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Antipsychotic drugs are often used outside their licensed indication to manage aggression in adults with intellectual disabilities in the absence of a diagnosed psychiatric disorder. The current case series shows that antipsychotics could be effective, but they are often used with non‐drug measures and sometimes cause side‐effects. Clinicians did not always carry out a thorough assessment followed by a formulation before prescribing medications, as recommended in the national and international guides (Deb et al, 2009; Unwin & Deb, 2010). It is also apparent that clinicians did not carry out tests to detect side‐effects of risperidone such as metabolic syndrome. Clinicians should use psychotropic medication for a minimum period of time and at the lowest possible dose, and should consider non‐drug management of aggression at the outset and at a regular interval.

We describe the results of a qualitative study that explored the knowledge and views 20 adults with learning disabilities and their carers had of medication prescribed for behaviour problems. We found that the adults with mild and moderate learning disabilities can provide sensible, consistent and valuable information about their thoughts and experiences of medication prescribed when questions are asked in an open‐ended format. We also found that few people with learning disabilities were fully informed about their treatment. Nevertheless, the prescribing of such medication emerged as a positive experience, in keeping with the wishes of the majority of participants interviewed who expressed satisfaction with the medication based on perceived benefit. For the minority of participants who expressed dissatisfaction with medication, the reasons related mainly to their perceived lack of role in the treatment decision, their experience of adverse effects, a perceived lack of efficacy and a ‘desire to lead a normal life’. Alternatives to medication were discussed by both adults with learning disabilities and their carers, and the relevance of these findings to clinical practice is addressed in the paper.

A high proportion of people with learning disabilities receive psychotropic medications such as antipsychotics, antidepressants, antianxiety drugs including benzodiazepines, buspirone and beta blockers, mood stabilisers such as lithium and some antiepileptic medications, psychostimulants, opioid antagonists and also vitamins and diets. Many receive these for behaviour problems for which these medications have not been indicated. Apart from a few exceptions of recent good quality randomised controlled trials (RCTs) of risperidone on the management of behaviour problems among children and adults with learning disabilities with and without autism, most of the evidence for the effectiveness of medication for the management of behaviour problems comes from non‐controlled or non‐randomised observational studies. The lack of evidence does not automatically mean that there is evidence that these medications are not effective. Current guidelines suggest that a thorough assessment of the cause and effect of the behaviour problems should be carried out before prescribing medications. A formulation should document the assessment and rationale for use of medications. Non‐medication based interventions should always be considered along with medication and where appropriate behavioural and psychological interventions should be employed either instead of or along with the medication. People with learning disabilities and their carers should be involved in the decision‐making process all along. Where necessary other relevant professionals should also be involved. At the outset the time, method and people involved with the follow‐up assessment should be determined. Follow up should involve an objective assessment of target behaviours but, more importantly, an assessment of the quality of life of the person and their carers. At each follow up a reformulation should be carried out along with consideration of non‐medication based management and the possibility of withdrawing medication. Important issues such as capacity, consent and legal issues should always be borne in mind. Medications should be used with some caution because of their adverse effects.

This article describes a national guideline for the use of medication in the management of problem behaviours in adults with an intellectual disability. As problem behaviours in this group are common and medication is often prescribed ‘off licence’, it is important that a framework is established to direct this practice. The article details a guideline development project that is of importance because it is the only national guideline in the area. It also highlights important issues in clinical practice in the field, and addresses the current evidence base on the effectiveness of psychotropic medications in the management of problem behaviours. There is a lack of good research evidence to support use of medication for problem behaviours. Where medication is used for this purpose, it should be used with a clear rationale, following a thorough assessment of the individual, and carefully monitored, and withdrawal should always be considered. People should always be given information in a way that they understand, and they should be given choices about their treatment.

The aim of the research was to scope issues of concern at transition for young people with learning disabilities and mental health problems/challenging behaviour from the perspective of parent carers, using a focus group interview consisting of ten participants, including one facilitator and administrative support. The interview was tape‐recorded, transcribed and thematically coded using Microsoft Word and NVivo. Two case vignettes were used to stimulate the discussion. Several themes emerged from analysis of the transcripts: access to information about rights and the services available for their son or daughter, and conflicts between carers and professionals. The experience of parent carers of people with learning disabilities is still not well understood. By understanding the views and experiences of parent carers, transition can be facilitated and concerned parties can work together to achieve better results.

The paper reports on a review of assessment scales commonly used for assessment of psychiatric illnesses or behaviour problems in adults with learning disabilities. Initially, a literature search was conducted to identify relevant peer‐reviewed journal publications pertaining to relevant scales. Those scales with more publications were reviewed with reference to the scale composition and psychometric properties. In total, eight behaviour scales, one psychiatric illness scale and three combined behaviour and psychiatric illness scales are reviewed.