At times, individuals with neurodevelopmental disorders (i.e. Autism, Intellectual Disability, ADHD) can behave in ways that are challenging to those around them. The behaviours may be directed toward others, or toward themselves and can be highly distressing for the individual, carers, and those around them. Behaviours are most distressing and challenging when they cause harm to other people or the individual. Common harmful behaviours include:
Behaviour toward others
- Hitting others with hands
- Hitting others with objects
- Scratching others
- Pulling hair of others
- Pinching others
- Biting others
- Pushing or pulling others
- Head-butting others
- Choking others
Behaviour toward self
- Skin picking self
- Biting self
- Head punching/slapping self
- Head to object banging self
- Body to object banging self
- Hair removal self
- Body punching or slapping self
- Eye poking self
- Banging with tools self
- Lip chewing self
- Nail removal self
- Teeth banging self
Often individuals with these types of neurodevelopmental disorders are unable to communicate the reason’s why they are completing these behaviours, and so a behavioural practitioner is employed to complete a functional behavioural assessment to make some hypotheses about why. The practitioner is interested in the function of the behaviour, (or the motivation behind the behaviour) and this is where the name functional behaviour assessment comes from.
So, WTF?
No, not that what the… actually we are always asking: what is the function?
Behaviours can generally be separated into four or five functional categories:
- Social Interaction
Individuals may display behaviours as a means to communicate with others and gain social attention or interaction. For example, the boy who throws an object in another child’s direction as a way to get their attention, or the girl who pulls another girls hair.
2. Escape
Behaviours may be used as a means to escape certain undesirable activities or environments. For example, the teenager who yells and screams when asked to start doing their homework, or the adult who runs toward traffic when getting in the car to go to the GP.
3. Non-social (Sensory)
Self-stimulation and repetitive behaviours may be used to reach a desired level or arousal, or as a way to reduce discomfort or anxiety. For example, the woman who picks at her skin, or the boy who isolates to his room and plays video games repetitively.
4. Tangible
Behaviours may be used to gain access to tangible resources such as money, food, games, or toys. For example the toddler who kicks and screams until they are given their favourite snack, or the man who hits himself in the head when he is not able to buy a soft drink, only to be given the soft drink to de-escalate the situation.
Its not just people with neurodevelopmental concerns who display challenging behaviours. We all do at times. Have a think about a time when you became frustrated and instead of communicating with language, you communicated with behaviour. If you drive a motor-vehicle, have you ever tooted your car horn at a fellow motorist in anger? This could be considered a challenging behaviour to other motorists and may cause some distress. Of course this is quite benign example but I hope it illustrates my point that challenging behaviours exist on a continuum from and can be considered normal in many ways.
Fortunately, most of us have reasonably well developed skills to problem solve, navigate the world, inhibit our impulses, and express our needs through language. However, when individuals are unable or unwilling to communicate the reasons why they perform certain behaviours, those who care and support the individual can be left perplexed and feel powerless to make change. They wish to reduce or contain the behaviour so that the individual and those around them are safe.
This is where the behavioural practitioner can help to determine the function of the behaviour. Once a hypothesis is made about the function of the behaviour, the behavioural practitioner can then make recommendations to reduce the likelihood that the behaviour will occur. Identified triggers can be minimised, and alternative behaviours which meet the individuals needs can be taught. Any factors that may be inadvertently rewarding the behaviour(s) can be avoided. Staff can also be trained in appropriate ways to respond to challenging behaviours and trained in strategies to teach alternative behaviours.
Working to reduce challenging behaviours is an ongoing process, and is grounded in the scientific method where hypotheses about the function of the behaviour are made, interventions are applied, and reviewed for their effectiveness. If the interventions are effective, brilliant! If not, the hypotheses and interventions are modified and trialled again. Of course, in the end, this process is about improving the quality of life of the individual, and equipping supports and caregivers with the tools necessary to keep the individual and those around them safe and well.