• A Hassiotis and I Hall.
• Department of Psychiatry & Behavioural Sciences, RF & UCMS, Wolfson Building, 48 Riding House Street, London, UK, W1N 8AA. a.hassiotis@ucl.ac.uk
• Cochrane Db Syst Rev. 2004 Oct 18 (4): CD003406.

BackgroundOutwardly directed aggressive behaviour is a significant part of problem behaviours presented by people with learning disabilities. Prevalence rates between 3.3% to 36% have been reported in the literature. Such behaviours run a long term course and are a major cause of social exclusionObjectivesTo determine the efficacy of behavioural and cognitive behavioural interventions for outwardly-directed aggressive behaviour for people with learning disabilities.Search StrategyThe Cochrane Library (CENTRAL), MEDLINE, EMBASE, CINAHL, ERIC and PsycINFO were searched using a strategy combining (Learning or synonyms) and (Disabilities or synonyms) and (Behaviour or synonyms) and (treatment or synonyms) to late 2002. Where appropriate, research filters were used.Selection CriteriaStudies were selected if more than 4 participants, children or adults, were allocated by random or quasi-random methods to either intervention or standard treatment/wait list.Data Collection And AnalysisReferences identified by electronic searches, examinations of bibliography and personal contacts were screened against inclusion criteria by two independent reviewers.Main ResultsThree studies based on adult populations with learning disabilities were deemed to be suitable for inclusion but data were only available in a form suitable for meta-analysis in two studies. Direct interventions based on cognitive-behavioural methods (modified relaxation, assertiveness training with problem solving, and anger management) appear to have some impact on reduction of aggressive behaviour at the end of treatment but not at follow up (up to six months) as rated by individuals and their carers.Reviewers' ConclusionsThe existing evidence on the efficacy of cognitive behavioural and behavioural interventions on outwards directed aggression in children and adults with ID is scant. There is a paucity of methodologically sound clinical trials. Given the impact of such behaviours on the affected individual, his or her carers and on service providers, effective interventions are essential. It is also important to investigate cost efficacy of treatment models against existing treatments. We recommend that randomised controlled trials of sufficient power are carried out using primary outcomes of reduction in outward directed aggression, improvement in quality of life and cost efficacy as measured by standardised scales.

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