Can we reduce the prevalence of challenging behaviour in people with intellectual disabilities?

This paper argues for a paradigm shift in our thinking about challeng-ing behaviour in people with intellectual disabilities. Traditionally, suchbehaviour is conceptualized as an individual problem requiring assess-ment and treatment. Prevalence is measured by the percentage ofindividuals displaying challenging behaviour. Epidemiological studiespoint primarily to ‘at risk’ characteristics of individuals. Interventionfocuses on changing the individual or changing the way in which theirbehaviour is managed. I argue that such an approach is insufficient.Effective approaches to individual intervention have not reduced theprevalence of challenging behaviour. We should see challenging behav-iour as a ‘public health’ (as well as individual) issue and, consequently,take a more systemic approach. Specifically I will argue that: we should stop thinking of challenging behaviour as just a character-istic of ‘at risk’ individuals; we should measure prevalence by the frequency/severity of incidentsas well as the percentage of individuals who display it; we should study the surrounding system-level meta-contingencies as well as contingencies surrounding individual behaviour;•we should extend intervention from treating the individual to reducing the prevalence of challenging behaviour.