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Introduction
Positive behaviour support (PBS) is a multifaceted framework developed to support people with an intellectual disability (ID) (also referred to as a learning disability) who present with challenging behaviour (Gore et al., 2013). PBS applies the principles of applied behaviour analysis through evidence-based interventions and is commonly used within ID services (Cooper et al., 2019; Gore et al., 2013; Lewis et al., 2021). The overarching aim of PBS is to improve quality of life for the individual and system around them through reducing challenging behaviours and educating caregivers (Goh and Bambara, 2012; Gore et al., 2013). PBS is one of the leading interventions for working with individuals with ID and challenging behaviour in the UK (LaVigna and Willis, 2012; Royal College of Psychiatrists, British Psychological Society, and Royal College of Speech and Language Therapists, 2007). However, there have been mixed findings relating to the efficacy of PBS in reducing challenging behaviour. Multiple randomised controlled trials of PBS-based staff training for adults with ID found that there was no significant reduction in challenging behaviour compared to treatment as usual (Bosco et al., 2019; Hassiotis et al., 2018). Thus, questions have been raised as to the efficacy of PBS interventions.
As behaviour is driven by our emotions, it is important to consider that weaknesses of PBS may be related to a lack of consideration of emotional development (ED) level (Izard, 2009). ED can refer to an increase in the ability to experience, express and understand a range of emotions across the life span, and to be able to process and cope with these effectively and appropriately. It has consistently been found that ED can be at a lower level than cognitive development in an ID population (Došen, 2014; Sappok et al., 2014; La Malfa et al., 2009; Sterkenburg et al., 2021; Vandevelde et al., 2016). Discrepancies between chronological and ED age in ID could be attributed to experiences of trauma, which subsequently cause challenging behaviour. A causal relationship between challenging behaviour and trauma has been established in the literature (McNally et al., 2021), and we know that those with ID are at a significantly higher risk of experiencing trauma. A systematic review and meta-analysis...