Intended for healthcare professionals

Practice Guidelines

Challenging behaviour and learning disabilities: summary of NICE guidance

BMJ 2015; 350 doi: (Published 02 June 2015) Cite this as: BMJ 2015;350:h2652
  1. Stephen Pilling, director, professor12,
  2. Elena Marcus, research assistant12,
  3. Craig Whittington, associate director, senior research associate12,
  4. Glynis Murphy, co-director, professor3
  5. On behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Mental Health, University College London, London WC1E 7HB, UK
  2. 2Centre for Outcomes Research and Effectiveness, University College London
  3. 3Tizard Centre, University of Kent, Canterbury, UK
  1. Correspondence to: S Pilling s.pilling{at}

The bottom line

  • Include the person with learning disabilities and his or her family and carers in assessments and interventions

  • Undertake functional assessments and implement behaviour support plans linked to these

  • Provide the least restrictive behavioural, cognitive behavioural, and psychosocial interventions, as close to home as possible

  • Reserve drugs as a treatment option for severe aggression or self injury, and only in combination with a behavioural, cognitive behavioural, or psychosocial intervention

  • Aim to increase quality of life as well as reducing behaviour that challenges

How patients were involved in the creation of this article

Three lay committee members with specific knowledge and experience of challenging behaviour in people with a learning disability contributed to the formulation of the recommendations summarised in this article. People with learning disabilities and carers of people with learning disabilities and behaviour that challenges took part in focus groups that informed the development of recommendations summarised in this article.

It is relatively common for people with a learning disability to develop behaviour that challenges. In educational, health, and social care settings, prevalence rates of challenging behaviour in people with learning disabilities vary from 10% to 15%,1 2 with rates peaking between the ages of 20 and 49 years. Rates are higher in people with more severe disabilities and within inpatient settings.1 Behaviour that challenges includes aggression, self injury, stereotypic behaviour, and withdrawal, which often result from the interaction of personal and environmental factors. Such behaviour can have detrimental consequences for the person, including lower quality of life, restrictive practices, physical abuse, and out of area placements.1

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on challenging behaviour and learning disabilities in adults, children, and young people.3


NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal …

View Full Text

Log in

Log in through your institution


* For online subscription