Hassiotis Angela A, Hall Ian
Department of Mental Health Sciences, University College of London, Charles Bell House, 67-73 Riding House Street, London, UK, W1W 7EY.
Cochrane Database Syst Rev. 2008 Jul 16(3):CD003406. doi: 10.1002/14651858.CD003406.pub3.
Outwardly directed aggressive behaviour is a significant part of problem behaviours presented by people with learning disabilities. Prevalence rates between 3.3% to 36% have been reported in the literature. Such behaviours often run a long term course and are a major cause of social exclusion.
To determine the efficacy of behavioural and cognitive behavioural interventions for outwardly-directed aggressive behaviour for people with learning disabilities.
The Cochrane Library (CENTRAL) 2007 (Issue 1), MEDLINE 1966 to February 2007, EMBASE 1980 to February 2007, PsycINFO 1872 to February 2007 and Dissertation Abstracts late 1960s to February 2007 were searched. Where appropriate, research filters were used.
Studies were selected if more than four participants, children or adults, were allocated by random or quasi-random methods to either intervention or standard treatment/wait list.
References identified by electronic searches, examinations of bibliography and personal contacts were screened against inclusion criteria by two independent reviewers. Two reviewers independently extracted and entered data into RevMan (Cochrane Collaboration software).
Four studies based on adult populations with learning disabilities were deemed to be suitable for inclusion in the current version of this review. Data were only available in a form suitable for meta-analysis in three studies, but due to heterogeneity of populations and interventions, meta-analysis was not performed. Direct interventions based on cognitive-behavioural methods (modified relaxation, assertiveness training with problem solving, and anger management) appear to have some impact on reduction of aggressive behaviour at the end of treatment and in some studies also at follow up (up to six months).
AUTHORS' CONCLUSIONS: The existing evidence on the efficacy of cognitive behavioural and behavioural interventions on outwardly directed aggression in children and adults with learning disabilities is scant. There is a paucity of methodologically sound clinical trials. Given the impact of such behaviours on the affected individual, his or her carers and on service providers, effective interventions are essential. It is also important to investigate cost efficacy of treatment models against existing treatments. We recommend that randomised controlled trials of sufficient power are carried out using primary outcomes of reduction in outward directed aggression, improvement in quality of life and cost efficacy as measured by standardised scales.
外向攻击性行为是学习障碍者所表现出的问题行为的重要组成部分。文献报道的患病率在3.3%至36%之间。此类行为往往病程较长，是导致社会排斥的主要原因。
确定行为干预和认知行为干预对学习障碍者外向攻击性行为的疗效。
检索了Cochrane图书馆（CENTRAL）2007年第1期、MEDLINE 1966年至2007年2月、EMBASE 1980年至2007年2月、PsycINFO 1872年至2007年2月以及20世纪60年代末至2007年2月的学位论文摘要。在适当情况下使用了研究筛选器。
如果有超过四名儿童或成人参与者通过随机或半随机方法被分配到干预组或标准治疗组/等待名单，则选择该研究。
由两名独立评审员根据纳入标准对通过电子检索、参考文献检查和个人联系确定的参考文献进行筛选。两名评审员独立提取数据并将其输入RevMan（Cochrane协作软件）。
四项针对成年学习障碍人群的研究被认为适合纳入本综述的当前版本。只有三项研究的数据形式适合进行荟萃分析，但由于人群和干预措施的异质性，未进行荟萃分析。基于认知行为方法的直接干预（改良放松、解决问题的自信训练和愤怒管理）似乎在治疗结束时对减少攻击性行为有一定影响，并且在一些研究的随访中（长达六个月）也有影响。
关于认知行为干预和行为干预对学习障碍儿童和成人外向攻击性行为疗效的现有证据不足。缺乏方法学上合理的临床试验。鉴于此类行为对受影响个体、其照顾者和服务提供者的影响，有效的干预措施至关重要。研究治疗模式相对于现有治疗方法的成本效益也很重要。我们建议进行有足够效力的随机对照试验，使用外向攻击性行为减少、生活质量改善以及通过标准化量表衡量的成本效益等主要结局指标。
