Clinical management of aggression in people with intellectual disability or autism spectrum disorder in formal care settings: a state-of-the-art review

Purpose This study is a part of a larger project aimed at reviewing clinical, care and managerial practices for people with intellectual disability or autism spectrum disorders (ID/ASD) and challenging behavior resulting in violence or aggression. The purpose of this study is to conduct a state-of-the-art review of interventions aimed at preventing and managing aggression in individuals with ID/ASD in formal care settings. Design/methodology/approach A systematic literature search was conducted on January 24th, 2024, focusing on three main concepts: “intellectual disabilities/autism spectrum disorders,” “aggressive behaviour” and “specialized services.” Four reference databases were searched. Two independent reviewers selected studies and conducted data extraction. References were categorized by major themes, with data extraction and narrative synthesis performed for each theme. Findings This paper found that the number of publications on this theme has gradually diminished over the past 30 years. The number of publications on psychosocial interventions increased, while those pertaining to pharmacological approaches decreased. In the former, studies on staff training have increasingly supplanted interventions directly targeting individuals with ID/ASD. Small, uncontrolled studies reported some efficacy for aggression management interventions, while controlled trials generally found no significant effects. Several authors emphasized the primary role of environmental factors in controlling aggression among individuals with ID/ASD. Research limitations/implications The selection of literature in a unique pool without creating a separate search equation for each subsection of the study. It may cause the omission of important publications in the field. It does not allow for a complete picture of evaluated interventions for the prevention and management of violent behaviors in individuals with IA/ASD. However, it allows us to trace the evolution of discussions on the topic. In addition, a formal evaluation of the methodological quality of the included studies was not conducted. Practical implications This review may inform researchers and practitioners about the current state of matters in clinical intervention for aggressive behavior in adults with ID/ASD. Originality/value To the best of the authors’ knowledge, this is the first review taking a historical perspective in analyzing the development of approaches for dealing with aggressive behavior in adults with ID/ASD in formal settings. This perspective enables considering past unproductive paths and inspires the development of new approaches.