What is challenging behaviour?
Challenging behaviour refers to behaviours that are difficult or challenging for parents, carers, and professionals to manage. These behaviours can be harmful to the young person, others around them, and make it difficult for the person to engage in activities and facilities in the community. These behaviours can have a negative impact upon the quality of life of the young person and their family.
Some examples of challenging behaviour include:
- aggression (for example hitting, kicking, biting)
- self-injurious behaviour (for example head banging, biting self, hitting self)
- repeated shouting or swearing
- not doing as they are told
- throwing items and destroying property
People with learning disabilities or autistic spectrum disorder (ASD) are more vulnerable to displaying these behaviours as they are more likely to have difficulties with communication, solving problems, and dealing with their emotions.
Understanding the challenging behaviour
In order to manage or cope with difficult behaviour it helps to understand why it happens. We call this the ‘function’. As well as this, we need to know what keeps it going or maintains it. There are a number of possible functions of behaviour for people including:
- pain, discomfort or illness
- avoiding something the they do not like, find difficult or were not expecting
- attempt to get more social interaction and attention
- to adjust the levels of sensory stimulation around them (get more or less of things like noise, smell, touch, movement)
- to get them to the things and activities that they want or like
It can be helpful to try and keep a record of the behaviour to see if you can spot a pattern to when, where, with whom the behaviours occur. Also consider what happens next or immediately after an incident or behaviour. This can help us to better understand the function of the behaviour. When we understand this we are in a better position to develop effective strategies.
Things that increase the likelihood of challenging behaviour happening
Some things that make challenging behaviour happen more often include:
- changes to routine. Some young people find it difficult to tolerate change, particularly if they are not prepared for the change.
- changes to the people around them, and people respond to them. This may lead young people to feel unsafe or unsure of those around them. For example new staff working with them, or different ways of working with them, or having more or less attention than they are used to.
- not understanding what others are trying to tell them can lead to individuals feeling confused, frustrated or anxious. Sometimes levels of understanding can vary depending on what else is happening around them and how they feel.
- not being able to express themselves or let others know what they need or want.
- too much or too little sensory stimulation (for example, a noisy room, or too bright lights) can trigger challenging behaviour
- pain and illness, and also a way of trying to cope with feelings of physical discomfort or pain
- boredom or lack of activities that they enjoy
- feeling overwhelmed by tasks and activities they they do not know how to do, do not like or do not want to do.
- feeling strong emotions, for example, feeling anxious, sad, scared or angry about something that has happened or may happen in the future.
Ways to support young people with challenging behaviour
Prevent the behaviour happening
- do they understand what is happening within their daily routine?
- could the routine be made clearer to them using written or pictorial sequence strips or timetables?
- perhaps they need clearer information about what is happening now?
- perhaps they need a warning of when something will start and stop in their routine?
- can you help them express themselves or do others need to adapt their communication to help them understand?
- would symbols or some key signs help them tune in to what you are saying, or make it easier for them to tell you what they want?
- have adults assumed that they understand the communication around them, when they have not?
- do they have access to activities, social opportunities and places that they enjoy, that make them feel good about themselves?
- are the demands or instructions pitched at the right level for them? Consider what support they need and how many instructions they can cope with at a time. If in doubt, show them as well as tell them.
- think about sensory needs and the environment. If there are things that frighten or overwhelm them, can anything be changed to make it easier for them? For example using headphones when a room is too loud or going to the supermarket at a quieter time.
- do they need regular exercise or movement breaks to help them concentrate and stay calm?
- do they have access to a favourite toy or something to fidgit with help?
- look out for signs of ill health or pain, and share these with others that support them. Stop issues like constipation, pain, tiredness building up.
Developing a young persons’ skills
Can you help them to respond to situations differently by supporting them to learn new skills or strategies? Sometimes the adults around a young person need to support them by prompting them to use these strategies and skills. Skills to develop might include:
- better communication so they ask for something, greet someone, say or indicate ‘yes’ or ‘no’, indicate pain, and so on. If they cannot talk, would learning a few key signs or having a symbol book help?
- use visual cues to help them understand what is happening. For example, school uniform and bag indicates school day, and keys and shoes indicate going out.
- timetables can help them know what is going to happen next
- label their feelings to help them with their emotions. Teach them when to ask for help, let them have somewhere safe to go to calm down. Give them things they can do to feel better if they are frustrated, angry or upset.
- play or interacting with others, and being comfortable in the same space as someone else. These are things you might need to build up to gradually rather than just trying and hoping it works.
Think about how other people responds to the behaviour
- how do others respond to the behaviour? Is there a standard way or does everyone do something different?
- do some responses seem to increase the behaviour and some de-escalate it?
- consider how to make the response more consistent across settings and people
- consider how best to calmly respond to their behaviour. Keep a calm voice, avoid raising your voice, limit words and keep them simple and straight forward. If you find an approach that works then let other people know.
- can you listen to the message behind the behaviour and address this. Their behaviour may indicate pain, upset, or confusion.
- are the boundaries or expectations for them clear and consistent? Do boundaries, rules or expectations need to be agreed or reviewed by the adults?
Think about how you can keep yourself, others and the young person safe. This may include:
- moving other people out of the way
- stepping back
- removing items from the space if they will get thrown or broken
- moving to another space if they will follow and co-operate
Try to appear calm, even if you do not feel it. Keep talking to a minimum and only use key phrases or words that focus on keeping safe and calm. Avoid telling off or arguing if things feel unsafe.
Is there anyone that you can ask for help, or can step in when you need a break?
If you feel you are unable to keep yourself or others safe please consider taking the young person to your GP, Sheffield Walk in Centre, Sheffield Children’s A&E department or contacting the police.
Managing challenging behaviour can be physically and emotionally draining. Think about how you can look after yourself. Allow yourself some time out to recharge your batteries will help you to stay resilient in the longer term. Sharing your thoughts with others who also know the young person will help you all to develop your understanding of their behaviour and useful management strategies.
Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.