Introducing the OBS-LDASC: An Innovative Tool to Monitor Behaviour That Challenges in Autism Spectrum Conditions and Learning Disability

Background: Behaviours that challenge are common in residential services for adults with Learning Disabilities (LD) and Autism Spectrum Conditions (ASC), and impact on quality of life. Behaviour monitoring is essential for clear identification of challenging behaviours and understanding factors which trigger and maintain behaviour. Existing monitoring tools for use in other populations require adaptation to reflect behaviours observed in LD/ASC. We present a new behaviour monitoring system, the Overt Behaviour Scale-Learning Disabilities and Autism Spectrum Conditions (OBS-LDASC), which was purposely designed for use with adults with ASC and/or LD. The OBS-LDASC is grounded on a Positive Behaviour Support framework and monitors challenging behaviour in residential settings. It is consistent with the existing evidence-base (e. g. Scotti et al., 1991; Didden et al., 1997; Ager and O’May, 2001) stating that a functional analysis must be conducted using detailed, accurate and up-to-date information about antecedents, behaviour and consequences. The unique flexibility offered by the OBS-LDASC allows it to be individualised to provide a truly person centred approach. The tool has been designed for use with people aged 16 years and over with ASC and/or LD. However, it has potential to be used in other clinical populations (e.g. forensic settings) and formats (e.g. self-monitoring). The OBS-LDASC is supported by a user manual, full training package and database, which allows automatic graphical presentation of data.

Objectives: The aims of this paper are: 1) to introduce a new behaviour monitoring system, the Overt Behaviour Scale-Learning Disabilities and Autism Spectrum Conditions (OBS-LDASC), and 2) to present psychometric properties of the tool and demonstrate its clinical utility. 

Methods: Using standard techniques for the development of new assessment instruments (e. g. Rust & Golombok, 1999), we adapted and extended existing tools for monitoring challenging behaviour in other clinical groups (e.g. OAS-MNR, Alderman et al., 1997; SASBA, Knight, 2008). The resulting OBS-LDASC provides continuous measurement of the severity, frequency and duration of 13 specific challenging behaviours (as defined by the UK Royal College of Psychiatrists, 2007), as well as the antecedents and consequences of behaviour. Inter-rater reliability was investigated from recordings made by support staff about ten video scenarios of behaviour that challenges. Test-retest reliability was established by asking the same participants to view the clips again four weeks later. Data from a clinical data sample established the validity of the tool.

Results: Estimates of test-retest reliability were moderate to strong. Inter-rater reliability was very good for type of behaviour and good for severity, but variable for antecedents and consequences. Clinical data demonstrate the type, prevalence and severity of challenging behaviour in those with LD/ASC, alongside the most common triggers and reducing factors.

Conclusions: The present results establish the robust psychometric properties of this innovative behaviour monitoring tool, as well as its utility for identification, understanding and informing intervention around challenging behaviours in clinical practice.