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.
Making changes
How is it going so far?
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.
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