In a care environment, challenging behaviour can be difficult to deal with. Learning how to deal with challenging behaviour effectively and empathically is vital to providing the best care for patients, and for maintaining a positive mentality. This article explains challenging behaviour- in what forms it appears and its possible triggers- and gives advice on how to handle it when it arises.
What constitutes Challenging Behaviour?
The definition of challenging behaviour is behaviour that is ‘culturally abnormal’. This generally covers behaviours that prohibit or seriously limit access to ordinary community activities. These types of behaviour typically appear in people who suffer from learning development disabilities (such as autism disorders), or in those with certain mental health issues. However, it is important to realise that the behaviours themselves are not caused by mental issues, rather enabled by them in those cases; anyone can behave in a way that can be considered challenging. It is therefore important to remember to not view the person behaving challengingly as having something ‘wrong’ with them simply due to the behaviour existing.
Challenging behaviour itself manifests in a variety of different forms, such as:
- Aggressive Behaviour– this consists of anything destructive towards people, such as hitting, verbal abuse, hair pulling, screaming, throwing objects, and biting and scratching
- Self-Injurious Behaviour– these are behaviours directed towards oneself that cause damage, like head-banging, eating non-foods, scratching, or grinding teeth
- Stereotyped Behaviour– behaviours one would probably think of if you heard the words ‘culturally abnormal’, such as repetitive speech, rocking, or repetitive movements
- Non-person Directed Behaviour– these are behaviours that aren’t directed at people, such as withdrawal, property damage, hyperactivity, theft, and inappropriate sexualised behaviour
What are the causes of Challenging Behaviour?
Many factors lead to the development of challenging behaviour, and these broadly fall into 4 different categories:
- Psychological- Challenging behaviours might develop as coping mechanisms for feelings of loneliness, devaluement, or exclusion. A patient may, for example, take up self-injurious behaviours in order to find relief from depression
- Environmental- in some cases, physical aspects of the world can trigger people into developing challenging behaviours. People might become aggressive in noisy environments, or react negatively to certain light levels. Inconsistencies in things such as staffing levels are also causes of challenging behaviour, because of a perceived threat or sense of discomfort because of the change.
- Social- oftentimes, challenging behaviours develop as a result of negative social environments. Boredom can enable people to develop challenging behaviours in order to entertain themselves. Someone with autism might learn that hitting someone will force them out of their personal space if they’re overwhelmed, or someone else might do things (typically in the stereotyped category) out of a need to try and have greater control over their social space.
- Biological- some people end up developing challenging behaviours because of biology. Having a lack of stimulation in some capacity can cause people to seek out destructive pursuits. Or the behaviours might develop out of a response to medication, or as a crude form of pain management. Conditions such as Lesch-Nyhan Syndrome are linked to self-injurious behaviour because of the way the brain handles hormones
Some people will only develop one form of challenging behaviour, but in others multiple can exist in ‘clusters’. For example, someone might have an aggressive outburst of destructiveness in order to get some attention.
Handling Challenging Behaviour
Whilst the implication here is that the behaviours are deliberate and intended to get a response in many cases, it is important to realise that this is not always true. In most people with severe learning/mental difficulties, there is no intention for upset. The simplest and foremost step, is to step back. Try and see what is going on from the person’s perspective, and understand why they act the way they do.
Outside of this, there are many things you can do. You should ensure that anyone who helps care for the person does things in a consistent manner, so as to avoid any environmental upsets. Communicating with the care team can help through the sharing of experience and knowledge, which in turn should help you anticipate potential problems; you might be able to avoid outbursts by enabling yourself to redirect attention to another activity, or pre-emptively reducing noise or light levels.
You should also try to work with the individual themselves. Find out from them whatever triggers they are aware of, such as noise or attitudes in carers that provoke the behaviour. Help them to recognise distress when it occurs, helping to deconstruct the belief that their behaviours are the most productive ways to deal with issues. Establish and develop coping strategies with them, including opening up any necessary additional ways of communicating their needs. If a lack of stimulation is the cause of the behaviour, then provide a variety of materials or activities for them, but make sure they are meaningful and appropriate, which should be established through communication with the patient. If the person with challenging behaviours has a communication disorder, then make sure that they have a method with which to effectively communicate, be it visually based or otherwise.
Above all else, remember to make the patient feel valued. Always take their views and insight into consideration, as they have much more experience of their feelings than you do. With any plan, your purpose should be to improve their quality of life. Happy people tend not to express challenging behaviours, so maximising the things that bring them happiness will help them.
The charity Scope has lots of information about challenging behaviour on their website: https://www.scope.org.uk/support/parents/challenging-behaviour/overview
The NHS, too, offers a lot of information on this topic:https://www.nhs.uk/conditions/social-care-and-support-guide/practical-tips-if-you-care-for-someone/how-to-deal-with-challenging-behaviour-in-adults/