CHALLENGING BEHAVIOURS

AND DEVELOPMENTAL DISABILITIES

Increased incidence of disruptive behaviors in persons
with developmental disability
12 to 15% of persons with DD display severe behavior
problems
Challenging behaviors are NOT a fundamental
characteristic of DD
Historically treatment has been unidimensional and
unidisciplinary.

RISK FACTORS WITH DD

Increased prevalence of neurological, sensory, and

physical abnormalities.
Decreased potential for coping skill deficits.
Lifestyle characterized by restrictiveness, prejudice,
limited personal independence, restricted personal control,
lack of mentally healthy experiences, abuse and
victimization.
Skill deficits in important functional areas, eg. anger
management, communication, problem solving.
Atypical learning history.

Understanding Behavior
Challenging behaviors seldom occur in isolation.
The manner in which challenging behaviors occur may
change over time and across situations.
Behaviors are seldom caused by a single factor. This
means that treatment will take the form of multiple
interventions.
The targets of intervention are the conditions that produce
the challenging behavior.

CBs = (re) P <~> E

CBs refers to Challenging Behaviors
= (re) denotes that any occurrence of a challenging
behavior results from
P refers to a persons current biomedical (physical,
psychiatric, and neuropsychiatric) and psychological
features
<~> denotes the dynamic interactions between features of
the person and features of the environment.
E denotes the physical, social, interpersonal and program
features of the persons environments.

Without a clear understanding of what is

producing the behavioral symptom
interventions become hit and miss in
nature. Often the focus is on treatment
rather than prevention. Most behaviors
are complex in nature. Each person with
CBs is unique.

Making changes
How is it going so far?

Could there be medical reasons for this behaviour?

What behaviour needs to be changed (cannot be tolerated)?
Why do you want to change it?
If all behaviour is communicationwhat is being communicated?
How long has this behaviour been present?
Has this behaviour worsened, lessened or stayed the same?
What has been tried in the past?
What has worked? Why has is worked?
What has not worked? Why didnt it work?

Instigating Influences (Triggers, Antecendents) and Other

Contributing Factors

Physical environment: Sensory elements noise, smells,

temperature, lighting, humidity. Disruptions, changes.
Lack of privacy. Lack of stimulation.
Social environment: The presence of a specific person.
Arguments. Teasing. Lack of attention. Being asked to
do something, etc, etc.
Program environment: Frequent changes in routine.
Unpredictable changes in preferred routines. Excessive
structure. Lack of flexibility. Lack of individual decisionmaking.

Instigating Influences (continued)

Medical Conditions: pain, constipation, indigestion,
seizures, menstrual cramping, medication side effects.

Psychiatric/Neuropsychiatric conditions: PTSD, mood

disorders, anxiety, hallucinations, delusions, irritability,
euphoria, agitation, brain injury.
Heywait a minute. If problem behaviors have
triggerswhat about positive behavior triggers??

Remove, Reduce, Alter

You cant fire the gun without the trigger

Remove the instigating factor from the persons life

without negative consequences to the person or those
around them.
Reduce the aversiveness of the triggers, eg. reduce the
amount of demands or increase the amount of time given
to complete the demand.
Alter the instigating conditions, eg. individual responds
more positively to demands made in a particular style or at
a certain time.

Vulnerabilities = Increased risk for CB

Physical environment conditions exposure to these elements may

create distress
Social Conditions abusive family, staff and peers. Demanding staff,
family and peers. Inadequate staffing and support. Lack of peer models.
Program Conditions frequent changes (no consistency), few
opportunities to pursue areas of interest, lack of stimulation, excessive
structure.
Psychological Conditions skill deficits in important areas, ie. problem
solving, attention, concentration, anger management, communication
skills, limited social, recreational and vocational skills
Medical Conditions conditions that produce pain, discomfort.
Psychiatric/Neuropyschiatric conditions mood lability, sleeping
problems, increased irritability (depression), anxious states.

CB -> Reinforcement = ^ Behavior Strength

+ Reinforcement: behaviour results in consequences

that person enjoys, is motivated to obtain, finds
rewarding and valuable.
- Reinforcement: behaviour results in the removal,
reduction or avoidance or conditions that the
person finds unpleasant, painful or unwanted.

Reinforcement Can we expect Bill to change?

Physical environment: Bill finds the stimulation in the workshop setting

overwhelming and becomes bossy and belligerent with coworkers. After about
ten minutes of this behaviour he is taken to one of the offices for time out.
Social: Staff sit and chat with Bill while he is sitting in the office.
Program: Bill does not have to work while he is in the office.
Psychological: While chatting with the staff in the office Bill gets to talk about
his concerns for his mother who recently was diagnosed with cancer and will
require surgery.
Medical: Bill has a sore back and his job involves moving heavy boxes. When
removed from his workplace he gets to sit down in a comfortable chair.
Psychiatric/Neuropsychiatric: Bill has been highly anxious about his mothers
condition and has been ruminating and worrying that he may have to look at a
major change in residential supports. He has been sleeping poorly. He is
offered a minor tranquilizer as a PRN and this reduces his anxiety level.

Interaction of factors
Typically a number of factors interact to account for the
fluctuation, severity and persistence of most CBs.
Consider Bills situation:
Poor coping skills + noisy environment + anxiety +
reinforcement + communication difficulties + back pain +
lack of positive learning experiences + lack of staff
awareness of psychological needs = CBs