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Antipsychotic medication over-prescribed for people with learning difficulties, NICE guidance says

29 May 2015

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There needs to be less reliance on antipsychotic medication for people with a learning difficulty and challenging behaviour, NICE says in guidance published today.

Early functional assessments and behaviour support plans may provide an effective alternative, it recommends.

Vivien Cooper, chief executive of the Challenging Behaviour Foundation (CBF) and a representative for the group that developed the NICE guideline, said: “Families of children, young people and adults who contact the CBF describe how hard it is to get the right support, in the right place, at the right time.”

“There is a need to move away from a crisis management approach with a reliance on restrictive practices, to early intervention and prevention, providing accessible, timely and practical information and support to meet individual need,” she said.

Challenging behaviour includes aggression, self-injury, withdrawal, stereotypic behaviour (such as rocking or hand flapping), and disruptive or destructive behaviour. It can include violence, arson or sexual abuse, and may bring the person into contact with the criminal justice system.

Prevalence rates for this behavior are higher in teenagers and people in their early 20s, and in particular settings (for example, 30–40% in hospital settings).

People with a learning disability who also have communication difficulties, autism, sensory impairments, sensory processing difficulties and physical or mental health problems (including dementia) may be more likely to develop challenging behaviour.