Challenging Behaviour or Symbolic Communication Disorder?

Tahir Saeed recommends that terminology should focus not on the symptoms of 'challenging behaviour', but on its causes. Tahir Saeed, Psychologist Child and Family Centre CoAction West Cork, Ardnageeha, Bantry, Co. Cork

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Most concepts in the field of disability have come from broad, harsh terms such as ‘insanity,’ ‘mental retardation,’ ‘word blindness’, etc. The concepts are unitary—either a condition exists or does not exist—and there has been a paucity of research into more precise categorisation within phenomena. Such ambiguity and vagueness gives way to more sophisticated and refined terms upon further review, keenly observed and critical analysis. New data can provide further divisions within a category, eg. mild, moderate and profound learning disability. The co-morbidity between two different but similar concepts becomes clearer and new categories are recognised.

The term ‘challenging behaviour’ was first introduced by the association for people with severe handicaps in North America. The concept soon supplanted a number of negative terms—‘abnormal’, ‘disordered’, ‘disturbed’, ‘dysfunctional’, ‘mal-adaptive’ and ‘behavioural problem’—which had previously been used to indicate broad categories of inexplicable or odd behaviours in people with learning disabilities. This switch in terminology reflected the general trend toward the use of more respectful, less deficiency- or problem-oriented language. The concept of challenging behaviour provided a reminder that problematic behaviour—or indeed any behaviour that impacts on the developmental progress and quality of life of the person—should be seen as a challenge to services, rather than as a manifestation of psychopathological processes.

However, an important question arises: can the mere change of terminology produce any qualitative change in the life of marginalised and labeled people? It seems that whatever concept is used in the fields of mental illness and learning disability, it will always carry a negative meaning. The concept of challenging behaviour is no exception—it has become highly-loaded, with negative undertones, particularly as a description of the behaviour of individuals with intellectual disabilities. These individuals have already been labeled as having limited control over their information processing capability, a low threshold of tolerance and sudden outbursts of temper, and who become quickly intimidated and hostile. These assumptions lead to an obvious expectation of aggressive, hostile, defiant or rebellious behaviours. The word ‘challenging’, is sometimes very difficult to convey adequately to people directly involved with the individual, as it is likely to engender feelings of threat or danger. It is even more difficult for family members to accept this terminology, and it can further engenders fear and despondency, as it further distances him/her from the mainstream of social acceptance.

Perhaps the whole concept of ‘challenging behaviour’, and associated problems should be further analysed more fully, in an attempt to illustrate and redefine the whole concept and to look for appropriate terminology which is more realistic and objective. Interestingly, ‘challenging behaviour’, although it may occur more frequently in persons with schizophrenia, affective disorders or learning disabilities, may also be displayed by individuals with no such diagnosis, in the complex circumstances of their daily life.

If we try to avoid terms or concepts, even though they may scientifically and realistically explain the phenomenon, we run the risk of ostracizing the problem. Besides, whatever concept is used will automatically take on negative meanings if it is associated with an adverse activity or symptoms. We all know that the effect of a sweet coating on a sour centre is only temporary.

Definitions

‘Challenging behaviours have been defined as behaviours which, due to their intensity, frequency or duration, place the physical safety of the person or others in jeopardy or are likely to seriously limit or delay access to or use of ordinary community facilities” (Emerson et al., 1987).

Other definitions have been criticised by Jones and Eyres (1993) as being arbitrary, or by Lowe et al. (1995) as being open to idiosyncratic interpretation. Jones and Eyres (1993) go so far as to question the usefulness of using a global term such as challenging behaviour.

Toogood (1994) offers a dual approach, defining ‘enduring patterns of behaviour which, at a given point in time, render what would be considered the ordinary range of services temporarily ineffective either as a function of the frequency, intensity or duration of the behaviour itself, or because of its negative consequences upon the life-style of the people concerned.’

Challenging behaviour does not refer only to physical aggression; it can be any inappropriate, absurd, weird, uncanny or bizarre behaviour—which may be mild or severe—which may hinder or negatively impinge on the environment around the individual. Normally, individuals communicate symbolically through the highly sophisticated means of communication ie. language. But sometimes, when his routine communicative capabilities fail to make others understand him, a ‘normal’ person may seek assistance from other means—gestures, a high-pitched tone, crying, shouting, etc. This may indeed help him to be listened to and a vicious cycle is developed in the cognitive schema, reinforced and strengthened through reciprocity.

The behaviour we term ‘challenging’ is actually a means of communication for individuals who, because of limited resources available in the repertoire of their behaviours, are unable to communicate what they wish to say or do. We can safely hypothesize that such behaviour is basically a symptom of an inability to communicate and to be understood; the behaviour is caused by the frustration which accompanies being unable to send one’s message’ or when another person is not properly equipped to understand the symbolic communication of the individual. If we only concern ourselves with the apparent inappropriate behaviour, we will never investigate and understand its underlying source; it is a fallacy to focus on the symptoms rather than the cause. The problem is compounded for individuals with intellectual disability because of their restricted communicative capabilities. People who are familiar to them may understand them, but this may be on a trial-and-error basis without a systematic approach. The presence of strangers may add to their confusion and greater communication difficulties—leading to further agitation and aggression.

New terminology

We must look for a term which is related to the phenomenon of communication and not to something which implies physical or verbal aggression. It would seem more appropriate to rename ‘challenging behaviour’ as Symbolic Communication Disorder, defined as any absurd, bizarre or inappropriate communication substitute for an ordinary symbol of communication (language) through which an individual tries to express himself-

A symbolic communication disorder may be as varied as any other form of human behaviour; it may be severe (hitting oneself or others), moderate (crying or shouting), or mild (sitting silently in a corner). The symptomatic behaviours can be investigated scientifically and analysed functionally, in order to categorize them accordingly. Initially, we may consider three categories:

  1. Internalized Symbolic Communication Disorder
  2. Externalized Symbolic Communication Disorder
  3. Dual-way Symbolic Communication Disorder
Internalized Symbolic Communication Disorder

This occurs when individuals want to express themselves and fail, or when other people misinterpret or misunderstand them, or refuse to understand them. Or an individual may himself misinterpret a situation. Whatever the cause, frustration results, forcing them to initiate a self-focused activity which is absurd or harmful. But, at least to a behavioural scientist, the message is explicit and unequivocal: I desperately require something such as food, or I am very bored, or my environment is too noisy or uncomfortable. The limited repertoire of communication available to the individual with intellectual disability may include slapping, biting, banging, masturbation, crying, shouting, etc. These behaviours usually gain quick attention because of their severity and absurdity.

Externalized Symbolic Communication Disorder

When an individual tries to express himself but is unable to do so, the frustration is often directed outward—he will initiate an activity to try to involve other persons around him. The individual may hit objects or persons in their immediate environment. Further exploration may be needed to determine whether such individuals have previously exhausted avenues of self-involved symbolic communication disorder, or whether they have always initiated attention-seeking through Externalized Symbolic Communication Disorder. Or it could be that people involved might have reinforced the behaviour at the first instance with overreaction not knowing the consequences.

Dual-way Symbolic Communication Disorder

Here the individual uses both of the strategies above, either becoming involved in an inappropriate self-directed activity, or directing his actions toward others. Since these behaviours are less predictable, they can occasionally dangerous. Investigations may be carried out to determine whether the presence of a particular individual or situation may accompany the self-directed or externally-directed behaviour.

These alternative concepts could help professionals to focus their energies on the source of the behaviour; it would be in their and the family members interest to have a clear picture of the concepts and their implications in order to plan a pragmatic strategy to help the individuals to communicate in better ways. Last but not least, to keep ourselves dynamic in the field of behavioral sciences we have to question concepts and ideas to explore new avenues for better understanding.

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