Contextual support and quality of life of individuals with intellectual disability and severe and persistent challenging behaviour

Abstract

The studies in this dissertation were part of the SCORE project, a follow-up study evaluating the effects of interventions in 24/7 intensive support facilities that are offered to adults with Intellectual Disability (ID) and severe challenging behaviour (CB). The studies were carried out in four specialized service organizations for people with intellectual disability in The Netherlands.

This dissertation shows that personalized, contextual intensive support plays an important role in the quality of life of individuals with intellectual disability and severe challenging behaviour. Higher appraisal of contextual support of a multidisciplinary team is positively associated with quality of life in adults with severe ID and CB, particularly when challenging behaviour is less severe. Additionally, extra intensive support is effective in reducing challenging behaviour over time, although its impact on adaptive functioning and overall quality of life remains limited. Furthermore, less communicative abilities are related to more challenging behaviour, emphasizing the need for targeted interventions that enhance both receptive and expressive communication skills. Strategies of Augmentative and Alternative Communication (AAC) can be beneficial, provided that it is implemented effectively. Overall, these findings highlight the necessity of individualized, well-implemented individual contextual support to improve both behavioural outcomes and quality of life for individuals with ID and severe CB.