Recognising and dealing with challenging behaviour

This article gives a brief overview of recognising and managing some types of challenging behaviour. It’s a complex subject, so if your role involves caring for patients with challenging behaviours on a regular basis it is advisable to attend specialist training. 

What do we mean by ‘challenging’?

Let’s begin with a definition of what ‘challenging behaviour’ is. NHS Choices says:

‘A person’s behaviour can be defined as “challenging” if it puts them or those around them (such as their carer) at risk or leads to a poorer quality of life.’

Working in the NHS, you may see patients with various elements of challenging behaviours such as: 

• Self-harm: scratching, head-banging, pulling, picking, eye poking, grinding teeth, and eating things that aren’t food.
• Aggression: Scratching, biting, hitting, grabbing, pinching, hair pulling, throwing objects, verbal abuse, spitting, and screaming.
• Destructiveness: damage to property, stealing, destruction of clothing, lack of awareness in terms of danger and withdrawal.
• Disruptive nature: Rocking, repetitive movements, repetitive speech and repetitive manipulation of objects.

It is the impact that these behaviours have that make them a challenge – both for the patient and those around them.

Reasons for challenging behaviour

In order to deal with challenging behaviour effectively, it’s helpful to know some of the reasons why it occurs. Often there are a combination of reasons. These can include: 

• Biological causes. You may often find the traits of challenging behaviour present in those with health problems that affect communication and issues with the brain, e.g. dementia, autism, learning difficulties, or mental health issues. Self-injuring behaviour can be linked to Lesch-Nyhan syndrome.
• Known ways of communication: perhaps the individual doesn’t know another way to communicate the need for a drink, food, or comfort. Sometimes it’s possible to re-teach ways that are considered more socially acceptable.
• Ways of maintaining arousal or stimulation: such as rocking.
• Signals of distress, abuse, anger, discomfort, frustration, or pain. Again, the individual may be unable to verbalise these feelings.

Challenging behaviour could also be a response to the environment. This could include over or under stimulation, inconsistencies in staff (including awareness, approach, training or staffing levels), or poor physical environments (such as extremes in noise levels or temperature).

What can you do to help?

You may find yourself dealing with challenging behaviour in a variety of situations.

It’s important to try to understand why the person you are caring for is behaving in this way and work out the most appropriate strategies to minimise distress and keep everyone safe. Different approaches will work for individual patients.

Redirect the situation

If you are able to catch the early warning signs, then it’s possible you could prevent any challenging behavioural outbursts from occurring now or in the future. This approach involves getting to know your patients and gaining an in-depth understanding of their needs.

For example, if you have a patient who suffers from anxiety, then you will find that being in a large group may make that person feel more anxious, in turn this can cause them to become agitated. So, to prevent this from happening, you could arrange for that person to receive one-to-one support or ensure they’re placed in smaller group situations.

Offer a distraction

In some cases, people find that if there is a distraction in place, they can focus their energy elsewhere which in turn avoids the challenging behaviour from presenting itself. However, it’s always important to remember that the person you are caring for may be behaving in a challenging way in an attempt to get your attention. In this situation, you could consider not responding directly to their behaviour. This can be a tricky balance as you don’t want to ignore them altogether. If, at any point, their behaviour puts you, the individual or another individual at risk, then it’s important to intervene calmly. If you need to seek further assistance, then don’t hesitate to do so.

Unless in an emergency or unsafe situation, a helpful place to start, when confronted by some form of challenging behaviour is to ask yourself: ‘Why does this person feel like they need to go to these extremes of showing this behaviour? What is happening from their point of view that is making them do this?’

Other ways to deal with challenging behaviour

• Make sure the individual feels listened to and valued.
• Ensure that where communication disorders exist, there is a method of communication available.
• Give the person other ways of communicating their needs.
• Determine triggers in the environment, such as attitudes of the carers, or noises that have the potential to maintain or provoke challenging behaviour.
• Help the person and their carers to recognise distress.
• Develop the individual’s coping strategies for dealing with problems.
• Consider potential problems and intervene where it’s appropriate.
• Ensure you have a variety of materials and activities on hand that are meaningful and appropriate.
• Ensuring appropriate levels of support.
• Making sure that everyone who is involved with an individual provides a consistent approach.

Overall, it’s important to remember that if you feel out of your depth, in harm’s way, or the individual who is presenting challenging behaviour is a harm to themselves, that you seek additional guidance and help.

Get in touch

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