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Br J Med Psychol. 2001 Sep;74(Pt 3):305-21.

Contingent reinforcement or defending the self? A review of evolving models of aggression in people with mild learning disabilities.

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  • 1Department of Psychological Medicine, Gartnavel Royal Hospital, Glasgow, UK.


This paper examines the changing approaches to working with people with a moderate to mild learning disability, who are frequently aggressive. Long-held assumptions about the lack of inter-personal understanding and impulsiveness continue to play a central role in clinical assessment and intervention for this group. Yet, there is a lack of controlled studies indicating the influence of such factors in frequent aggression. The dominant behavioural tradition has long encouraged such assumptions, but has focused on people with more severe disabilities where such assumptions are arguably more appropriate. The current review of the literature shows a clear evolution away from a strict behavioural approach towards cognitive-behavioural therapy (CBT) approaches that take account of the heterogeneous psychosocial causes of aggression. We find support for CBT in the child-development literature, which examines inter-personal difficulties from an information-processing perspective. Finally, we argue that much of the literature implicitly utilizes the concept of self, and we suggest that this should be made explicit in a reformulated theory of the 'person', incorporating the self concept and embedding individual cognitive processes and behaviour in a social context.

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