{
  "abstract": "Objectives To determine whether the onset of physical health problems/sensory impairments is associated with incident challenging behaviours.Design A retrospective, population-based cohort study using longitudinal data from primary care records. HRs were estimated using Cox proportional hazards models accounting for recurrent events and time-varying exposures.Setting UK primary care data sourced from the Clinical Practice Research Datalink (CPRD) Aurum and Gold databases, covering over 850 000 person-years between 2009 and 2019.Participants 166 989 individuals with recorded intellectual disabilities were included in the cohort.Primary outcome measures Incident identification of challenging behaviours before or after a recorded incident of physical health problems/sensory impairment. Physical health problems/sensory impairments assessed included constipation, epilepsy, pain, visual impairment, hearing impairment, bowel incontinence, urinary incontinence and sleep problems.Results 21.21% (n=35 415) of the cohort had challenging behaviour recorded at least once in primary care records over the 11-year study period, equating to an incidence rate of 0.10 per person-year. 40.9% of episodes of challenging behaviour were associated with an incident physical health problem/sensory impairment. All eight physical health problems/sensory impairments were significantly associated with higher HRs for challenging behaviours after full adjustment for demographic and mental health covariates. These associations held across multiple sensitivity analyses. The strongest associations were found for bowel incontinence (HR=2.24; 95% CI 2.01 to 2.50), urinary incontinence (HR=1.93; 95% CI 1.77 to 2.11), constipation (HR=1.89; 95% CI 1.74 to 2.05) and sleep problems (HR=1.74; 95% CI 1.58 to 1.90).Conclusions This is the first longitudinal study to establish a temporal association between the onset of physical health problems/sensory impairments and challenging behaviours in people with intellectual disabilities. These findings highlight the need for proactive identification and management of physical health problems/sensory impairments as part of assessment processes to prevent or reduce the impact of challenging behaviours.",
  "authors": [
    {
      "affiliations": [
        "School of Health and Wellbeing, University of Glasgow, Glasgow, UK"
      ],
      "name": "Elliot Millington"
    },
    {
      "affiliations": [
        "School of Health and Wellbeing, University of Glasgow, Glasgow, UK",
        "School of Health in Social Science, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Ewelina Rydzewska"
    },
    {
      "affiliations": [
        "School of Health and Wellbeing, University of Glasgow, Glasgow, UK"
      ],
      "name": "Andrew Jahoda"
    },
    {
      "affiliations": [
        "Intellectual Disabilities Research Institute (IDRIS), University of Birmingham, Birmingham, UK"
      ],
      "name": "Richard P Hastings"
    },
    {
      "affiliations": [
        "School of Health and Wellbeing, University of Glasgow, Glasgow, UK"
      ],
      "name": "Anne MacDonald"
    },
    {
      "affiliations": [
        "School of Health and Wellbeing, University of Glasgow, Glasgow, UK"
      ],
      "name": "Michael Fleming"
    },
    {
      "affiliations": [
        "Intellectual Disabilities Research Institute (IDRIS), University of Birmingham, Birmingham, UK",
        "School of Psychology, University of Birmingham, Birmingham, UK"
      ],
      "name": "Caroline Richards"
    },
    {
      "affiliations": [
        "School of Health and Wellbeing, University of Glasgow, Glasgow, UK"
      ],
      "name": "Amanda Gillooly"
    },
    {
      "affiliations": [
        "NHS Greater Glasgow and Clyde, Glasgow, UK"
      ],
      "name": "Elita Smiley"
    },
    {
      "affiliations": [
        "School of Health, University of Lancashire, Preston, UK"
      ],
      "name": "Umesh Chauhan"
    },
    {
      "affiliations": [
        "School of Health and Wellbeing, University of Glasgow, Glasgow, UK"
      ],
      "name": "Christine Pacatti"
    },
    {
      "affiliations": [
        "School of Health and Wellbeing, University of Glasgow, Glasgow, UK"
      ],
      "name": "Craig Melville"
    }
  ],
  "title": "Temporal associations between incident physical health problems/sensory impairments and challenging behaviours in people with intellectual disabilities: a population-based longitudinal cohort study of primary care in England",
  "uid": "f1650b44-d66c-5f8e-bcfa-261639f6491e"
}