skip to main content

Physical Causes of SIB in ID — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModerateIntellectual DisabilityPhysical Causes of SIB in IDMRCPsych Paper B

A 25-year-old man with moderate learning disability and autism has developed recurrent head-banging over the past 2 weeks. He uses only a few words and cannot reliably describe pain or other symptoms. There has been no clear change in his staffing, routine or environment. According to NICE NG11, which is the most appropriate component of his initial assessment before the behaviour is formulated solely in behavioural terms?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Assess physical and mental health problems and medication effects, including possible pain

The correct answer is B. NICE NG11 recommends that the initial assessment of behaviour that challenges considers physical and mental health problems and the effects of medication, including adverse effects. For recent-onset behaviour, clinicians should examine whether changes in physical or psychological health are contributing. This is particularly important when communication difficulties may prevent the person from reporting pain. Assessment should be clinically targeted and incorporated into a broader functional formulation rather than requiring every conceivable condition to be definitively excluded first. An EEG is indicated only if the presentation suggests epilepsy. Psychosis is one possible mental health contributor but should not take priority over a comprehensive assessment. Medication should be reviewed, not stopped indiscriminately. A behaviour support plan should be informed by assessment rather than substituted for it.

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, recommendations 1.5.5 and 1.5.11, 2015 (updated 2020). https://www.nice.org.uk/guidance/ng11/chapter/recommendations