Updating a meta-analysis of intervention research with challenging behaviour: Treatment validity and standards of practice

Background This meta-analysis of interventions with challenging behaviour in children with disabilities updates a comprehensive meta-analysis that previously addressed reported standards of practice and effectiveness of different strategies. Method Four effect-size algorithms were calculated for published intervention cases, and results analysed and compared to previous findings by behaviour target, intervention type, and other factors. Results The evidence largely supports intervention effectiveness, with some inconsistency reflecting the fact that the four metrics assess different aspects of change. Skills replacement, consequence combined with systems change, and antecedent interventions generated selective positive results, large enough to be clinically meaningful. Conclusions Behavioural interventions effectively reduce challenging behaviour, particularly when preceded by a functional analysis. Teaching replacement skills was most effective, especially if used in combination with systems change and/or traditional antecedent and consequence manipulation. Positive changes as well as enduring limitations to both research design and standards of clinical practice in comparison to 18 years ago are discussed.