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Challenging Behaviour — MRCPsych Paper B MCQ

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ModerateIntellectual DisabilityChallenging BehaviourMRCPsych Paper B

A 35-year-old man with mild intellectual disability has recurrent episodes of aggression and self-injury. Initial assessment has not identified a coexisting physical or mental health disorder, the function of the behaviour remains unclear, and there is no immediate very severe risk to him or others. According to NICE NG11, what is the most appropriate next step?

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Correct answer: B — Undertake a functional assessment and develop a written behaviour support plan

The correct answer is B. Because the behaviour is recurrent and its function remains unclear after initial assessment, NICE NG11 recommends functional assessment to identify triggers, consequences and maintaining factors. This formulation should inform a written, person-centred behaviour support plan containing proactive, preventive and reactive strategies. Antipsychotics are not routine first-line treatment: they are considered only when non-pharmacological interventions have failed, treatment of a contributing health problem has been ineffective, or risk is very severe, and must accompany psychological or other interventions. Regular benzodiazepines do not address the function of the behaviour. Residential placement is unnecessarily restrictive, while increasing staffing alone may be part of a support plan but is not a substitute for assessment and formulation.

Reference: National Institute for Health and Care Excellence. Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges. NICE guideline NG11, sections 1.5–1.8. 2015, minor changes 2020. https://www.nice.org.uk/guidance/ng11/chapter/recommendations