The development and persistence of problem behaviors in individuals with developmental disabilities (DD) represent a great concern to their caregivers and may endanger the individuals themselves. United Kingdom surveys of people with DD within the severe range of mental handicap suggest that about 20% of the child and adolescent population and 15% of the adult population exhibit some form of problem behavior.1,2 More recently, Jacobson3 wrote that one in four individuals with diagnosed DD also had a diagnosed mental illness or a behavioral disorder.

The causes of problem behaviors are complex and usually entail a combination of personal (internal) and social (external) factors. The personal causes of behavior problems can include skill deficits that interfere with the meeting of personal needs and may include symptoms of unappreciated psychiatric conditions. The social causes can include interpersonal and environmental conditions that may conspire unwittingly to reinforce problem behaviors.

It is important to appreciate that each individual’s problem behavior takes place against the backdrop of a unique personal history and within a particular biopsychosocial milieu. Therefore, effective therapy to reduce an undesirable behavior cannot be developed until that behavior has been analyzed carefully and the specific circumstances that control it have been recognized. A biopsychosocial model offers a way of interpreting behavior problems that provides guidelines for the development of effective therapy.

The following pages define what is meant by problem behaviors and discuss possible causes for such behaviors in people with DD. They present a biopsychosocial model of the development and maintenance of problem behaviors and discuss some intervention strategies resulting from this model of problem behavior.

Adapted from: Sudhalter V. Problem behaviors in individuals with developmental disabilities. In: Devinsky O and Westbrook LE, eds. Epilepsy and Developmental Disabilities. Boston: Butterworth-Heinemann; 2001;165–174.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised May 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.