The term challenging behaviour can be used to describe behaviour which is perceived as inappropriate to the social situation. Following significant Acquired Brain Injury (ABI), the person may demonstrate challenging behaviour which may be triggered by:
- Confusion, disorientation, misunderstanding, fear, anxiety and frustration subsequent to impairments of cognition and communication (including language processing).
- Psychological and psychiatric problems including anxiety, depression, psychosis and occasionally mania.
- Fatigue and sleep disturbance.
The types of challenging behaviour which the person with ABI may develop potentially include verbal abuse, shouting/swearing, physical aggression, socially unacceptable behaviour, spitting, destruction of property, sexually inappropriate behaviour, behaviours which prevent necessary care interventions being carried out etc.
Challenging behaviour, whatever its nature, can be viewed as having a communicative purpose i.e. the behaviour communicates that there is something the person wants or that there is a problem/need which requires attention. Due to the effects of brain injury and/or mental illness, the person may be unable to express their wants/needs etc in a more appropriate and effective manner.
Challenging behaviour may communicate a wide range of emotions and needs, including:
- Fear/anxiety/confusion/distress.
- Sadness.
- Anger/frustration.
- Pain/feeling unwell.
- Hunger/thirst.
- Tiredness.
- Too cold/hot.
- Uncomfortable.
- Embarrassment.
- Desire.
- Missing family/home/normal life.
- Grief.
- Boredom.
- Loneliness.
The behaviour may be an attempt to communicate that the person:
- Does not understand their situation and/or information communicated to them and is confused, distressed, anxious, angry etc.
- Is unable to identify the cause of their distress due to cognitive problems (including impairments of insight). This, in turn, affects their ability to effectively communicate the problem.
- Is unable to express their needs clearly because of communicative or cognitive impairments.
- Is feeling overwhelmed and struggling to cope with the physical, cognitive (including impairments of information processing) and communicative demands placed upon them.
- Is struggling to cope with their current living/social circumstances, which may result in distress/anxiety, potentially exacerbating levels of confusion.
There are innumerable potential communicative purposes which may result in the person engaging in challenging behaviour. Getting to know the person well will support understanding of these behaviours and, ultimately, is likely to decrease the occurrence of challenging behaviour.
Understanding that the person’s challenging behaviour has a communicative purpose can be helpful. It will support the development of strategies to:
- Avoid triggers for challenging behaviour.
- Reduce the person’s confusion and distress.
- Provide the person with reassurance and orientation.
- Support the person to express their feelings/needs etc.
- Support the person’s ability to understand other people’s communication.
- Provide activity and distraction for the person.
- Address important needs e.g. social, medical, care needs.
Addressing the communicative purpose of challenging behaviour enables:
- The person to be supported to develop more effective communication strategies in order to express their needs using appropriately.
- The person’s carers to develop:
- An understanding of the purposes of challenging behaviour.
- Strategies to most effectively support the person’s communication abilities.
- A communicative environment which supports the person’s communicative and cognitive needs.
To reduce the risk of challenging behaviour, it is important to:
- Understand why the behaviour occurs and identify the triggers.
- Support the person to communicate their needs more effectively.
- Use preventative strategies such as occupation and diversion.
- Consistently reinforce appropriate behaviours.
- Address all important needs e.g. health issues, cognitive problems (including confusion) physical impairments, pain, psychological and psychiatric problems.
- Support the person by adopting an approach of unconditional positive regard. If the person could communicate their needs etc in a more successful/appropriate manner, they would. Engaging in challenging behaviour would serve no useful purpose in this context.
Please see section on challenging behaviour for further information. Ensure appropriate referrals are made in order to obtain specialist advice and support (Clinical Psychologist/Neuropsychologist and/or Consultant Psychiatrist/Neuropsychiatrist). It is important that appropriate measures are implemented to ensure the safety of the person and those around them.
