TOPLINE

Physical health problems or sensory impairments were associated with an increased risk for challenging behaviours in people with intellectual disabilities.

METHODOLOGY

• Researchers conducted a retrospective cohort study of people with intellectual disabilities using longitudinal data from UK primary care databases between 2009 and 2019.
• They examined temporal associations between eight incident physical health problems or sensory impairments (constipation, epilepsy, pain, visual impairment, hearing impairment, bowel incontinence, urinary incontinence, and sleep problems) and challenging behaviours.
• For each incident physical health problem, an exposure period was defined as extending 12 months before and after the recorded clinical event.
• The primary outcome considered was the reporting of challenging behaviours, documented in the primary care records.
• A total of 166,989 individuals with intellectual disabilities (mean age at study entry, 33.1 years; 41.50% female individuals) were included, with a mean follow-up duration of 5.8 years per person.

TAKEAWAY

• Overall, 21.21% of individuals had one or more recorded challenging behaviours, with an overall incidence rate of 0.10 per person-year; 63.85% of the people with intellectual disabilities had a record of at least one of the incident physical health problems or sensory impairments.
• Incident physical health problems or sensory impairments were associated in time with 40.9% of challenging behaviour episodes.
• All eight physical health problems or sensory impairments were significantly associated with a higher risk for challenging behaviours. Bowel incontinence showed the strongest association (adjusted hazard ratio [aHR], 2.241; P < .001).
• Urinary incontinence (aHR, 1.930; P < .001), constipation (aHR, 1.890; P < .001), and sleep problems (aHR, 1.735; P < .001) were also linked to challenging behaviours.

IN PRACTICE

"Physical health problems/sensory impairments commonly act as biological vulnerability factors for the onset of incident challenging behaviours. Comprehensively screening for unrecognised physical health problems/sensory impairments should be a routine part of all assessments of incident challenging behaviours experienced by individuals with intellectual disabilities," the authors of the study wrote.

SOURCE

The study was led by Elliot Millington, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland. It was published online on July 03, 2026, in BMJ Open.

LIMITATIONS

Primary care coding probably underidentified challenging behaviours. More than 70% of the cohort had missing data on the severity of intellectual disabilities.

DISCLOSURES

The study received support from the Scottish Learning Disabilities Observatory, which was funded by the Scottish Government. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.