Grey Ian M, Hastings Richard P
KARE, Newbridge, Co. Kildare and Department of Psychology, Trinity College, Dublin, Ireland.
Curr Opin Psychiatry. 2005 Sep;18(5):469-75. doi: 10.1097/01.yco.0000179482.54767.cf.
To critically review the most recently published studies on the treatment of challenging behaviours/behaviour disorders for individuals with intellectual disability.
Literature published in the review period was from three traditions: applied behaviour analysis, psychopharmacology, and service evaluation. Applied behaviour analysis treatments have a large evidence base, and recent research has focused on refining issues such as dealing with low rate behaviours, improving generalization, the effects of choice-making, and setting event variables that may affect treatment outcomes. Recent interest in risperidone as a treatment for behaviour disorder has dominated the literature on pharmacological interventions. Several empirical studies support the use of risperidone in children, although a recent review is more sceptical of the quality of the evidence to date. A small number of service evaluation studies suggest in particular that applied behaviour analysis technologies can be scaled up to benefit large numbers of patients.
Applied behaviour analysis methods for the assessment and treatment of behaviour disorders continue to be the focus of research, and continue to result in positive outcomes. Recent data show the value of using applied behaviour analysis technologies as a service model for people with behaviour disorders. Pharmacological treatments, especially risperidone, also have a developing evidence base despite a lack of understanding of their mechanisms of action. A number of questions about behaviour disorders remain unanswered, especially whether early intervention may be effective and their putative relationship with psychiatric conditions.
批判性地回顾最近发表的关于治疗智力残疾个体具有挑战性的行为/行为障碍的研究。
综述期间发表的文献来自三个传统领域：应用行为分析、精神药理学和服务评估。应用行为分析治疗有大量的证据基础，最近的研究集中在完善一些问题，如处理低发生率行为、提高泛化能力、决策的影响以及可能影响治疗结果的背景事件变量。最近对利培酮作为行为障碍治疗药物的兴趣主导了药理学干预方面的文献。一些实证研究支持在儿童中使用利培酮，尽管最近的一篇综述对目前证据的质量更为怀疑。少数服务评估研究特别表明，应用行为分析技术可以扩大规模以使大量患者受益。
用于评估和治疗行为障碍的应用行为分析方法仍然是研究的重点，并继续产生积极的结果。最近的数据显示了将应用行为分析技术用作行为障碍患者服务模式的价值。尽管对其作用机制缺乏了解，但药物治疗，尤其是利培酮，也有不断发展的证据基础。关于行为障碍仍有许多问题未得到解答，特别是早期干预是否有效以及它们与精神疾病的假定关系。
