation in time and space, sleep disturbance, hallucinations and repetitive movement. The second body of theory is Bakhtin’s work on cultural resistance. This demonstrates that many of the so-called ‘challenging behaviours’ manifested by people with dementia, can better be understood as coping, sense-making and self-determining strategies adopted in order to survive within prevailing organisational cultures. Based on a series of studies carried out in intermediate and long-term care since 2009, the paper draws on a range of narrative and film-based examples to demonstrate the ‘courage, humour, fortitude and cunning’ with which, as Walter Benjamin noted, the oppressed have always met the conditions of their oppression. In the process, ‘challenging behaviour’ is given political and ideological meaning, as protest, perpetrated by people who are struggling against extreme odds to be reinstated as full citizens. / Conference website: http://www.aginggraz2017.com/conference-schedule

<p>Årsakene til at mennesker med psykisk utviklingshemming utvikler utfordrende atferd er mange og sammensatte. Biologiske, psykologiske og miljømessige faktorer bidrar hver for seg eller sammen til at atferden oppstår. Uri Bronfenbrenners økologiske modell for sosial utvikling beskriver faktorer som kan påvirker atferd. Det handler om nære relasjoner og om omkringliggende systemers innvirkning på relasjonene. Studiens hensikt har vært å beskrive kommunalt ansatte omsorgsgiveres erfaringer med økologiske faktorers betydning for å kunne mestre og forebygge for utfordrende atferd hos mennesker med psykisk utviklingshemming. Åtte omsorgsgivere fra seks ulike omsorgsmiljøer har blitt intervjuet om sine erfaringer. Studien er gjennomført etter kvalitativ forskningsmetode. Materialet har blitt samlet inn og analysert etter hermeneutisk tilnærming. Omsorgsyternes erfaringer med økologiske faktorers betydning i omsorgsarbeidet er tydeliggjort i fem beskrivningskategorier: Tøff hverdag, Ulik tilnærming - nesten samme praksis, Ulike miljøer, Trygt arbeidsmiljø og Lukkede miljøer. Studien viser at økologiske faktorer påvirker forekomst av utfordrende atferd hos mennesker med psykisk utviklingshemming. Bevisstheten om de enkelte faktorenes betydning kan bidra til å utvikle forebyggende tiltak i omsorgsmiljøene.</p> / <p>The causes behind the development of challenging behaviour in people with learning disability are numerous and complex. This type of behaviour is prompted by a combination of biological, psychological and environmental variables. The ecological model proposed by Uri Bronfenbrenner for social development describes variables that can influence behaviour, mainly the close relations between people and how surrounding systems influence those relations. The purpose of this study is to describe how caretakers, employed by various municipalities, have used ecological factors and drawn experience from them in handling and preventing challenging behaviour in people with learning disability. Eight caretakers from six different environments have been interviewed on their practical experience. The study has been carried out with qualitative research techniques. The material has been collected and analyzed according to a hermeneutical approach. The caretakers` experience of the importance of ecological factors in the caregiving tasks is demonstrated in five description categories: Difficult daily tasks, Different approach- almost same practice, Different environments, Safe working environment and Closed environments. The study demonstrates that ecological factors influence the incidence of challenging behaviour in people with learning disability. Being conscious of the importance of the various factors may promote the development of preventive measures in the caretaking environments.</p>

Introduction: Knowledge and attributions are frequently cited as variables which may help to understand staff responses to challenging behaviour in people with a learning disability. Previous research has found only partial support for Weiner‟s (1980, 1986) model of helping behaviour within a learning disability context. The study developed a clinical definition of „helping behaviour‟, and examined knowledge of challenging behaviour and the combination of attributions from Weiner‟s (1980, 1986) model in predicting staff helping behaviour. In addition the emotion regulation strategies of cognitive reappraisal and expressive suppression were investigated in moderating the relationship between attributions and helping behaviour, developing an overarching framework between attributions, staff stress and positive staff approaches to challenging behaviour. Method: One hundred and seven support staff completed self-report measures of knowledge of the term and management of challenging behaviour, causal attributions, emotion regulation style and behavioural response to challenging behaviour. Results: Knowledge and helpful attributions were significantly correlated with helping behaviour, however, when regressed onto helping behaviour, only knowledge significantly contributed to the variance. No significant correlations were found between emotion regulation styles and attributions. No moderating or mediating effect was found for emotion regulation styles on the relationship between attributions and helping behaviour.