Functional analysis of behaviour refers to a method of gaining information about the behaviour itself. This should be carried out in addition to a comprehensive assessment of all potential contributory factors to the behavioural difficulties.
Functional analysis aims to identify the antecedent factors and consequences of the behaviour as well as provide a detailed description of the behaviour. This is facilitated by the use of ABC (antecedent, behaviour, consequence) charts:
Antecedents: This refers to all relevant factors at play prior to the episode of challenging behaviour (including specific triggers for the behaviour):
- Consider factors related to the person’s physical and mental wellbeing (e.g. boredom, low mood, anxiety, confusion, fatigue, pain, physical illness).
- Consider the person’s behaviour in the context of executive functioning difficulties e. potential to display irritability, agitation and impulsive/aggressive outbursts.
- Consider was the person likely to be experiencing significant feelings of overstimulation/overwhelm.
- Consider environmental factors e.g. noise levels, levels of stimulation, temperature, other people present etc.
- What was the person doing just prior to the occurrence of the behaviour?
- Was a care/treatment intervention being carried out?
- What demands had been placed upon the person or requests made of them?
- Did the person possibly misunderstand/misinterpret the situation and/or what was said or asked of them (due to communicative and/or cognitive impairment)?
- Was the person struggling to communicate a request/need just prior to the incident? The person’s ‘demands’ (requests/needs) may have been perfectly reasonable (e.g. in pain and requesting removal of source of discomfort or confused/frightened needing reassurance) but the person was unable to successfully communicate their very real needs resulting in the behaviour. Did staff understand the reason for the request and try to provide the necessary support/assistance to reduce distress and discomfort prior to the episode?
Behaviour: a detailed description of the episode of challenging behaviour (the more information the better):
- What was the behaviour e.g. swearing, spitting, shouting, verbal/physical aggression?
- Was the behaviour directed at another person?
- Was the behaviour directed at property/environment?
- Was the behaviour directed at themselves i.e. self-harm?
- Did the behaviour escalate to being potentially dangerous (e.g. from verbal abuse/threatening behaviour to actual physical aggression)? At times it is not possible for staff to meet the person’s requests immediately i.e. wanting to leave hospital ‘now’, which may lead to an escalation of the behaviour.
- How long did the behaviour last?
Consequences: what happened directly after the episode of challenging behaviour?
- How did the behaviour end?
- What management strategies did staff use, if any, to bring the episode of challenging behaviour to a close?
- Was there a need for staff to use approved control and restraint procedures?
- Was medication administered (oral or intramuscular)?
- Was the behaviour potentially inadvertently reinforced e.g. challenging behaviour displayed during personal care causing carers to withdraw from completing the intervention, which is possibly what the person was trying to achieve by the behaviour (i.e. the behaviour was reinforced).
- Were the person’s demands met because of the challenging behaviour and thus reinforced?
ABC charts can have limitations: they can be time consuming and it may not be possible to record all episodes of behaviour. However, they can be helpful in working out why the behaviour is occurring, what it looks like and what the usual consequences are. ABC charts can help inform care staff of the purpose of the behaviours and what the person may be trying to communicate. Care staff can often have a very good feel for the usual triggers and reinforcers of particular behaviours.
Individualised behaviour recording charts can be designed to fulfil the needs of recording behaviour in particular settings. They may be designed to yield additional information over and above what is recorded via a standard ABC chart.
Assessment of challenging behaviour should also include:
- Record of the frequency (how often it occurs).
- When it usually occurs e.g. if it occurs at a particular time of day or in the context of particular care interventions.
- How severe are the consequences (e.g. in terms of damage, injury etc and how long does an episode of behaviour persist).
Functional analysis of behaviour requires specialist advice and support. Referral to Clinical Psychology/Neuropsychology or Neuropsychiatry is recommended.
Please see below for examples of Behaviour Recording Charts:
Example: Behaviour Recording Chart 1
Example: Behaviour Recording Chart 2