An educational day entitled ‘Different approaches to challenging behaviour’ was presented by professionals from the British Institute of Learning Disabilities (BILD) and St Michael’s House in the Stakis Hotel, Dublin, on 26 March. A general introduction by Dr Nigel Beail on psychotherapeutic services for people with learning disabilities was followed by two two-hour workshops. Workshop presenters had themselves used the recommended approaches with individuals presenting with challenging behaviour and had assisted carers in putting the approaches into practice. The BILD Workshop focused on a specific intervention for challenging behaviour, while the St Michael’s House Workshop gave research findings from a survey on challenging behaviour and recommended underlying principles for dealing with such behaviours.
The term ‘challenging behaviour’ is an umbrella concept embracing many meanings and varying interpretations, depending on social convention, the individuals concerned, the environment in which the behaviour occurs and the subjective perceptions of others. One widely used definition is that challenging behaviour is ‘behaviour of such an intensity, frequency or duration that the physical safety of others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit or delay access to and use of ordinary community facilities’ (Emerson et al. 1987). Challenging behaviour can affect the physical and psychological well-being of the individual, their family, peers and carers. It can hinder education, employment, day-care placement, social and recreational life, emotional development and relationships. The most serious effect on the individual is that of self-injurious behaviour (SIB), which is distressing both for the individual and for those around him/her. The effects of challenging behaviour may permeate a whole family, constraining their social and leisure activities, as well as being physically and emotionally draining. There is a significant prevalence of challenging behaviour among people with learning disabilities; the survey conducted by St Michael’s House indicated that 35 per cent of service users demonstrated ‘some level of challenging behaviour’.
Dr Mark Harrold and Mark Mulrooney’s research suggests that training programmes must be sufficiently flexible and robust to address the range of challenging behaviours, as identified in their survey. Their workshop aimed to promote principles to be used with individual approaches. These principles are adapted from the Jack Tizzard Memorial Lecture on Decreasing Behaviours, and they look at necessary characteristics which the carer or person who is trying to change or decrease the challenging behaviour (the ‘change agent’) should possess. These include: having a perceptive sensitivity, liking people, being self-actualised, having a sense of humour, not liking to lose, having optimistic tendencies, and the ‘Mafioso characteristic’—not taking the behaviour personally. These characteristics enable the change agent to be a proactive problem-solver when dealing with challenging behaviour. Their workshop concluded with role-plays to develop awareness and understanding of the level of frustration and confusion a client may experience when trying to gain attention from a carer, or to communicate his/her needs. If they are unsuccessful, an outburst of challenging behaviour may release tension or attract the carer’s attention.
Mark Harrold stressed that the ‘nutshell has still not been cracked’ in relation to the reduction of challenging behaviour. The subject is one of vast complexity and it requires much further study, research and innovative practice.
Phoebe Caldwell of BILD, who conducted the second workshop, views challenging behaviour as a medium of communication which an individual finds understandable, non-threatening and rewarding. By using the approach of ‘intensive interaction’ one acknowledges signals with which the individual is familiar and responds ‘in their world’. ‘Intensive interaction’ involves the carer in mirroring or reflecting back the individual’s actions or ‘their language’, by ‘joining in’. The individual may be screaming, banging objects or engaging in self-injurious behaviour. If the individual is banging themselves, one should consistently echo their banging by lightly tapping oneself, and then the individual, following their rhythm and volume—thus moving them from a solitary occupation to a shared activity. As proficiency is developed in the use of their language, and rapport is developed, it may be possible to steer them to alternative activities, perhaps to mirror the other person’s actions, such as stroking their face. Phoebe Caldwell presented a video which demonstrated intensive interaction with a young woman who screamed in a harsh, high-pitched voice throughout the day. In response, the screams were imitated with a whistle; the volume and frequency of screaming were reduced, and for the first time the woman reached out to hold Phoebe’s hand. The intensive interaction approach appeared to surprise the woman and immediately gained her attention.
Sinason (1992) has pointed out that ‘no single approach is likely to provide the whole answer [to challenging behaviour]’. For this reason it is important to continue examining new approaches. Challenging behaviour creates considerable difficulties and barriers for all concerned and the BILD conference was an opportunity to consider several approaches to reducing its prevalence. The day was held in a friendly and relaxed atmosphere and a literature pack was provided to all participants. It is hoped that with further such conferences challenging behaviour may become less of a challenge.