Challenging behaviour can occur in people with dementia and psychosis, but is also sometimes apparent in those with a learning disability. It can commonly occur amongst children and adults with learning disabilities, although challenging behaviour also occurs in people without learning difficulties too. Challenging behaviour can be displayed by people with mild, moderate and severe learning disabilities, and tends to affect normal development and ability to learn.
Defining Challenging BehaviourEmerson et al (1987) suggested that, “Severely challenging behaviour refers to behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit or delay access to and use of ordinary community facilities.”
The term challenging behaviour refers to any behaviour that puts the person displaying the behaviour and others at risk. This type of behaviour can interfere with home life and family members, and can affect the person’s ability to be able to safely interact with community members and facilities.
Challenging behaviour can be violent, aggressive, disruptive or destructive and can sometimes lead to self-harm and injury. Examples of challenging behaviour include repetitive headbutting, kicking, spitting, inappropriate sexualised behaviour and stereotyped behaviour such as rocking or elective incontinence. This type of behaviour is, in many cases, as a result of difficulty with comprehension and communication and is not controlled by the person displaying the behaviour. Challenging behaviour may be an attempt to gain control a confusing world.
In severe cases, challenging behaviour can result serious or fatal injury, such as brain damage as a result of head banging. However in many cases, the behaviour is mild or moderate, but can still cause a lot of distress and disruption to all affected.
Causes Of Challenging BehaviourIt is not known exactly why some people exhibit challenging behaviour. In some cases challenging behaviour can arise as a result of a learning disability or condition such as Hyperkinetic Disorder or Attention Deficit Hyperactivity Disorder (ADHD).
The basic symptoms for Hyperkinetic Disorder include an inability to regulate behaviour, hyperactivity and impulsivity in a range of social settings, such as in the home and at school. Aside from Hyperkinectic Disorder/ADHD, other causes of challenging behaviour may be as a result of conditions such as autism or epilepsy. Sensory impairment may lead a child to revert to stimulation that develops into challenging behaviour.
Some children without learning disabilities may display challenging behaviour during their early years, which diminish as they grow and develop social and communication skills. However, children with learning disabilities tend to develop at a different or slower rate, and so enter later childhood, teenage years and eventually adulthood sometimes with limited ability to effectively communicate, comprehend or rationalise.
TreatmentChallenging behaviour may be as a result of emotional imbalance or disturbance, or due to a biological condition. The key is to diagnose each individual case to try and ascertain the cause of the challenging behaviour, before addressing it. Therefore there is no definitive treatment for challenging behaviour, as it is based on the individual’s needs and social context. It may be a simple case of anger management therapy, or addressing any physical stimulation such as pain that leads to the behaviour.
If possible, the person displaying the challenging behaviour should be supported by all concerned – family, teachers and carers – to gain a means to communicate effectively themselves to avoid reverting to the challenging behaviour.
The earlier challenging behaviour is identified, the better. Intervention and functional analysis at an early age by a psychologist or medical practitioner can help to identify root causes, encouraging alternative ways of communicating and achieving results in the child displaying the behaviour. This sort of treatment can last for years, and will require input from home and school.