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Challenging Behaviour

Background

As all children grow up there are times when they show difficult or inappropriate behaviour. Challenging behaviour is a term that is used to describe particularly "difficult" or "problematic" behaviour, which is experienced as challenging by parents and others who care for and support these individuals. Challenging behaviour is more common in individuals with learning disabilities than in those without; approximately ten percent of children with learning disabilities exhibit severely challenging behaviour.

Those with physical, emotional, social and communication difficulties may also show behaviour that is worrying, difficult or challenging. A person's underlying medical and/or psychiatric condition, age, social experiences, adverse life events and a range of other factors can affect the type of behaviour.  Sometimes an underlying cause, for example genetic, may leave the individual prone to challenging behaviours of varying intensity and nature.

Credits

Last updated March 2017 by Professor J Turk, Honorary Professor of Developmental Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King's College, University of London, and Consultant Child and Adolescent Psychiatrist, Child and Adolescent Mental Health Neurodevelopmental Services, South London and Maudsley NHS Foundation Trust.

Although great care has been taken in the compilation and preparation of all entries to ensure accuracy, we cannot accept responsibility for any errors or omissions. Any medical information is provided is for education/information purposes and is not designed to replace medical advice by a qualified medical professional.

What are the symptoms?

There are many types of behaviour that can be described as challenging. Examples of these include:

  • self-injury
  • physical aggression
  • verbal aggression
  • disruption and destruction of property or the environment
  • stereotyped behaviours (e.g. rocking, jumping up and down, twirling)
  • inappropriate or unacceptable sexual behaviour
  • smearing and urination
  • stealing
  • manipulative, deceitful and non-compliant behaviour
  • chaotic and disorganised hyperactivity
  • absconding.

What are the causes?

Challenging behaviour can be a result of many factors. Some children with learning disabilities (intellectual disability) lack the communication and emotional skills to convey what they need. A child may show certain behaviours to communicate that they are experiencing physical or emotional discomfort. Assessing behaviour may also be part of the process to diagnose an underlying condition. There are also some conditions in which certain types of behaviour may be more common, such as Lesch Nyhan syndrome, Prader-Willi syndrome, Fragile X syndrome, Cornelia de Lange syndrome and autism. However, not all children with the same condition will necessarily show a particular behaviour.

How is it diagnosed?

For behaviour to be defined as "challenging", the nature of the behaviour, its seriousness, intensity, duration and the frequency must all be observed. A combination of observations and reporting by parents, school staff and other professionals will need to occur.

Some people feel that it is not appropriate to label a child as having challenging behaviour as it can be caused as much by the way the child and their family are supported as by the child's characteristics. The label of "challenging behaviour" can have a negative impact and this must be considered carefully during assessment sessions.

How is it treated?

Most challenging behaviours are best managed without medication. The most effective types of interventions will take into account what social, developmental, biological and psychological factors are affecting the child's behaviour. Any causes of physical or psychological pain or distress need to be identified and treated vigorously. With appropriate levels of stimulation, care, support and encouragement, and teaching of new coping skills, behaviour can usually be kept within acceptable limits. Professionals may conduct a "functional assessment" to find out the needs which are being met by their behaviour and what its "communicatory function" is. This is done to help professionals suggest ways to prevent and respond to behaviour in a way that encourages more productive behaviours instead. The responses they suggest attempt to teach the child alternative and more acceptable ways of getting their needs met as part of a positive behaviour support plan. Although this method will require much time and effort, positive improvement in behaviour will be seen provided these strategies are used all the time, wherever the individual is, and by all who come into contact with the child (e.g. both at home and school). Treating or managing underlying medical conditions and addressing sensory and communication needs is also essential to have a positive effect on behaviour. With good support, most challenging behaviour can be reduced to a level whereby it does not impinge on the individual's and family's quality of life.

Inheritance patterns and prenatal diagnosis

Inheritance patterns
Some conditions that include challenging behaviour as a feature may be genetic and have a specific inheritance pattern although challenging behaviour itself is not inherited.

Prenatal diagnosis
Prenatal diagnosis of the underlying condition may be possible for some causes of challenging behaviour. The type of testing will depend on the condition.

Is there support?

Challenging Behaviour Foundation

Family support line: 0300 666 0126
Email: support@thecbf.org.uk
www.challengingbehaviour.org.uk

The Foundation in a Registered Charity in England and Wales No. 1060714, established in 1997. It provides information and support to families and professionals caring for individuals with severe learning disabilities who are described as having challenging behaviour. The Foundation has both a parents email network and a professionals email network and also a wide range of free resources available for families.

Group details last confirmed April 2017.

References

Cooper P, Smith JS, Upton G. Emotional and behavioural difficulties: theory to practice. 1994; London, UK: Routledge.

Clements C, Martin N. Assessing behaviors regarded as problematic for people with developmental disabilities. 2002; London, UK: Jessica Kingsley.

Emerson, E. Challenging Behaviour: analysis and intervention in people with learning disabilities. 2001; Cambridge, UK: Cambridge University Press.

McGill P. An introduction to challenging behaviour [e-text]. Available at: http://www.challengingbehaviour.org.uk

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