Managing Challenging Behaviour Information

What is 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 reflects the fact that some of the behaviours are a challenge to professionals, teachers, carers and parents.

  • That means the person showing these behaviours is not a ‘problem’ to be fixed, or someone doing something ‘wrong’, but that the behaviour is a sign that something isn’t working or something is wrong.
  • It shows that there is some need being unfulfilled, or a problem with communication.

Challenging Behaviour

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, an individual with autism/dementia 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.

Challenging Behaviour

Behaviour is challenging if it causes harm to the person or others, or if it stops them fulfilling some aspect of their lives, such as:

  • Someone cannot go to school because they show some aggressive behaviour.
  • Someone cannot go swimming because they tend to run off.

It is the impact of these behaviours that makes them challenging.

Challenging Behaviour

Challenging behaviour can be:

  • Self-injurious:
  • Head-banging, scratching, pulling, eye poking, picking, grinding teeth, eating things that aren’t food.
  • Physical/non-physical aggression:
  • Biting and scratching, hitting, pinching, grabbing, hair pulling, throwing objects, verbal abuse, screaming, spitting.
  • Non-person directed:
  • Damage to property, hyperactivity, stealing, inappropriate sexualised behaviour, destruction of clothing, lack of awareness of danger, withdrawal.
  • Stereotyped:
  • Repetitive movements, rocking, repetitive speech and repetitive manipulation of objects.

Learned behaviour

  • The person may have learned that the behaviour can be a very powerful way of controlling the environment.
  • Many behaviours are also responses to previous experiences. A baby who gets a smile when he coos usually learns to coo more often. The same is true for challenging behaviours. If a child has learned that screaming gets him out of a difficult task, he might scream in the future to escape.

     How we respond to his actions can have a significant effect on what he does the next time he is in a similar situation.

  • The person may have learned that they enjoy the reaction or interaction they get as a result of the behaviour.
  • Consider alternative to this behaviour

Learned behaviour

  • An example of a productive behaviour might be asking for something to eat, then receiving a cookie. The function of making the request is to get the cookie.
  • For a child with limited language skills, the strategies involved in getting a cookie might look very different. But if the end result is the same, whatever the individual needed to do to be fed is the method by which he has learned to ‘get a cookie.’
  • Over time, an individual with significant communication challenges is likely to develop some creative and interesting methods for communicating—some of which might be considered challenging.

Reasons for Challenging Behaviour

Whenever behaviour occurs, it is important to consider its purpose, or what is most often called its function. 

 

  • difficulty in processing information,
  • unstructured time,
  • over-sensitivity or under-sensitivity to sensory stimuli
  • a change in routine,
  • transition between activities,
  • inconsistencies, ie, in staff
  • a physical reasons like feeling unwell, tired, hungry, discomfort or pain
  • response to the environment
  • not being able to communicate these difficulties can lead to anxiety, anger and frustration, and then to an outburst of challenging behaviour.

Reasons for Challenging Behaviour

Biting may be due to pain in the mouth, teeth or jaw. Spitting may be related to a difficulty with swallowing or to producing too much saliva, the person may enjoy the way saliva feels.

Aggression may be due to adolescent hormonal changes.

Some biting behaviour may be a continuation of infant mouthing behaviour, or a later occurrence of the mouthing phase.

The person may be using this behaviour to communicate that something is causing distress and to get it to stop. They may have no other functional way of communicating their needs, wants and feelings.  

Understanding the reasons behind the behaviour

 

  • Helps staff to provide the right support to the individual
  • Helps to de-personalise crisis situations.
  • It address factors that lead to crisis situations.
  • Avoids us becoming triggers to the behaviour.
  • Understanding the reasons for the behaviour can help us
    to avoid future crisis or prevent it from escalating further

Ways to understanding the reasons
behind the behaviour

Completing a behaviour diary, which records what has occurred before, during and after the behaviour, could help you to understand its purpose. It is important to make notes on the environment, including who was there, any change in the environment and how the person was feeling. A diary may be completed over a couple of weeks or longer if needed.

Rule out medical and dental causes

     Visit the GP or dentist and seek a referral to a specialist if needed. Bring along notes about when the behaviour happens (ie what time of day and in which situations), how often it happens, when it first started, and how long it lasts.

Consider how you and others are approaching, supporting and communicating with the individual and develop a Positive Behaviour Plan

Managing challenging behaviour

Positive Behaviour Plan

A framework that uses a range of strategies that aim to assist a person to reduce behavioural challenges in order to increase their quality of life.

  • Values-based.
  • Person-centered.
  • Strengths, talents, needs, and wishes.
  • Adjustments to the environment.
  • Teaching new skills.

It helps us to recognise the various behaviour stages and ensure that plans are in place to enable staff to support the individual.

An active process to enable us to understand what a person is communicating.

Keys to Empathic Listening:

  • Non-judgemental
  • Undivided attention
  • Listen to facts and feelings
  • Time to reflect
  • Paraphrase

Managing Behaviour

Behaviour influences behaviour.

Understanding this can help staff to Consider how our behaviour impacts those in our care.

Rational Detachment

  • Stops staff taking behaviours of others personally
  • Helps to de – personalise the situation.
  • Helps staff to stay calm and maintain self-control.

Develop and expand functional communication

  • Find a way to build effective communication that is appropriate for the person across his daily activities.
  • It is important to work on communication skills to replace, the behaviour
  • Individuals’ communication needs will be unique. Talking may not be the best method of communication for all individuals.
  • What resources are available to help individuals communicate?

Managing behaviour strategies

Introduce communication tools

  • Support the person to use other ways of communicating their wants, needs and physical pain or discomfort, eg by using a visual stress scale, PECS (Picture Exchange Communication System), pictures of body parts, symbols for symptoms, or pain scales, pain charts or apps. Sign language voice output devices and other tools
  • Use social stories to explain why it’s not appropriate to bite/spit/hit, and describe alternatives.
  • Some people use communication boards to indicate how they are feeling. This could be a blackboard or a Velcro board with key emotional words or emotional faces. Every time the person engages in challenging behaviour, encourage them to use this form of communication instead.
  • Some people may find it easier to communicate by text or email

Adapt the Environment

Changing the environment can often reduce behavioural episodes.

These are some things to consider when working to create a more

successful environment

  • Organize and provide structure: Provide clear and consistent visual schedules, calendars, consistent routines, etc. so that the person knows what is coming next.
  • Inform transitions and changes: Recognize that changes can be extremely unsettling, especially when they are unexpected. Refer to a schedule, use countdown timers, give warnings about upcoming changes, etc.
  • Provide a safe place and teach when to use it: A calming room or corner, and/or objects or activities that help to calm

Managing behaviour strategies

Provide sensory opportunities

  • Find alternative activities, or provide a bum bag of alternative objects, that provide a similar sensory experience to that provided by the challenging behaviour, and build these into the daily routine.
  • For a person who bites, you could provide chewy tubes, gum, carrots, raw pasta or sultanas.
  • For a person who pinches, you could provide play-dough.
  • For a person who hits, you could do a clapping song/rhyme.
  • For a person who pulls hair, tie long hair back and find something to replicate the pulling sensation, eg ‘row your boat’ game, tug of war, climbing up a rope.#

Managing behaviour strategies

Rewards

  • Using rewards and motivators can help to encourage a particular behaviour. Even if the behaviour or task is very short, if it is followed by lots of praise and a reward, the person can learn that the behaviour is acceptable. 

Relaxation

  • Look at anger/emotions management and create opportunities for relaxation. You can do this by, for example, looking at bubble lamps, smelling essential oils, listening to music, massages, or swinging on a swing. 
  • Challenging behaviour can often be diffused by an activity that releases energy or pent-up anger or anxiety. This might be punching a punch bag, bouncing on a trampoline or running around the garden.

Managing behaviour strategies

Remove physical and sensory discomforts

  • Provide relief for physical discomfort, eg pain killers.
  • Remove unpleasant sensory input, eg use ear defenders to block out noise, use sunglasses to reduce light, and reduce strong smells, replacing them with smells that the person prefers.
  • Prepare the person for any changes in routine or for meeting new people. You could use visual supports, showing photos of new people and places, introducing them in small stages. A child or adolescent with autism may find physiological changes associated with puberty difficult to cope with, and you may need to prepare them for this.

Ignoring challenging behaviour

  • Ignoring challenging behaviour means not giving in to the behaviour that you are trying to eliminate, to the best of your ability. If he kicks to get a cookie, ignore the kicking and do not give him a cookie. But, use other strategies here to teach him to request a cookie, and be sure to give the cookie when he asks, so as to build his trust in you.
  • Note that when you first start to ignore a behaviour (called extinction) it may increase the behaviour. Stay the course.
  • Certain behaviours (those that are dangerous or injurious) are more difficult to ignore and sometimes need to be redirected or blocked (e.g. putting a pillow by his head so that his self-hitting does not do damage), even as you strive to not allow the behaviour to ‘win.’

Redirection

edirection can be a very powerful tool, giving you the opportunity to steer your child into a situation that is more positive, or more manageable. It also helps to avoid or calm an escalating situation.

Tell the person what they need to do instead of the behaviour, eg “David, hands down”. Use visual cues such as picture symbols to back up instructions.

Redirect to another activity that is incompatible with the behaviour (eg an activity that requires both hands, or that occupies the mouth, such as sucking a sweet) and provide praise and reinforcement for the first occurrence of appropriate behaviour, eg “David, that’s excellent playing with your train”.

The Use of Time Out

  • The use of a time out can vary considerably, and to be most effective, it is important that it is done correctly. A time out is not just a change in location—it means the individual loses access to something they find rewarding or cool

How to use time-out correctly

  • A fun, enjoyable activity should be in place before using time-out (e.g. playing video game, visiting friends).
  • Time-out should not lead to the individual avoiding or delaying an unpleasant task or work activity
  • Time-out should take place in a boring and neutral setting.
  • No attention should be given during time-out.
  • Time-out should be discontinued shortly after the individual is calm and quiet (approximately 10 seconds of calm behaviour).

Positive Language

  • Use positive/proactive language: Use language that describes what you want the individual to do

     (e.g. ‘I love how you used a tissue!’ ), and try to avoid saying ‘NO’, or ‘don’t’ (e.g. ‘stop picking your nose.’ ).

  • When behaviour does occur, be careful not to:
  1. Show disappointment or anger
  2. Lecture or threaten
  3. Physically intervene (unless necessary for safety, such as keeping a child from running into the street)

Respond quickly and consistently, eg for spitting, wipe away saliva immediately. Limit verbal comments, facial expressions and other displays of emotion, as these may inadvertently reinforce the behaviour. Try to speak calmly and clearly, in a neutral and steady tone of voice.

Managing a Crisis Situation

  • Generally, when an individual is engaged in the active, disruptive stage of a behaviour, such as a tantrum or aggression, the essential focus has to be on the safety of the individual, those around them, and the protection of property.
  • It is important to keep in mind that when he is in full meltdown mode, he is not capable of reasoning, being redirected, or learning replacement skills. However, this level of agitation does not usually come out of thin air.
  • You can learn skills to help anticipate and turn around an escalating situation that seems to be headed in this direction.

Remain as calm as possible

Assess the severity of the situation

Follow the Crisis Plan and focus on safety

Determine whom to contact

In case of emergency, call 999. Always take suicide threats seriously!

Know Ways to Calm an Escalating Situation

Be on alert for triggers and warning signs.

Try to reduce stressors by removing distracting elements, going to a less stressful place or providing a calming activity or object.

Remain calm, as his behaviour is likely to trigger emotions in you.

Be gentle and patient.

Give him space.

Provide clear directions and use simple language.

Praise attempts to self-regulate and the use of strategies such as deep breathing.

Physical Restraints and Seclusion

  • When severe and dangerous behaviours pose a risk of  physical harm to the individual or to others in the vicinity,physical restraints or seclusion as a brief intervention are sometimes necessary to maintain safety.
  • Physical restraints are physical restrictions immobilizing or reducing the ability of an individual to move their arms, legs, body, or head freely.
  • Seclusion (putting the individual briefly in a room by himself to ‘calm down’) can provide a quick halt to an immediate threat, but in the long run, seclusion is not a solution to the behaviour itself.
  • It is important to note that while restraints and seclusion can serve to maintain safety, it is an intervention of last resort and should only be used when less restrictive and alternative interventions are not effective, feasible, or safe. Improper use of these techniques can have serious consequences physically and emotionally.