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Managing Challenging Behaviour From People With Disabilities

Photo: Managing Challenging Behaviour From People With Disabilities
In 2009, the Australian Bureau of Statistics reported that just under one in five people in Australia had some form of disability. Of these people, over eighty percent had a condition in which they felt impaired and which restricted them from carrying out some basic aspects of day to day life (1).

Why do disabled patients display challenging behaviour?

As a result of impairments, environment, and interpersonal relationships, disabled people are more likely to display challenging behaviour in order to have their personal needs met. Each behaviour tends to have an underlying function and reasoning by the person who displays it. Therefore we can see challenging behaviour as a message from the patient that something is not right, or perhaps missing that they require assistance and attention.
Although in most cases disabled patients do not want to display difficult behaviour, carers and healthcare providers may themselves feel challenged when assisting and supporting the patient (2).

Reasons for challenging behaviour can be straightforward or quite complex, and made up of a number of factors. For example, disabled patients who are highly physically dependent on a carer may find that withdrawal is the only way they can show emotions of frustration, anger, or even pain, whereas patients who have severe learning disabilities may use challenging behaviour as a way of communicating their needs. The environment can also play a role in difficult behaviours. If the patients are feeling over or under stimulated, perhaps through extreme levels of noise, temperature or through the people around them, they can become easily upset and distressed (2).

As a healthcare provider, it is important to understand the reasoning for such behaviour and think from the patient’s point of view why they felt the need to act in a certain way.

Assessing challenging behaviour

Functional analysis can help to explore the behaviour and get to the root of its intended function. A doctor can use the following strategies to develop a support plan for the patient and their carer to minimise challenging behaviours (2).

  • Establish the nature of the behaviour:  Work out if the behaviour is actually a problem, and if it is new or a well-established behaviour.
  • Determine facts about the behaviour: Find out whether different carers have different perceptions of the behaviour.
  • Define the frequency, extent and nature of the behaviour:  Look for patterns and whether it occurs under certain circumstances.
  • Understand the purpose of the behaviour:  Question what the patient attempting to achieve. It could be that the patient is looking for a reward, attention and interaction, stimulation, or wanting to avoid the situation altogether as they feel threatened.
  • Assess patient history: Find out if the behaviour has ever happened in the past. If so, then it is important to understand the triggers behind it, and which interventions have been previously successful.
  • Assess medical history: Look into medical history to determine any new symptom, diagnosis or medication which has been introduced to the patient. Any such change can cause the patient to act differently.
  • Determine whether there have been any recent environmental changes: The patient may be reacting to a change in their daily routine, the introduction or removal of a key figure in their life, or perhaps to physical environmental changes around them.

A support plan which is based on a positive response from the patient is most likely to offer a positive change with less challenging behaviour displayed in the future. Change will not be immediate, but a slow and consistent approach can be effective in the long run (2).

Managing challenging behaviour in disabled patients

A behaviour support plan can be developed to help manage challenging behaviour. Strategies should include ways to improve the quality of life and significant members of the patient’s life should be made aware of the plan.

Primary prevention methods will mean improving communication with the patient, changing their environment and encouraging expression and engagement in learning activities. People who work with the patient should respond to early signs of behaviour which indicate unmet needs, to avoid a situation in which the patient feels the need to revert back to challenging behaviour. Reactive strategies should also be discussed beforehand so that staff can effectively respond to challenging behaviour if it was to occur (3).

Other factors to consider minimising the chances of challenging behaviour should be (3);

  • Minimise using aversive, restrictive and punishment tactics. Such approaches can lead to the patient feeling undignified, giving them a lower quality of life and reduce their desire to participate.
  • Work with the patient to help build their skills. This can give a higher level of personal satisfaction and feelings of success. Skill building is also a way for the patient to improve their communication and will help them succeed in daily life.
  • Develop staff skills and knowledge. These key figures who work on a regular basis with the patient need to have working knowledge and skill building abilities so they can effectively connect and communicate with the patient.
  • Re-design the patient’s environment. This can include improving staff attitude, making a more therapeutic and calming environment, and ensuring that the patient is able express their individuality by being offered regular choice.




Sources:


1. Australian Bureau of Statistics
2. Scope
3. Disability Services Commission


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