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PBS Approach — MRCPsych Paper B MCQ

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EasyIntellectual DisabilityPBS ApproachMRCPsych Paper B

An adult with a moderate intellectual disability displays recurrent aggression during changes in routine. Physical and mental health contributors have been assessed, and there is no immediate risk requiring emergency containment. The multidisciplinary team plans a positive behavioural support approach. Which intervention best reflects this approach?

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Correct answer: A — Identifying the behaviour's function and using person-centred proactive strategies to improve quality of life and teach alternative skills

Positive behavioural support is based on understanding the function of behaviour through assessment and developing a person-centred behaviour support plan. The plan prioritises proactive environmental changes, meaningful activity and teaching alternative communication, emotional-regulation or social skills, with improvement in quality of life as a central outcome. Punishment does not address the function of the behaviour and is inconsistent with a supportive, least-restrictive approach. Medication should not be the sole first-line strategy for behaviour that challenges. Restraint and seclusion are restrictive reactive measures; they may be considered only when necessary and proportionate to significant immediate risk, alongside proactive interventions and a plan to reduce their use.

Reference: National Institute for Health and Care Excellence. Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges (NG11), recommendations 1.5.9, 1.6.1 and 1.9.1–1.9.4. 2015. https://www.nice.org.uk/guidance/ng11/chapter/recommendations