1. Challenging Behaviour WTF?@jopyrah

2. Activity 11. Pair up & pick 5 behaviours each so youhave 10 in total.2. Hand your list to the pair to your left.3. Work out the percentage of behaviours are considered positive by society.4. Pair with highest % wins chocolate bar.28/11/12 switchedoncare.com2 3. Shout out 10 examples of behaviourPinching PullingShoutingHeadbutting Self/harm & aggression?28/11/12 switchedoncare.com 3 4. BehaviourSuch is the power of our culture; it is difficult to think aboutbehaviour objectively, in a passive, neutral way. Wejudge before observing.We must train ourselves to do the opposite; to observe and gather evidence before judging. Mugger? Hypoglycemic?28/11/12switchedoncare.com 4 5. Challenging Behaviour - What it looks likeculturally abnormal 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 seriouslylimit use of, or result in the person being denied access to, ordinary community facilities.Emerson, 199528/11/12switchedoncare.com5 6. Challenging Behaviour - What it looks likeBehaviour can be described as challenging when it is ofsuch an intensity, frequency or duration as to threatenthe quality of life and/or the physical safety of theindividual or others and is likely to lead to responsesthat are restrictive, aversive or result in exclusion.Challenging Behaviour - a unified approach: British Psychological Society,Royal College of Psychiatrists and Royal College of Speech andLanguage Therapists. 200728/11/12switchedoncare.com 6 7. Stereotypical Common Types AggressionDestructiveSelf injuryDisruptive28/11/12switchedoncare.com 7 8. Impact Physical HealthMental Health IsolationExclusion NeglectQuality of Life Stress Relationship Strain Guilt/ShameExpense28/11/12 switchedoncare.com 8 9. Behaviour in contextRisk Ecological SettingSpecificBehaviour Consequence FactorsFactors Events Triggers Antecedent Behaviour Consequence28/11/12 switchedoncare.com9 10. RiskFactors Risk Factors10-15% of people with learning disability will display challenging behaviour.54% of individuals exhibit more than one CB.Risk factors include:Level of LD, Gender, Age, Specific Disorders.Emerson et al 2001Lesch Nyhan SyndromePrader Willi Syndrome28/11/12 switchedoncare.com 10 11. EcologicalFactorsEcological Factors Ecology is the relationship between us and ourenvironment. The influence of the environment on ourbehaviour. Challenging behaviour is more likely under the followingconditions: No stimulation Inadequate Training & Support28/11/12 Disorganisedswitchedoncare.com 11 12. Other unhelpful conditions Too controlling Lack of choice Reactive to challenging behaviour. Ignore appropriate behaviour. Abusive Crowded Temperature28/11/12switchedoncare.com12 13. Setting EventsSettingEventsSetting events increase theSometimes called slow triggers. likelihood of challengingThe start and end of setting behaviour by increasing theevents is often unclear. potency of consequences (reinforcement/punishment)Setting events precede challenging behaviour but cane.g. Being tired increases the continue during and after value of going to bed. challenging behaviour. e.g. Food tastes better when your hungry.e.g absence makes the heartgrow fonder...Setting events are more functionally connectedto challenging behaviour than ecological or risk factors. 28/11/12 switchedoncare.com 13 14. Setting Events Feeling Physically Unwell Psychologically UnwellSitting around doing nothing Lack of carer attentionWaiting for long time without food or drink28/11/12switchedoncare.com 14 15. Specific Triggers Specific TriggersWhether or not challenging behaviour occurs will be determined by more obvious events, with clear starting and stopping points.These are known as antecedents or fast triggers ortechnically speaking discriminative stimuli.These occur immediately before behaviour and end priorto the behaviour occurring.28/11/12switchedoncare.com15 16. Examples of Triggers Specific TriggersAsked to do something you dont want to doOr dont know how to doBeing ignored when you want somethingBeing told you cant have something you want 28/11/12switchedoncare.com 16 17. Activity 2 In a group draw a comic strip showing how setting events and triggers can culminate in particular behaviour.28/11/12switchedoncare.com17 18. Consequence Consequences Our behaviour is influenced by our environment and the impact our behaviour has on our environment. The nature of that impact determines whether we will go on to repeat the behaviour when faced with similar conditions in future. This is how we learn and our behaviour evolves. 28/11/12switchedoncare.com 18 19. ConsequenceConsequence TypesReinforcementPunishmentStrengthens behaviour Weakens behaviourIncreases the future Decreases the futurefrequency, duration andfrequency, duration andor intensity of behaviouror intensity of behaviourThere are two kinds of bothpunishment & reinforcement 28/11/12 switchedoncare.com 19 20. Consequence Common Outcomes - More or LessSate verb (used with object), sated, sating.1.to satisfy (any appetite or desire) fully. Get sensory feedback or stimulationSensory Get attention Get objects, item orAttention activitiesTangible Escape or avoid something or someone Escape 28/11/12 switchedoncare.com20 21. ConsequenceReinforcementPositiveNegativeStrengthen behaviour Behaviour is strengthened because the outcome of because the outcome of behaviour is something behaviour is that pleasant or rewarding is something unpleasant or added. unrewarding is takenaway.e.g. When I hit my head staff come and sit with me. e.g. When I take the stone from my shoe my foot stops hurting.Reinforcement STRENGTHENS behaviour whether positive or negative 28/11/12switchedoncare.com21 22. ConsequenceActivity 3 I am tired I need sleep!I get noticedI sign bed (sent to bed)(no one notices) I throw a cup (it breaks) 28/11/12switchedoncare.com22 23. Consequence PunishmentPositiveNegativeBehaviour is weakened Behaviour is weakenedbecause the outcome ofbecause the outcome ofbehaviour is that behaviour is thatsomething unpleasant or something pleasant oraversive is added.rewarding is taken away.e.g. As I walk through a lowe.g. My dinner is in the dogdoor way my head is for being late home.bashed.Punishment WEAKENS behaviour whether positive or negative 28/11/12switchedoncare.com23 24. What Type of Punishment is this? Click here to go to video http://goo.gl/q0wyB28/11/12switchedoncare.com 24 25. Whether an outcome is punishment or reinforcement is decided by its effect on behaviour.A hug could positively punish behaviour where this is an aversive sensation, asRestraint can positively occurs in ASD.reinforce behaviour it isdesigned to manage.28/11/12switchedoncare.com25 26. Positive Behavioural SupportPBS is a way of working with people who present challenging behaviour. Starting bylooking at the context in which it occurs (see slide 9) and the meaning it has forthe individual concerned, drawing understanding from this and developingappropriate methods of working with the person.PBS is proactive, ethically sound and values led. It offers a solution-focussedframework of support that rejects the use of aversives or punishment.Improvements in lifestyle can, under the PBS model, be seen both as intervention and as the result of intervention.Because people with challenging behaviours often have long standing and difficult to understand behaviours we do not expect overnight change. PBS is a long term realistic developmental approach.There is significant research supporting its efficacy.28/11/12 switchedoncare.com26 27. PBS recognises:The environmental influence on behaviour.The importance of quality information to support approaches.The need to create the right conditions in the first place.The need to understand triggers for prevention.The need to improve & develop skills.Improving skillsQuality information The right conditions28/11/12switchedoncare.com 27 28. The PBS ModelBroadly thought of as having three stages:1) Primary PreventionApproaches that reduce challenging behaviour likelihood - baselineapproaches.2) Secondary PreventionApproaches used when a persons challenging behaviour begins to emerge,when early signs are noticed.3) Reactive StrategiesApproaches that allow challenging behaviour to be safely responded towhen prevention is no longer possible. These are crises and riskminimising approaches.28/11/12switchedoncare.com28 29. Positive Behavioural SupportRiskEcologicalSettingSpecificBehaviour Consequence Factors FactorsEvents Triggers EcologicalPrimarySecondaryReactiveChangePreventionPrevention StrategiesProactiveReactive28/11/12 switchedoncare.com 29 30. Final Thoughts...Challenging behaviour is functional, serving legitimateneeds.99% of the time it serves as a way of communicating theseneeds.The challenge is working out what is being said, why andcreatively changing conditions so that challengingbehaviour is no longer necessary or is replaced by moresocially acceptable skills.28/11/12switchedoncare.com 30 31. Challenging BehaviourWhats The Function?Thank you for listening!28/11/12switchedoncare.com 31