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Challenging Behavior And Learning Disabilities

People who have learning disabilities are often vulnerable to and can present with a wide range of mental health needs. Sadly these often go unrecognized. Challenging behavior and mental health difficulties can occur separately or can co-occur. Many psychotherapeutic approaches have been adapted for individuals who have learning disabilities. Read more
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Treatment guides

  • Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges | National Institute for Health and Care Excellence (NICE) | 2015 download archived copy
  • Challenging behavior: a unified approach | Royal College of Psychiatrists | 2016 download archived copy
  • Functional assessment of individuals with cognitive disabilities | McCue, Chase, Dowdy, Pramuka, Patrick, Aitken, Fabry | 1994 download archived copy
  • Incorporating Attachment Theory into Practice: Clinical Practice Guideline for Clinical Psychologists working with People who have Intellectual Disabilities | Skelly, Anonymous, Fletcher, Flood, Jones | 2017 download  archived copy
  • Psychological therapies and people who have intellectual disabilities | Beail (Eds) | 2016 download  archived copy
  • Understanding and responding to behavioral challenges: an investigative approach | Mark Burton | 2001 download archived copy

Information Handouts

Information handouts

The Challenging Behaviour Foundation are a UK charity who have a great selection of resources . I have linked to selection of information sheets below:


  • Functional behavioral assessment (FBA) and challenging disorders: supporting behavioral change for children with Autism Spectrum Disorders (ASD) | 2013  download  archived copy

Other Resources

A Manual of Cognitive Behaviour Therapy for People with Learning Disabilities and Common Mental Disorders is a therapist manual by Hassiotis, Sarfaty, Azan, Martin, Strydon & King. It is available for free on the UCL Psychiatry web page and is accompanied by some other resources therapists may find helpful:

What Are Learning Disabilities And Challenging Behavior?

Signs and Symptoms of Learning Disabilities and Challenging Behavior

Learning disabilities affect the way that a person learns new things, understands information, or communicates. Functional difficulties may encompass:

  • understanding new or complex information
  • learning new skills
  • coping independently

People with learning disabilities are subject to a higher incidence of negative life events, and of experiencing discrimination and stigma, and may have access to fewer resources or coping skills (Emerson & Hatton, 2007). As a result, rates of mental health problems among people with learning disabilities are higher than in the general population (McManus, Meltzer, Brugha, Bebbington, & Jenkins, 2009).

Challenging behavior has been defined as “Behavior of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behavior which is likely to limit or deny access to and use of ordinary facilities” (Emerson et al., 1988). Examples of challenging behavior might include violence or aggression to others, self-injurious behavior, destructive behavior, and stereotypic behaviors.

Psychological Models and Theory Relevant to Learning Disability and Challenging Behavior

The behavioral approach is often used to understand behaviors of concern. It is based on theories of learning, the analysis of relationships between behavioral and environmental events, and an analysis of the function of behavior. Behavior is measured on dimensions such as frequency, duration, intensity, or consequences. Tools such as ABC charts are used to understand antecedents and consequences of behavior. Once a behavior is understood interventions such as positive and negative reinforcement can be used to modify behavior.

Evidence-Based Psychological Approaches for Working with People with Learning Disabilities

There is evidence that cognitive behavioral therapy is an effective treatment for conditions such as anxiety and depression in adults with learning disabilities (Unwin, Tsimopoulou, Kroese, & Azmi, 2016).


  • Emerson, E., Cummings, R., Barrett, S., Hughes, H., McCool, C. and Toogood, A. (1988). Challenging behaviourand community services 2: Who are the people who challenge services? British Journal of Learning Difficulties,16(1), 16–19.
  • Emerson, E., & Hatton, C. (2007). Mental health of children and adolescents with intellectual disabilities in Britain. The British Journal of Psychiatry, 191(6), 493–499.
  • McManus, S., Meltzer, H., Brugha, T., Bebbington, P., & Jenkins, R. (Eds.). (2009). Adult Psychiatric Morbidity in England 2007: Results of a Household Survey. London: NHS Information Centre for Health and Social Care.
  • Unwin, G., Tsimopoulou, I., Kroese, B. S., & Azmi, S. (2016). Effectiveness of cognitive behaviouraltherapy (CBT) programmesfor anxiety or depression in adults with intellectual disabilities: A review of the literature. Research in Developmental Disabilities, 51/52, 60–75.