Challenging behaviour and disability
What is challenging behaviour?
Challenging behaviour is a term used to describe a wide range of behaviours that can be demonstrated by people with learning, communication and other difficulties. It can be argued that anyone can show challenging behaviour.
Challenging behaviour used to be described as ‘problem behaviour’ or ‘difficult behaviour’ or ‘socially unacceptable behaviour’, but in recent years the term challenging behaviour has been used to reflect the fact that some of the behaviours that are seen are a challenge to us as professionals, teachers, carers and parents. That the person showing these behaviours is not a ‘problem’ to be fixed, or someone doing something wrong that needs to be sorted, but that the behaviour is a sign that something isn’t working. It shows that there is some need being unfulfilled, or a problem with communication.
In essence it is that there is something going wrong that needs to be addressed, not that there is a person doing something wrong who needs to be stopped.
The term challenging behaviour refers to the definition given by Emerson (1995). He defines challenging behaviour as; “Behaviour(s) of such intensity, frequency or duration that the physical safety of the person or others is likely to be put in jeopardy, or behaviour which is likely to limit the use of, or result in the person being denied access to ordinary community facilities.”
In other words, behaviour is challenging if it causes harm to the person or others, or if it stops them fulfilling some aspect of their lives. For example, if someone cannot go to school because they show some aggressive behaviour or if someone cannot go swimming because they tend to run off.
It is the impact of these behaviours that makes them challenging, not any judgement about their appropriateness.
There are many different types of behaviours that can be termed challenging:
- Self-injurious behaviour includes head-banging, scratching, pulling, eye poking, picking, grinding teeth, eating non-foodstuffs.
- Aggressive behaviour toward others includes biting and scratching, hitting, pinching, grabbing, hair pulling, throwing objects, verbal abuse, screaming, spitting.
- Stereotyped behaviour including repetitive movements, rocking, repetitive speech and repetitive manipulation of objects.
- Non-person directed behaviour includes damage to property, hyperactivity, stealing, inappropriate sexualised behaviour, destruction of clothing, incontinence, lack of awareness of danger, withdrawal.
What is the link between disability and challenging behaviour?
Challenging behaviour is more likely to occur if a person is disabled. Each person’s story is different and unique, but a combination of impairments, environment, interpersonal relationships and other factors contribute to a behaviour being more or less likely to occur. A disabled person is more likely to be put into a position where they have to develop some form of behaviour in order to have their needs met. For example, a young person who has a visual impairment and makes use of a manual wheelchair that they cannot propel may learn to shout out in order to have their needs recognized if their appropriate communication skills have not been recognized and developed. An individual with autism who has a strong negative reaction to their personal space being invaded may learn that hitting people makes them move away.
Each behaviour has a function for the person displaying it.
Reasons for challenging behaviour
There are many potential reasons or combination of reasons for a behaviour to be shown. In some cases the reasons may be quite simple – a person cannot cope with crowds so runs away. Or there may be a complex mix of factors involved.
Challenging behaviour can stem from biological causes. For instance, Lesch-Nyhan syndrome is linked to self-injurious behaviour due to differences in how the brain handles chemicals and hormones.
Stereotyped behaviour (such as rocking) may be the means by which a person maintains the level of stimulation or arousal they want.
Challenging behaviour may be a means of communication. The need for food, drink or comfort may be the reason for the behaviour. In cases like this, it may be possible to teach more socially acceptable ways of communicating a need.
Challenging behaviour can be a sign of abuse, distress, anger, frustration, discomfort or pain. Withdrawal of co-operation (for example, at mealtimes) may be the only means available to a highly physically dependent person of showing emotions.
Challenging behaviour can be a response to the environment. This could include under- or over-stimulation, poor physical environment (such as extremes in temperature or noise levels), inconsistencies in staff including staffing levels, awareness, approach and training.
Challenging behaviour is not the same as psychiatric disturbance. A mental health problem may exist and this should be explored by appropriate professionals; communication difficulties can have significant impact on diagnosis.
Other facts about challenging behaviour
Some of the most common aims of challenging behaviour are:
- Gaining the attention of others
In most people who have severe learning disability, these behaviours are not premeditated and are not designed purposely to upset, however the emotional response they create in us tends to make us think that the person is deliberately trying to ‘wind us up’ or that they ’are only doing it for attention’. When confronted by some form of challenge, it’s always worth stepping back and asking yourself - why does this person need to go to all the effort of showing this behaviour? What’s going on from their point of view that makes them need to do this?
Some people will show only one form of challenging behaviour whereas in others, 'clusters' of behaviours are evident. For instance, aggression, outburst and destructiveness may occur together.
Mental health, challenging behaviour and disability
People with learning difficulties can suffer from the same mental health and emotional difficulties that others do. In many cases they can be less well equipped and supported to deal with them. It can be difficult to deal with anxiety if you do not have the words to describe what you are experiencing. It can be difficult to cope with depression if you do not have the social support to help you. Sometimes behaviour can be a sign of a wider problem with someone’s mental health. Refusal to eat may be a sign that the person is feeling down, or aggressive behaviour could be a sign of high anxiety. It is important to try and see the problem from the perspective of the person showing the behaviour.
Management of challenging behaviour
The key to managing challenging behaviour is to understand why it is happening from the person’s point of view, rather than making assumptions about why it is happening.
The behaviour will have a function, and this should be explored using functional analysis. This involves assessing the whole person, their abilities, their skills, their deficits, their likes and dislikes, their family background, their health, their ability to cope with demands and many other things. From this, the professional involved should be able to work out what the behaviour is achieving – what function it serves. From this a support plan can be developed.
Strategies for assessing challenging behaviour
1. Establish the nature of the behaviour:
- Is it really a problem?
- Is it an established behaviour?
- Is it a new behaviour?
2. Determine the facts:
- Is the information received about the behaviour reliable?
- Are there differences in carer perceptions of the problem behaviour?
- Does the behaviour only occur with certain carers?
3. Describe the behaviour:
- Nature, frequency, extent of the behaviour
- Is there a pattern or does it occur at certain times of the day?
- Under what circumstances does the behaviour occur?
4. Determine the outcomes of the behaviour:
- Escape from or avoidance of a threatening event?
- Rewards such as attention, food or drink?
- Interaction with others?
5. Examine the individual's history:
- Is there a history of the same behaviour?
- What were the previous interventions?
- Were the previous interventions successful?
- Were there unknown trigger factors?
- Under what circumstances did the behaviour occur?
6. Examine the medical history:
- Has there been a new diagnosis/illness?
- Has the medication been reduced or increased?
- Has the frequency of epilepsy increased?
- Is the medication used inappropriately?
- Has new medication been prescribed?
7. Determine changes to the environment:
- Has there been a change of carer or key worker?
- Has there been a change in daily routine?
- Has there been a change in activities?
- Has there been a change in the peer group?
- Has there been a change in frequency of family visits?
- Is a close family member ill/in hospital?
- Is there a lack of stimulation?
- Is there over-stimulation?
- Is fatigue present?
- Has there been any loss or bereavement?
- Is there pain or discomfort?
- What is the carer’s attitude towards the individual?
- Has there been a change in noise level?
- Are there too many people around for the client to cope with?
Developing a support plan
Supporting an individual with a particular behaviour will depend entirely on why they are showing this behaviour. Two people may show the same behaviour for entirely different reasons and require a very different response.
A support plan that is based on a positive response will have the best chance of achieving a positive change. Remember, this behaviour is happening for a reason, it won’t stop or change unless you address that reason.
If the person struggles with change, how can you support them to cope? Will they benefit from visuals and timetables? If they cannot deal with crowds then reduce the need for them to be in crowds and slowly introduce them back. If they hit out because they have a need that they cannot communicate then find a way to teach them to express themselves.
Understand the person and help them develop a positive means of working through their difficulty.
Sometimes this is not easy. Supporting someone who is aggressive will challenge you as a parent, carer or professional. Change does not occur overnight and getting it right first time may not happen. But real, long-lasting change in even the most challenging individual can happen with a well thought out, positive approach applied consistently.
Some common themes in managing behaviour:
- Ensure the individual feels valued and listened to.
- Make sure that where communication disorders exist, the individual has a method of communicating effectively.
- Give the individual other ways of communicating a need.
- Reduce, where necessary, expectations of the individual and of care staff.
- Determine triggers in the environment, such as noise or attitudes and beliefs in carers that might provoke or maintain challenging behaviour.
- Help the individual and their carers to recognise distress.
- Develop the individual's coping strategies for dealing with problems.
- Anticipate potential problems and intervening where appropriate (for example, by providing additional support, redirection to another activity or reducing noise level).
- Training and support for care staff in prevention and management of problems.
- Care staff sharing knowledge and expertise.
- Provision of a variety of activities and materials that are appropriate and meaningful.
- Ensuring appropriate levels of support.
- Ensuring that all involved with an individual provide a consistent approach.
There are few golden rules in supporting people with who display some form of challenging behaviour. But one of them would be that happy people tend not to challenge. Find out what makes the person happy and make it happen more in their life, then you may find that the behaviour starts to disappear.
Challenging behaviour is often seen in people with learning disability and other types of impairment. This behaviour represents a challenge to us to address something that is not working in that person's life.
It is reasonable to expect that with comprehensive assessment, appropriate levels of stimulation, communication techniques, carer support and consistency, encouragement and teaching of new coping skills, this type of behaviour can be managed effectively. It is important to set realistic goals for the individual and aim to increase the person’s quality of life and minimise the impact of the behaviours displayed.
Challenging behaviour: references
Emerson E (1995) Challenging Behaviour: Analysis and Intervention in People with Severe Intellectual Disabilities Cambridge University Press. Cambridge. ISBN 052140665X.
Further information on challenging behaviour
Challenging Behaviour Foundation
Families and carers can now ring 0845 602 7885 to speak to a Family Support Worker.
Tel: 01634 838739 (main office)
Information and support to parents, carers and professionals. Various information factsheets also available.
Learning Disability Helpline (open Monday-Friday 9am-5pm)
Tel: 0808 808 1111
Textphone: 0808 808 8181
National organisation exclusively concerned with people with learning disabilities and their families. Range of services and support.
British Institute of Learning Disabilities (BILD)
Tel; 01562 723010
BILD produce a number of publications on challenging behaviour
For more information on Scope
This information was last reviewed May 2013.
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