Measurement tools for behaviours that challenge and behavioural function in people with intellectual disability: A systematic review and meta-analysis of internal consistency, inter-rater reliability, and test-retest reliability


Behaviours that challenge (BtC) are common in people with intellectual disability (ID) and associated with negative long-term outcomes. Reliable characterisation of BtC and behavioural function is integral to person-centred interventions. This systematic review and meta-analytic study quantitatively synthesised the evidence-base for the internal consistency, inter-rater reliability, and test-retest reliability of measures of BtC and behavioural function in people with ID (PROSPERO: CRD42021239042). Web of Science, Embase, PsycINFO and MEDLINE were searched from inception to March 2024. Retrieved records (n = 3691) were screened independently to identify studies assessing eligible measurement properties in people with ID. Data extracted from 83 studies, across 29 measures, were synthesised in a series of random-effects meta-analyses. Subgroup analyses assessed the influence of methodological quality and study-level characteristics on pooled estimates. COSMIN criteria were used to evaluate the measurement properties of each measure. Pooled estimates ranged across measures: internal consistency (0.41–0.97), inter-rater reliability (0.29–0.93) and test-retest reliability (0.52–0.98). The quantity and quality of evidence varied substantially across measures; evidence was frequently unavailable or limited to a single study. Based on current evidence, candidate measures with the most evidence for internal consistency and reliability are discussed; however, continued assessment of measurement properties in ID populations is a key priority.

Publication DOI:
Divisions: College of Health & Life Sciences
College of Health & Life Sciences > School of Psychology
College of Health & Life Sciences > Aston Institute of Health & Neurodevelopment (AIHN)
Funding Information: This work was supported by The Baily Thomas Charitable Fund , grant number 5682\u20138803 . The funders had no role in the study design, data collection, analysis and interpretation of data, preparation of the manuscript or the decision to submit the pape
Additional Information: Copyright © 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (
Uncontrolled Keywords: Intellectual disability,Behaviours that challenge,Function,Measurement,Measurement properties,Psychiatry and Mental health,Clinical Psychology
Publication ISSN: 1873-7811
Data Access Statement: Data availability is not applicable to this article as no new data were created or analysed in this study.
Last Modified: 17 May 2024 07:23
Date Deposited: 17 Apr 2024 11:39
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Related URLs: https://linking ... 272735824000552 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Review article
Published Date: 2024-06
Published Online Date: 2024-04-16
Accepted Date: 2024-04-12
Authors: Shelley, Lauren
Jones, Chris
Pearson, Effie (ORCID Profile 0000-0002-4328-1653)
Richards, Caroline
Crawford, Hayley
Paricos, Arianna
Greenhill, Courtney
Woodhead, Alixandra
Tarver, Joanne (ORCID Profile 0000-0003-0555-6043)
Waite, Jane (ORCID Profile 0000-0002-8676-3070)



Version: Accepted Version

Access Restriction: Restricted to Repository staff only


Version: Published Version

License: Creative Commons Attribution

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