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Challenging behavior

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LR22 D Maddy Listens to Upset Zack

Art by Luna Rose

Challenging behaviour is defined as "culturally abnormal behaviour(s) of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to the use of ordinary community facilities" [1].

Challenging behaviour is most often exhibited by people with developmental disabilities, dementia, psychosis and by children, although such behaviours can be displayed by any person.

Types of challenging behavior[]

Common types of challenging behaviour include self-injurious behaviour (such as hitting, headbutting, biting), aggressive behaviour (such as hitting others, screaming, spitting, kicking), inappropriate sexualised behaviour (such as public masturbation or groping), and behaviour directed at property (such as throwing objects and stealing).

Some people consider stereotyped behaviors like rocking, echolalia, and hand-flapping to be challenging behavior. However, some researchers and disability advocates, especially in the autism rights movement, have argued that these behaviors help with sensory and emotion regulation and should be accepted.[2][3][4]

Causes of challenging behavior[]

Challenging behaviour may be caused by a number of factors, including:[5][6][7][8]

  • Biological (pain/discomfort, medication, sensory seeking, distracting from sensory overload)
  • Social (boredom, seeking social interaction, the need for an element of control, lack of knowledge of community norms, insensitivity of staff and services to the person's wishes and needs)
  • Environmental (physical aspects such as noise and lighting, or gaining access to preferred objects or activities)
  • Psychological (feeling excluded, lonely, devalued, negatively labelled, disempowered, living up to people's negative expectations)
  • A means of communication

A lot of the time, challenging behaviour is learned and brings rewards. It is very often possible to teach people new behaviours to achieve the same aims. Behaviour analysts have focused on a developmental model of challenging behaviour.[9]

Experience and research suggests that what professionals call "challenging behaviour" is often a reaction to the challenging environments that services or others create around people with developmental disabilities. It can be a method of communicating dissatisfaction with the failure of services or others to listen for what kind of life makes most sense to the person. This is especially possible where services or others create lifestyles and relationships that are centered on what suits them or the service and its staff rather than what suits the person.

Challenging behaviour can often be viewed as a ‘behavioural equivalent’ of a mental health problem. However, research evidence indicates that challenging behaviors and mental health problems are relatively independent conditions.[10]

A common principle in behaviour management is looking for the message an individual is communicating through their challenging behaviour: "All behaviour has meaning". This is a core in the functional analysis process.

Children communicate through their behaviour, especially those who have not acquired language and vocabulary skills to tell the adult what the problem is.

In adults with developmental disabilities, certain types of challenging behaviour can predict contact with police and hospital admission.[11]

Behavior response cycle[]

Challenging behaviors may be viewed as occurring in a cycle:

  • Trigger
  • Escalation
  • Crisis
  • Recovery

Analysis of this cycle provides a foundation for using a variety of strategies to minimize the triggers of challenging behavior, teach more appropriate behaviors in response to these triggers, or provide consequences to the challenging behavior that will encourage a more appropriate response. Behavioral strategies such as Applied Behavior Analysis, operant conditioning and positive behavior support use similar approaches to analyzing and responding to challenging behaviors.

Challenging behaviour by people in learning disability services[]

Because of language skill deficits accompanying their condition many people with learning difficulties find it difficult to use verbal strategies to express themselves, resolve conflicts etc. As a consequence the can resort to behaviour which is labelled as challenging

Main article: Challenging behaviour and learning disabilities

Treatment and support[]

Understanding the unmet need that causes challenging behavior can inform the approach. Then, caregivers can help the person find a better way to address the need.

Asking the person about the behavior can sometimes reveal the reasons behind it. A gentle, nonjudgmental conversation may help the person express what was wrong and what they needed. Patience is important to help the person open up.

However, not everyone can express what is wrong. Functional behavior analysis can sometimes clarify external triggers. However, these don't always reveal internal experiences and can sometimes be misleading.[12]

Communication skills[]

LR22 Communication Cards 1

Picture cards offer a simple way to communicate needs, feelings, and wants.

Teaching communication and assertiveness skills can help people express unmet needs in better ways.[13][14] This may involve scripting, assertiveness training, or use of augmentative and alternative communication (AAC) for those who struggle to speak.

It is also critical for listeners to pay close attention to communication attempts. Communication may take extra time or prompting with some individuals. If people don't listen, then the person may resort to challenging behavior again.

Redirection[]

Caregivers may be able to recognize precursors to challenging behavior. For example, if a child often whines before an outburst, then a caregiver can pay attention and remove them from a stressful situation.

Caregivers may be able to help the person meet an unmet need. They may be able to prompt the person to assert themselves (e.g. "Do you need a break?") or provide alternative behavior options that are safer. For example, a person who hits themselves might benefit from a massage.[15]

Controversial practices[]

Controversial ways to manage challenging behavior include restraint, seclusion, ignoring the person, and aversive stimulus such as electric shock.[16] These may increase stress without addressing underlying causes.[17]

Ethical considerations[]

Training people to stop certain types of behavior has several risks:

  • The behavior may be meeting a specific need. Preventing the behavior without identifying and helping with the need makes the need go unmet.
  • The behavior may be an attempt to communicate a need for help. Silencing this leaves the person without help.
  • Preventing someone from showing early signs of stress could lead to them showing more drastic behavior "out of nowhere."
  • Repressing too much instinctive behavior could be psychologically damaging. Research shows that in autism, autistic masking (suppressing self-expression like stimming and special interests) is linked to anxiety, depression, suicidality, and other serious issues.[18][19][20]

Sometimes, it is caregivers instead of the person who need the behavior adjustment.

Supports must focus on helping the person instead of eliminating an annoyance. The goal should be to help meet the person's needs in a safe and reasonable way, even if it is time-consuming or unconventional.

See also[]

Notes[]

  1. ↑ Emerson, E. 1995. Challenging behaviour: analysis and intervention with people with learning difficulties. Cambridge: Cambridge University Press
  2. ↑ Kapp SK, Steward R, Crane L, Elliott D, Elphick C, Pellicano E, Russell G. 'People should be allowed to do what they like': Autistic adults' views and experiences of stimming. Autism. 2019 Oct;23(7):1782-1792. doi: 10.1177/1362361319829628. Epub 2019 Feb 28. PMID: 30818970; PMCID: PMC6728747.
  3. ↑ Rethinking repetitive behaviors in autism
  4. ↑ Stimming, therapeutic for autistic people, deserves acceptance
  5. ↑ What’s the Relationship Between Autism and Self-Harm?, Healthline
  6. ↑ A Risk from Within: Understanding and Treating Self-Injury in Autism
  7. ↑ Essential Guide to Self Injurious Behaviour and Autism, Research Autism (PDF)
  8. ↑ Self-injurious behaviour - a guide for all audiences, National Autistic Society
  9. ↑ (2007). A Preliminary Description of the Occurrence of Proto-injurious Behavior in Typically Developing Children. Journal of Early and Intensive Behavioral Intervention 3 (4): 334–47.
  10. ↑ (2010). Challenging behavior and co-morbid psychopathology in adults with intellectual disability and autism spectrum disorders. Research in Developmental Disabilities 31 (2): 362–6.
  11. ↑ (2011). Psychometric properties of the Disability Assessment Schedule (DAS) for behavior problems: An independent investigation. Research in Developmental Disabilities 32 (2): 653–8.
  12. ↑ Shkedy, G., Shkedy, D., Sandoval-Norton, A. H., & Cerniglia, L. (2019). Treating self-injurious behaviors in autism spectrum disorder. Cogent Psychology, 6(1). https://doi.org/10.1080/23311908.2019.1682766
  13. ↑ A Risk from Within: Understanding and Treating Self-Injury in Autism
  14. ↑ Shkedy, G., Shkedy, D., Sandoval-Norton, A. H., & Cerniglia, L. (2019). Treating self-injurious behaviors in autism spectrum disorder. Cogent Psychology, 6(1). https://doi.org/10.1080/23311908.2019.1682766
  15. ↑ Lindsmith, Kirsten. The Dark Side of the Stim: Self-injury and Destructive Habits. The Artism Spectrum (personal blog)
  16. ↑ Minshawi NF, Hurwitz S, Fodstad JC, Biebl S, Morriss DH, McDougle CJ. The association between self-injurious behaviors and autism spectrum disorders. Psychol Res Behav Manag. 2014 Apr 12;7:125-36. doi: 10.2147/PRBM.S44635. PMID: 24748827; PMCID: PMC3990505.
  17. ↑ Shkedy, G., Shkedy, D., Sandoval-Norton, A. H., & Cerniglia, L. (2019). Treating self-injurious behaviors in autism spectrum disorder. Cogent Psychology, 6(1). https://doi.org/10.1080/23311908.2019.1682766
  18. ↑ Conceptualising Autistic Masking, Camouflaging, and Neurotypical Privilege: Towards a Minority Group Model of Neurodiversity
  19. ↑ Cassidy S, Bradley L, Shaw R, Baron-Cohen S. Risk markers for suicidality in autistic adults. Mol Autism. 2018 Jul 31;9:42. doi: 10.1186/s13229-018-0226-4. PMID: 30083306; PMCID: PMC6069847.
  20. ↑ Cassidy, S.A., Gould, K., Townsend, E. et al. Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample. J Autism Dev Disord 50, 3638–3648 (2020). https://doi.org/10.1007/s10803-019-04323-3 Download citation

See also[]

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