Essay on Challenging Behaviour

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100 Words Essay on Challenging Behaviour

What is challenging behaviour.

Challenging behaviour means when someone acts in a way that is hard for others to deal with. It can be things like yelling, hitting, or not following rules. This behaviour can make it tough for them to make friends or do well in school.

Why Do People Show Challenging Behaviour?

Sometimes people show challenging behaviour because they are upset or they need something. They might not know how to tell others what they want or how they feel, so they act out instead.

How to Deal with Challenging Behaviour

If someone is showing challenging behaviour, it’s important to stay calm. Try to understand why they are acting that way. Talk to them in a kind and gentle way to help them feel better.

Helping Out

Everyone can learn how to behave better. With patience and support, people who show challenging behaviour can improve. It’s important to help them and teach them good ways to deal with their feelings.

250 Words Essay on Challenging Behaviour

Challenging behaviour is when someone acts in ways that are hard for others to deal with. It can include being very angry, yelling, hitting, or not following rules. This kind of behaviour can cause trouble at home, school, or in other places.

There are many reasons why a person might show challenging behaviour. Sometimes, they might be upset or frustrated and don’t know how to share their feelings in words. Other times, they might not understand what is expected of them. Some people might have a tough time learning or have a condition that makes it harder for them to control their actions.

Dealing with Challenging Behaviour

When someone is showing challenging behaviour, it’s important to stay calm and not get angry too. Trying to understand why the person is acting this way can help. It’s also good to set clear rules and talk about why certain actions are not okay. Giving praise when they do the right thing can also encourage good behaviour.

Getting Help

Sometimes, it’s hard to handle challenging behaviour alone. It’s okay to ask for help from teachers, family, or professionals who know how to deal with these situations. They can give advice and support to make things better for everyone.

Remember, challenging behaviour can be tough, but with patience and help, people can learn to act in better ways.

500 Words Essay on Challenging Behaviour

Challenging behaviour is a term used to describe actions that are hard for people to deal with. It can be seen in children and adults alike. Sometimes, when people act in ways that seem tough to understand or manage, they are showing challenging behaviour. This might include yelling, hitting, not following rules, or doing things that can be risky. It’s important to know that these actions are often a way of communicating, especially when someone finds it hard to use words to express their feelings or needs.

Reasons Behind Challenging Behaviour

There are many reasons why someone might show challenging behaviour. For kids, it might be because they are tired, hungry, or not feeling well. Sometimes, they might be upset or frustrated because they can’t do something they want to. For others, there could be bigger issues like feeling stressed, having trouble at home, or facing problems at school. It’s like when you can’t find the right puzzle piece, and it makes you feel annoyed. That’s how someone might feel inside when they act out.

Effects on Others

When someone behaves in a challenging way, it can affect the people around them. Teachers, parents, and other kids might feel stressed or unsure about what to do. It can make school or home feel less calm and safe. Imagine if your friend kept taking your pencils without asking; it might make you feel upset or make it hard to do your work. That’s a bit like how challenging behaviour can make others feel.

Helping with Challenging Behaviour

To help someone with challenging behaviour, it’s important to stay calm and patient. Think of it like a detective trying to solve a mystery. You have to look for clues to understand why the person is acting this way. Talking to them, listening, and showing that you care can make a big difference. Sometimes, making changes like having a clear routine or giving them a quiet place to take a break can help too.

Learning from Each Other

Dealing with challenging behaviour can teach us a lot. It can help us get better at understanding how other people feel and why they do certain things. By working together, kids, teachers, and parents can learn new ways to help each other. It’s like learning a new game; at first, it seems hard, but with practice, everyone gets better at it.

Challenging behaviour is a part of life for many people. It’s not just about the actions that are hard to handle but also about understanding the reasons behind them. By being kind, patient, and working together, we can help make things better for everyone. Remember, every person is different, and by trying to understand each other, we can create a happier and more understanding world.

That’s it! I hope the essay helped you.

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How to Positively Approach Challenging Behaviours

essay on challenging behaviour

We’ve all experienced challenging behaviour – throwing a tantrum, hitting people we love, and refusing to cooperate. For most of us, it occurred at a period in our lives around the age of two when the world was still new, confusing, and difficult to navigate. As we started to learn how to do things for ourselves or how to ask others to help us, the challenging behaviours disappeared – we had more effective ways to get the things we wanted. Now imagine you never went through that second stage – you still had to rely on people around you to guess what you wanted and when. And what if they then ignored you or got it wrong? Wouldn’t it frustrate you? This is how it is for the majority of children and adults with a severe learning disability, and according to mounting evidence , it could be the key to understanding many of their challenging behaviours.

For many decades, the treatment of people with a severe learning disability and behaviour described as challenging has been subject to the so-called ‘medical model’ , under which challenging behaviour is seen as ‘part of the syndrome’, a necessary and unavoidable consequence of intellectual disability. It has naturally resulted in treatment methods where the sole aim is to suppress challenging behaviour much like unpleasant medical symptoms might be treated in other complex conditions. Sometimes this approach works, but at what cost? 

Positive behavioural support (PBS) is emerging as the leading alternative . It sees challenging behaviour not as an inevitable characteristic of severe learning disability, but as the product of a larger framework involving psychological, social, and biomedical factors.

The grounding principle is that all behaviour is functional – it is always used to either get something we want or to avoid something we don’t. Therefore, it is only when we appreciate the function of challenging behaviour that we can start to root out its primary cause.

For many people with a severe learning disability who have no verbal communication, challenging behaviour is often the most effective way of communicating their needs or desires. When somebody with a severe learning disability uses challenging behaviour, such as throwing things, hitting people or self-harming, their family or carers will understandably stop what they’re doing and rush over to reassure them.

As part of an effort to stop the behaviour, they will likely resort to giving rewards such as something to eat, a favourite toy or removal from an anxiety-provoking situation. Children and adults with a severe learning disability learn this pattern of behaviour and outcome and, as a result, their challenging behaviours grow. The PBS approach aims to improve the general quality of life for people with a severe learning disability and therefore reduce the need for challenging behaviour to be used in the first place .

The initial step in any PBS strategy should be to assess possible causes of the behaviour. Key things to consider are that the person might be in physical pain (how would you feel if you had a painful toothache and no one was taking any notice?), bored, or feeling a lack of control over their lives. Often though, this is easier said than done, especially if the same behaviour is used to achieve different outcomes. 

PBS works because it aims to teach people at risk of displaying challenging behaviour new skills to either get the things they want for themselves or communicate their needs more effectively. Ways this can be done are giving the person different coloured tokens to represent things like ‘I want a drink’ or ‘I want to go to the park’, asking them to point to pictures of what they want, or teaching a simplified signing language such as Makaton . 

Of course, there is no blanket approach suitable for everyone, and PBS is at heart a person-centred way of working. One way it achieves this is through the Functional Behavioural Assessment where specific triggers for one particular person’s challenging behaviour (e.g., loud noises, limited social contact, being unable to go swimming, running, bowling, etc.) are noted and planned for in advance.

Another emerging theme coming from the bridge of psychology with medicine is using what we know about the brain and behaviour to envision what life must be like from the perspective of somebody with a particular type of severe learning disability. Researchers such as Professor Chris Oliver of the Cerebra Centre are combining brain scans with psychological experiments to show how and why people with different types of severe learning disability might be more likely to show challenging behaviours in particular situations. 

PBS is now a mainstream treatment framework for the prevention of and response to challenging behaviour in at least four different countries including the UK and the US; Ireland has gone one step further , putting into place legislation that requires the use of PBS in residential or respite care settings. It is making such a radical and beneficial change simply because it recognises people with a severe learning disability as individuals and not medical cases. There are proven results for PBS both in academic journals and from thousands of family testimonials.

Huw MacDonald currently works for the Challenging Behaviour Foundation , a UK based charity supporting the rights of children and adults with a severe learning disability and their families.

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National Collaborating Centre for Mental Health (UK). Challenging Behaviour and Learning Disabilities: Prevention and Interventions for People with Learning Disabilities Whose Behaviour Challenges. London: National Institute for Health and Care Excellence (NICE); 2015 May. (NICE Guideline, No. 11.)

Cover of Challenging Behaviour and Learning Disabilities

Challenging Behaviour and Learning Disabilities: Prevention and Interventions for People with Learning Disabilities Whose Behaviour Challenges.

2 introduction.

Some people with a learning disability display ‘behaviour that challenges’. Behaviour that challenges is not a diagnosis and is used in this guideline to indicate that such behaviour is a challenge to services, family members, carers and the person, but may be functional for the person with a learning disability. The behaviour may appear only in certain environments, and the same behaviour may be considered challenging in some settings or cultures but not in others. It may be used by the person for reasons such as creating sensory stimulation or gaining assistance. Some care environments increase the likelihood of behaviour that challenges. This includes those with limited social interaction and meaningful occupation, lack of choice and sensory input, excessive noise, those that are crowded, unresponsive or unpredictable, and those characterised by neglect and abuse.

When children, young people or adults with a learning disability engage in behaviour that challenges, they may experience a series of escalating reductions in their quality of life, such as restrictive practices (Interventions that restrict a person's movement, liberty or freedom to including locking doors, preventing a person from entering certain areas of the living space, seclusion, manual and mechanical restraint, rapid tranquillisation and long-term sedation), physical abuse, placement breakdown and out-of-area placements ( Department of Health, 2007 ; Emerson & Einfeld, 2011 ; Royal College of Psychiatrists, 2007 ). Families, carers and staff also experience a reduction in quality of life, often reporting frustration, fatigue, exhaustion, burnout and feeling unable to continue in their caring role ( Hastings, 2002a ; Lecavalier et al., 2006 ). Meanwhile, when families, carers or staff are unable to cope, service commissioners are often uncertain about what to do. At times, they fund the person's care in poor-quality services that are out of area, that may be very expensive, and that may increase the risk of behaviour that challenges even further ( Allen et al., 2007 ; Barron et al., 2011 ; McGill & Poynter, 2012 ). Such placements are often a long distance from families, meaning that their quality of life, and that of their family member, may be even more compromised ( Bonell et al., 2011 ; Chinn et al., 2011 ). This guideline addresses these important issues for people with a learning disability, their families and carers, staff and service providers and commissioners.

2.1. Definitions and terminology

2.1.1. learning disabilities.

In the UK, the term ‘learning disabilities’ was first used formally in 1991 in a speech by the then Health Minister, Stephen Dorrell, to refer to what had previously been termed ‘mental handicap’ or ‘mental retardation’ (which people with a learning disability and their families found unacceptable). Since then ‘learning disabilities’ has been the accepted term in government documents. In the White Paper Valuing People, the Department of Health (2001) defined a learning disability as:

  • a significantly reduced ability to understand complex information or learn new skills (impaired intelligence)
  • a reduced ability to cope independently (impaired social functioning)
  • a condition which started before adulthood (18 years of age), and has a lasting effect.

It is important to be clear that the term ‘learning disabilities’ employed in this guideline implies pervasive or global learning disabilities, affecting most aspects of cognitive functioning, and not specific learning difficulties, such as dyslexia.

Services for adults with a learning disability in the UK are familiar with the above definition. In children's services, however, rather different terms are used, because education authorities prefer the term ‘learning difficulties’, which covers a broader group of children.

Internationally, the term ‘learning disability’ is often confused with dyslexia and so in international contexts the preferred phrase is ‘intellectual disability’. This is becoming the accepted term in Australia, New Zealand, Canada, USA and Europe. In the UK, the term ‘learning disability’ is still the most widely used and accepted – only the British Psychological Society and the Royal College of Psychiatrists have adopted the phrase ‘intellectual disability’ (December 2013). Therefore in this guideline the term ‘learning disability’ is used.

Whatever the term used, it is widely recognised that learning disability is largely a socially constructed phenomenon ( Finlay & Lyons, 2005 ), which has had varying different definitions over time and across countries. Currently most developed countries accept a 3-part definition:

  • Significant impairments in cognitive functioning
  • Significant impairments in adaptive behaviours
  • Occurring in the developmental period.

The disabilities are thus seen as being located in the individual, and a major challenge to this so-called ‘medical’ model has come from those who espouse a social model of disability and who argue that disability arises from the inability of social environments to adapt to fit a person's needs. With a responsive environment, they argue, impairments would not become disabilities ( Shakespeare, 2006 ; Thomas, 2007 ).

People with a learning disability may have varying degrees of impairment and there have been numerous attempts to subdivide the population on the basis of cognitive ability. For example, the World Health Organization International Classification of Diseases, 10 th revision (ICD-10) subdivision is into:

  • Mild learning disability – intelligence quotient (IQ) between 50 and 69
  • Moderate learning disability – IQ between 35 and 49
  • Severe learning disability – IQ between 20 and 34
  • Profound learning disability – IQ less than 20.

Such classifications have been heavily criticised however, not least because they rely on IQ. It is important to be aware that IQ cannot be measured with much accuracy below 50, and certainly the accuracy is highly compromised below 35. Moreover a person's IQ can vary depending on the test and when the test is conducted, and it may change over longer periods of time. In addition, people's everyday skills are not only dependent on IQ: some people with relatively high IQ can seem very disabled if they are very socially impaired (for example, able people with autism spectrum disorder) and/or if they have major difficulties with communication, while conversely others with good social skills and expressive language can appear more able than their IQ might suggest. Consequently, taking all of this into account, the subdivisions above are not very useful. The picture becomes even more complicated when considering children: education authorities in the UK refer to children with moderate and severe learning difficulties, and these terms do not map well onto the World Health Organization subdivisions above. Thus a child with ‘moderate learning difficulties’ in school becomes an adult with a ‘mild learning disability’, and a child with ‘severe learning difficulties’ in school becomes an adult with a ‘moderate learning disability’ in adult services.

Nevertheless, the GDG recognises that there is a very large range of abilities among people with a learning disability: some people have good mobility, considerable language skills, adequate self-care skills, and may only need help with more complex tasks, while others may have far more extreme degrees of disability, with very poor mobility, little or no language skills and need a great deal of assistance with self-care and other tasks. Consequently it will sometimes be necessary in this guideline to distinguish people with more skills from those with fewer skills, for example when recommending assessments or treatments that will not all be suitable for everyone.

2.1.2. Behaviour that challenges

It is widely recognised that people with a learning disability are at increased risk of various mental and physical health problems. In addition, some engage in behaviour that has been called challenging. Emerson's definition of ‘challenging behaviour’ is:

Culturally abnormal behaviour(s) 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 seriously limit use of, or result in the person being denied access to, ordinary community facilities ( Emerson, 1995 ).

The Royal College of Psychiatrists (2007) defined ‘challenging behaviour’ very similarly as:

Behaviour of such an intensity, frequency or duration as to threaten the quality of life and/or the physical safety of the individual or others and is likely to lead to responses that are restrictive, aversive or result in exclusion.

Historically, such behaviour had been described as ‘inappropriate’, ‘abnormal’, ‘disordered’, ‘dysfunctional’, ‘problem’ or ‘maladaptive’. However, research has shown that the behaviour in question is actually quite adaptive and functional in some ways, and not disordered. The newer term, ‘challenging behaviour’, was thought to have some advantages over these earlier terms, in that it suffers from fewer semantic contradictions, and it was also intended to remind professionals, staff and policy makers that such behaviour was a challenge to services.

The intention of the term ‘challenging behaviour’ was to prevent the phrase being used as a diagnosis and to stop people feeling that they needed to ‘fix’ the person, so that they would instead concentrate on ‘fixing’ the environment. However, since the introduction of the term many professionals and carers have felt that the reason for the change in terminology has been lost sight of. The frequent use of personal pronouns and verbs (such as ‘his challenging behaviour’ or ‘she has challenging behaviour’), imply that the problem is within the person. It is important to recognise that ‘challenging behaviour’ is rather the result of an interaction between the person and their environment, and as such is largely socially constructed. The term ‘behaviour that challenges’ is preferred as an alternative, and this phrase will be used in this guideline.

The kinds of behaviour referred to include: aggressive behaviour (such as verbal abuse, threats and physical violence), destructive behaviour (such as breaking or destroying furniture and other objects and setting fires), disruptive behaviour (such as repetitive screaming, smearing faeces, setting off fire alarms when there is no fire, calling the emergency services when there is no emergency), self-injurious behaviour (including self-biting, head banging), sexually harmful behaviour (including sexual assaults, rape and stalking). Some of these behaviours may fall under the purview of the criminal justice system, but by no means all those with a learning disability who engage in illegal behaviour are arrested, as the criminal justice system requires not just actus reus (proof that the act was done) but also mens rea (proof that it was intended), so most people with a severe disability who engage in potentially illegal behaviour are not involved in the criminal justice system.

The setting in which behaviours occur can influence whether the behaviour is considered challenging ( Emerson & Einfeld, 2011 ). For example, behaviours such as shouting and jumping are acceptable at a rock concert but not in a library, and physical aggression is acceptable in a boxing ring but not outside of the ring. Similarly, some behaviours, such as running away from home, may be seen as challenging in some circumstances, such as when the person lives with supervision at home and is unsafe out alone, but they may not be challenging in other circumstances, such as if the person is on a fitness programme involving daily running, and is safe out on their own. Likewise, carers and professionals sometimes disagree about whether a behaviour is challenging, and at times cultural differences and differences in perspective underlie this. For many carers, sleep difficulties in the person they care for may feel very challenging. For example, if someone with severe disabilities who is not safe to be up alone, frequently wakes for large parts of the night, wanders about the house, falls down the stairs, destroys household objects and exhausts his or her carers, it is likely that such acts would be seen by them as behaviour that challenges. In circumstances such as these, it is important to be clear that it is not the poor sleep per se that is challenging, but the behaviour that occurs when the person would normally be asleep. If this person lived in a staffed house with waking night staff, the poor sleep might not be seen as challenging, and likewise if they woke at night and were lying quietly in bed, poor sleep might not be seen as challenging.

2.1.3. Carers

In this guideline the word ‘carer’ is used to refer to a person who provides unpaid support to a partner, family member, friend or neighbour with a learning disability and behaviour that challenges. It does not refer to paid carers or care workers, who are defined as ‘ staff ’ in this guideline (see below), unless otherwise specified.

2.1.4. Staff

In this guideline, the term ‘staff’ includes health and social care professionals, including those working in community teams for adults or children (such as psychologists, psychiatrists, social workers, speech and language therapists, nurses, behavioural analysts, occupational therapists, physiotherapists), paid carers or care workers in a variety of settings (including residential homes, supported living settings and day services) and educational staff.

2.2. Prevalence

The prevalence of behaviour that challenges has been the subject of numerous studies, which have produced a range of figures. The reason there is such a range is that the prevalence depends on a variety of methodological issues. For example:

  • Studies in hospital/institutional environments always produce much higher figures. This may be partly because people have been admitted there as a result of behaviour that challenges, and partly because aspects of the hospital/institutional environment (such as low engagement levels) may cause an increase in behaviour that challenges. For example, Oliver and colleagues (1987) in a well-known study of self-injurious behaviour in a total population of people with a learning disability in touch with services, reported a prevalence rate for self-injury of 12% in hospitals for people with a learning disability, but only 3% for adults with a learning disability in the community. Borthwick Duffy (1994) showed an even bigger discrepancy between institutional and community-based prevalence rates for behaviour that challenges: 49% versus 3% respectively.
  • Studies may use different definitions of the behaviour to be counted. For example, they may count only 1 type of behaviour. Oliver and colleagues (1987) , for instance, asked whether anyone had shown self-injurious behaviour of the following kind: ‘repeated, self-inflicted, non-accidental injury, producing bruising, bleeding or other temporary or permanent tissue damage’ within the previous 4 months. Had they used a definition that did not require the behaviour to have caused ‘tissue damage’, they would have probably found higher figures. Likewise, had they employed a longer period of time, for example ‘in the last year’, they may well have found higher figures. Moreover had they also counted other behaviour that challenges, such as aggression, they would have found even higher figures.
  • Most studies count prevalence by asking staff or carers for their opinions. It is likely that the staff and carers vary in their observational powers and their memory so that some may recall some behaviours that others do not. Likewise, behaviour that challenges varies with the environment, including the social environment, such that the behaviour might be far more problematic for some staff or carers than others, so that different people will report different rates.

With these provisos in mind, the accepted range for prevalence of behaviour that challenges, is approximately 5 to 15% of people with a learning disability who are known to services ( Borthwick-Duffy, 1994 ; Emerson, 2001 ; Emerson & Bromley, 1995 ; Kiernan & Qureshi, 1993 ). These figures derive from surveys of total populations of people with a learning disability (administratively defined) and including all types of behaviour that challenges. In England, according to Emerson (2014) this translates to 41,500 children and between 8800 and 26,500 adults with learning disability and behaviour that challenges ).

Typically, in these surveys, researchers interview staff and carers about people with a learning disability, and use a specific definition of behaviour that challenges. As an example, that of Kiernan and Qureshi (1993) , which defines quite a serious level of behaviour, is given below:

  • Showed behaviour that ‘at some time caused more than minor injury to themselves or others, or destroyed their immediate living or working environment’.
  • Showed behaviour ‘at least once a week that required the intervention of more than 1 member of staff to control, or placed them in danger, or caused damage that could not be rectified by care staff or caused more than 1 hour's disruption’.
  • Showed behaviour ‘at least daily that caused more than a few minutes disruption’.

It is relatively rare for studies to use a particular questionnaire, with a specified cut-off point, to establish prevalence, as would be common in medical or other diagnostic studies, based on a widespread view that this is an inappropriate approach for the topic of learning disabilities and behaviour that challenges, partly because of the great variations seen for the same person in different environments.

Few prevalence studies have asked about behaviour that has come to the attention of the criminal justice system. An exception to this is McBrien and colleagues (2003) who surveyed all adults known to learning disabilities services in an area with a general population of about 200,000. They reported that 3% of the adults with a learning disability known to services had a current or previous conviction and a further 7% had had previous contact with the criminal justice system but no conviction. As Murphy and Mason (2014) point out, this is likely to be an overestimate of the true proportion of people with a mild learning disability involved with the criminal justice system, as most people with a mild learning disability do not receive services (between one- and two-thirds disappear from services on leaving school) and therefore they were probably not included in the survey.

This fact, that most studies of the prevalence of behaviour that challenges consider only the people with a learning disability who are known to services (so-called administrative prevalence), together with the fact that many people with a mild learning disability disappear from services after school age, means that the prevalence of behaviour that challenges displayed by people with a severe learning disability, who almost all receive services, is fairly well established. The prevalence of behaviour that challenges among people with a mild learning disability is more difficult to know. As already noted, people with a mild learning disability are more likely to lose touch with services if they have no special needs when they leave school, but to remain in touch with services if they have behaviour that challenges. Nevertheless, the uncertainties of this administrative prevalence approach has brought some researchers to examine total cohort studies of a general population of children. These studies, however, while they may solve the problem of ensuring a total population is captured, encounter other problems, such as how learning disabilities and behaviour that challenges are defined within the survey. Emerson and Einfeld (2011) describe 3 surveys of this type, 1 giving the prevalence of ‘conduct disorder’ among children aged 5 to 16 years with ‘intellectual disabilities’ as 12% (while that of non-disabled children was 4%), 1 giving a figure of ‘behavioural difficulties’ for children aged 6 to 7 years with ‘intellectual disabilities’ of 24% (compared with 8% for non-disabled children), and the 3rd giving a figure for ‘behavioural difficulties’ for British children aged 3 years with ‘early cognitive delay’ of 30% (compared with 10% for children without delays). Clearly the fact that these surveys often use a variety of definitions of intellectual or learning disabilities and/or cognitive delay, as well as a variety of definitions of the behaviour to be counted, make them difficult to compare with the more common studies of administrative prevalence of behaviour that challenges. Nevertheless, they all broadly agree that behaviour that challenges is about 3 times more common in children with disabilities than in typically developing children.

2.3. Co-occurrence and persistence

It is known that behaviour that challenges can co-occur, such that between a half and two thirds of people who show behaviour that challenges, engage in more than 1 form (where ‘form’ is classified as ‘aggression’, ‘self-injury’, ‘property destruction’ and ‘other’, Emerson, 2001 ). Matson and colleagues (2008) , for example, found that people who showed self-injury were more likely to have other behaviour that challenges such as aggression, when compared with those without self-injury, matched for age, gender and degree of disability. In a recent study, in which Oliver and colleagues (2012) also found considerable co-occurrence between self-injury, aggression and repetitive behaviours in children with a severe learning disability, Oliver and colleagues (2012) argued that high-frequency repetitive behaviours could be a risk marker for other behaviour that challenges.

Even with 1 ‘form’ of behaviour that challenges, such as self-injury, it is common for people to show more than 1 topography: for example, Oliver and colleagues (1987) in their survey found 54% of those who showed self-injury had more than 1 topography, 3% showed more than 5 topographies, and, among those who wore protective devices, 7% had 5 or more topographies.

It has been repeatedly found that the prevalence rates of behaviour that challenges varies considerably with age, peaking in people with a learning disability in their late teens and early twenties and gradually reducing thereafter ( Borthwick-Duffy, 1994 ; Davies & Oliver, 2013 ; Kiernan & Kiernan, 1994 ; Oliver et al., 1987 ). Some behaviours that challenge are persistent, however, and it appears that when such behaviour is very severe, it can be long-lasting. For example, Murphy and colleagues (1993) reported in their study of those whose self-injury was so severe as to require protective devices, that the average age of onset of self-injury was 7 years and the duration (so far) was 14 years. In a follow-up of this Murphy and Oliver cohort, Taylor and colleagues (2011) , found that 84% of those who showed self-injury in the 1987 study, continued to show self-injurious behaviour 18 years later. Similarly, Murphy and colleagues (2005) found that, in a total population of South London children with a learning disability or autism who were known to services, the presence of ‘behaviour problems’ at mean age of 8.9 years predicted the presence of ‘behaviour problems’ in the same individuals as adults (mean age 20.9 years). Likewise, Emerson and colleagues (1988) reported that when local authority agencies were asked who their 2 or 3 ‘most challenging’ individuals were, the people they named had been showing that same behaviour for over 20 years.

Nevertheless, while some people show behaviour that has a lengthy and serious trajectory, behaviour that challenges that emerges in some young children disappears over time ( Oliver et al., 2005 ). Cooper and colleagues (2009a ; 2009b) have also reported considerable change in aggressive and self-injurious behaviours over a 2-year period in adults with a learning disability, when all such behaviours are counted and not just the most serious levels of such behaviours.

2.4. Associated characteristics

A number of characteristics are known to be associated with behaviour that challenges, including gender, degree of disability, communication skills, sensory impairments, various historical factors, and the presence of some genetic and other disorders:

  • Gender: males are somewhat more likely than females to show certain types of behaviour that challenges, especially aggressive behaviour ( Borthwick-Duffy, 1994 ; McClintock et al., 2003 ). Males and females are about equally likely to show self-injury ( Oliver et al., 1987 ).
  • Degree of disability: there is very broad agreement across numerous studies ( Borthwick-Duffy, 1994 ; Cooper et al., 2009a ; Cooper et al., 2009b ; Kiernan & Qureshi, 1993 ; Oliver et al., 1987 ) that behaviour that challenges is more prevalent among people with severe and profound disabilities, and this is especially so for self-injurious behaviour ( McClintock et al., 2003 ). This does not mean that people with a mild disability are never challenging: some may be very challenging, but most will not be. The lower prevalence in less disabled people may not be obvious to professionals working in adult services because many people with a mild disability (the most numerous group) ‘disappear’ from adult services after they leave school, and those who remain in touch with adult services may well be there because they are the ones with behaviour that challenges.
  • Communication skills: children and adults with poorer communication skills tend to have higher rates of behaviour that challenges ( Emerson, 2001 ; Kiernan & Kiernan, 1994 ; Murphy et al., 2005 ), especially self-injury ( McClintock et al., 2003 ). This may be the important variable (or one of them) underlying the relationship between the degree of learning disability and behaviour that challenges.
  • Sensory impairments: sensory impairments, such as hearing and/or visual impairments put people at increased risk of behaviour that challenges ( Cooper et al., 2009a ; Kiernan & Kiernan, 1994 ).
  • Low mood: there are very few studies that examine the relationship between mood and behaviour that challenges. A reason for this is the difficulty of measuring mood in people with a severe disability. However, Hayes and colleagues (2011) demonstrated that low mood, reliably rated on the Mood Interest and Pleasure Questionnaire, was associated with behaviour that challenges being displayed by people with a severe learning disability.
  • Attachment: attachment towards carers and staff, and the associated behaviours, have been considered to have the function of promoting carers' and staff support of children, assisting them in regulating their own emotions at times of stress. There are very few studies of attachment and behaviour that challenges in children or adults with a learning disability ( Schuengel et al., 2013 ). However, in 1 study of young people with a learning disability in a day care setting, it was shown that young people with poor attachment had higher levels of behaviour that challenges, and this was not explained by factors such as the presence of autism ( De Schipper & Schuengel, 2010 ).
  • Traumatic events: it has been supposed for many years that traumatic experiences may lead to behaviour that challenges. It is only recently that this has been reliably established by 2 different studies. In 1, a group of adults with a learning disability who had been abused were matched for age, gender, communication skills and degree of disability to a non-abused group ( Sequeira et al., 2003 ). The abused group had significantly more mental health needs, post-traumatic stress disorder symptoms and behaviours that challenge. In the other study, carers of people with a severe learning disability were asked about their family members' behaviours before and after abusive events, using standardised measures ( Murphy et al., 2007 ). A very consistent pattern emerged of significantly fewer behaviours that challenge before the traumatic event, significantly raised levels just after the traumatic event, and some improvement years later. Adaptive behaviours changed in the opposite direction: they were significantly higher before the traumatic event, fell significantly immediately afterwards, and recovered somewhat years later.
  • Mental health needs: some researchers have argued that the presence of mental health needs raises the risk of behaviour that challenges ( Cooper et al., 2009a ; Cooper et al., 2009b ; Hemmings et al., 2006 ; Moss et al., 2000 ). This has been much disputed, mainly because the presence of mental health needs is usually based on self-report of distress in the general population, and yet the people with most severe behaviour that challenges often have the least verbal skills, making diagnosis of mental health needs difficult. This is further complicated by arguments about whether behaviour (including behaviour that challenges) can be seen as a ‘symptom’ of mental health needs, and, if this premise is accepted, then the co-occurrence of the 2 becomes tautological.
  • Behavioural phenotypes: a number of specific syndromes associated with learning disabilities have raised risks of particular types of behaviour associated with them (this is discussed further in 2.5.1 ). Occasionally the links between syndromes and behaviour are very specific, to the extent that almost everyone with that specific diagnosis shows that specific behaviour. An example of this is Lesch–Nyhan syndrome, an X-linked metabolic disorder resulting in mild or moderate learning disabilities but severe physical disabilities, in which a characteristic form of self-injury appears in the first few years of life, specifically severe self-biting, in most affected children ( Hall et al., 2001 ). Such a close link between syndrome and behaviour, however, is rare – typically syndromes simply raise the risk of specific behaviours, such that they are only somewhat more common than in other disorders (see Table 2 for some examples of these).

Table 2. Behavioural phenotypes in some common syndromes.

Behavioural phenotypes in some common syndromes.

2.5. Causes

There is very broad agreement that behaviour that challenges results from a multiplicity of causes. These include biological, psychological, social and environmental causes. They can be conceptualised through diagrams such as Oliver's biopsychosocial model of self-injury ( Oliver, 1993 ), Murphy's biopsychosocial model of aggression ( Murphy, 1997 ) and Langthorne and colleagues' (2007) integrative model for behaviour that challenges. Individualised formulation diagrams, such as Murphy and Clare's case examples (2012) , also show similar factors at play, for particular individuals. The contributions of the various factors are summarised below.

2.5.1. Biological causes

In the past, biological causes were thought to be the most prominent reason for behaviour that challenges and it was partly this idea that led to the belief that the behaviour is a part of the person with a disability. There were a number of pieces of evidence that were thought to support this view:

  • The higher prevalence of behaviour that challenges displayed by people with a more severe disability and therefore, some have argued, more extensive brain damage or dysfunction (see section 2.2 ).
  • The co-occurrence of behaviour that challenges with genetic syndromes and other diagnoses (see below and Table 2 ).
  • The discovery that some very specific biochemical substances were associated with particular types of behaviour that challenges (for example, high endogenous opioids associated with severe self-injury).

There are, of course, many reasons why more severe disability may be associated with the presence of behaviour that challenges. For example, more severe degrees of disability are usually associated with poorer communication skills and there are very clear psychological reasons why poor communication skills may underlie the causes of behaviour that challenges (see section 2.5.2 ).

Nevertheless, it is difficult to explain why specific syndromes would produce raised risks of specific behaviour that challenges, without some biological component (see Table 2 ). In Lesch–Nyhan syndrome, for example, it used to be thought that all those with the syndrome showed a very specific behaviour, early self-biting, which frequently was so distinctive, and severe, that it led to the diagnosis, and which often then extended into other forms of serious self-injury. It is now known that in some Lesch–Nyhan variants self-injury does not appear ( Jinnah et al., 2010 ) and so it may be that this will help in finding the exact link between the disorder and the self-injury. Of course, in many syndromes the links between the syndrome and the behaviour are nothing like so specific, and even when there are apparent links, environmental effects are still often present ( Bergen et al., 2002 ; Hall et al., 2001 ; Langthorne & McGill, 2012 ; Taylor & Oliver, 2008 ).

Finally, as regards ‘biological causes’, there are also a number of conditions that would broadly fall into the ‘biological’ category that are known to worsen behaviour that challenges, and these include sensory impairments, pain and physical health problems or discomfort. People with a learning disability have more health problems than those without a disability because of a variety of comorbidities, and these health needs are difficult to diagnose, partly because people with a learning disability have associated communication problems. As a result, there have been a number of high-profile reports on the poor health outcomes of people with a disability in the UK, that have been likened to those of non-disabled people in the developing world ( Heslop et al., 2013 ; Mencap, 2007 ; Michael, 2008 ).

The relationship between behaviour that challenges, and the person's health needs is complex, and has been studied both in large-scale cross-sectional surveys, often relating to annual health checks ( Cooper et al., 2006 ), and in small-scale single case series ( Bosch et al., 1997 ; Kennedy & O'Reilly, 2006 ; Peebles & Price, 2012 ). De Winter and colleagues (2011) , in a systematic review of physical health issues and behaviour that challenges, found 45 relevant studies, covering issues as diverse as motor disorders, sensory impairment, epilepsy, gastrointestinal disease, sleep disorders and dementia. They noted the absence of evidence related to infectious diseases, cancer, pulmonary and cardiac disease. They concluded that strong evidence existed for a relationship between visual impairment and self-injurious behaviour, pain in cerebral palsy and problem behaviour, and some evidence for a relationship between both gastrointestinal reflux and poor sleep, and behaviour that challenges. They concluded there was no evidence that epilepsy was related to behaviour that challenges.

2.5.2. Psychosocial causes

Psychosocial causes have been frequently investigated because psychosocial factors have a very widespread influence on behaviour that challenges. Children, young people and adults with a learning disability are among the most stigmatised individuals in society, especially when they show behaviour that challenges. They tend to have very little power, are more frequently abused than most other populations, and struggle to obtain what they need to make a success of life. The psychosocial factors relevant to behaviour that challenges have been studied in very different ways for different subpopulations, and these are briefly described below. Generally it has been agreed that behaviours are mostly learnt, and the psychosocial environment is crucial to their appearance, escalation, elicitation and extinction.

For people with a severe disability, it appears that behaviour that is challenging for others, is often functional for them, allowing them to control their lives in particular ways, such as gaining sensory stimulation, attracting the attention of carers or staff members, removing demands or gaining tangible items. Essentially, behaviour that challenges, may produce the desired effect by itself, through self-stimulation, or it may ‘teach’ carers and staff to respond in particular ways through social positive or social negative reinforcement: for instance, if someone is aggressive or self-injurious, carers and staff may well try to meet their needs by taking some action contingent on the behaviour. They may go and speak with the person (a form of social positive reinforcement), offer them food, drink or their favourite toy, activity or tangible item (if made available through social means, this is also a type of social positive reinforcement). Carers and staff may stop asking the person to do a task (the removal of the task negatively reinforces the behaviour) or they may move away to leave the person alone (social negative reinforcement). Essentially, these actions may ‘teach’ the person with a disability to repeat those behaviours in similar circumstances, in the presence of discriminative stimuli, and at the same time, any cessation in the behaviour may in turn ‘teach’ carers and staff to use the same strategy next time to stop the behaviour. Stimuli that signal that reinforcers are available act as discriminative stimuli and deprivation states produce motivating operations ( Vollmer & Iwata, 1991 ), accounting for some of the variability of behaviour in different circumstances. Many children, young people and adults who show behaviour that challenges have no speech or very little speech, and it seems that much behaviour that challenges can be seen as functioning like communication for those with very poor language skills, even though they may lack intent. The person in question is often thought by carers to be misbehaving ‘deliberately’ but this is mostly not the case.

The discovery of the variety of possible psychosocial functions of behaviour that challenges, in the 1980s and 1990s, led to attempts to match a number of specific behavioural strategies (such as extinction) to the putative functions of behaviour that challenges, in attempts to reduce it. The likelihood of the behaviour serving communicative functions, in turn, led to the development of interventions teaching specific communicative acts (so-called functional communication training originated by Carr and Durand (1985 )), which, it was hypothesised, could replace the function of the behaviour that challenges. In both cases, one of the necessary first steps was to develop a way of analysing the behavioural function of an individual's behaviour, in order to match intervention strategies to the function, and a number of methods of functional behaviour assessment were developed (Lloyd & Kennedy, in press). Very simple analyses could be conducted through the use of Aberrant Behavior Checklist (ABC) charts and scatter plots but these gave a limited amount of information. Functional behaviour assessments began to be developed which involved interviews or questionnaires, conducted with staff or carers, such as the Functional Analysis Interview ( O'Neill et al., 1997 ), the Behavior Assessment Guide ( Willis et al., 1993 ), the Motivation Assessment Scale ( Durand & Crimmins, 1992 ), the Questions About Behavioral Function (QABF) measure ( Vollmer & Matson, 1995 ), and the Functional Analysis Screening Tool (FAST) ( Iwata et al., 2013 ).

More direct methods of analysing the function of behaviour were also developed: in some cases this involved conducting direct observations of the person in their naturalistic environment, with subsequent sophisticated analysis of data, such as by conditional probabilities ( Oliver et al., 2005 ). In other cases, this was undertaken by experimental functional analysis, involving the use of analogue conditions in which the behaviour of the person was directly assessed, while providing brief periods in which discriminative stimuli and specific reinforcers were deliberately presented, in order to examine which ones set off the behaviour ( Iwata et al., 1994 ). These experimental functional analyses could be lengthy, however, and sometimes inconclusive, such that various adapted methods were developed ( Hagopian et al., 2013 ), including brief versions that could be done at out-patient settings ( Northup et al., 1991 ).

For people with a mild learning disability, these methods of functional behavioural assessment were sometimes more difficult to use, partly because the behaviours occurred less frequently, despite being extremely serious when they did occur (such as, arson or sexually harmful behaviour). According to Didden and colleagues (2006) , functional analyses still led to more effective behavioural treatments, though increasingly since then assessments have been adapted for people with a mild learning disability that use self-report rather than carer report ( Murphy & Clare, 1995 ; Novaco & Taylor, 2004 ; SOTSEC-ID collaborative, 2010 ) and intervention methods have increasingly become cognitive-behavioural rather than simply behavioural ( Lindsay, 2005 ; SOTSEC-ID collaborative, 2010 ; Willner et al., 2013 ). The influence of psychosocial variables has also broadened to include psychological distress (assessed directly with the person with a learning disability) and cognitive distortions, including those arising from causes such as perceived stigma ( Dagnan & Waring, 2004 ), as well as those arising from abusive experiences ( Lindsay, 2005 ).

2.5.3. Environmental causes

The reliable appearance of much higher rates of behaviour that challenges in certain environments (see Section 2.2 ) led to the proposal that some environments have such a major role in causing behaviour that challenges, that we should be intervening with environments and social systems, rather than with individuals, in order to reduce behaviour that challenges. Very high rates of behaviour that challenges have been reported in institutions, which typically entail a relative lack of activities, poorer social support, higher rates of physical interventions and restrictive practices (such as locked doors), and more frequent reports of abusive practices. Very high rates of behaviour that challenges are also associated with poor parenting, particularly with abusive practices. Such practices, of course, do not only occur in institutions and in particular families but may occur in all types of environments at times. McGill (in press) has termed these ‘challenging environments’ and has developed the concept of the opposite kind of environment: the ‘capable’ environment, in which good-quality care reduces the risk of behaviour that challenges. This approach is inextricably linked with the positive behaviour support (PBS) approach, which developed from applied behavioural approaches, amalgamating these with person-centred planning, non-aversive methods and quality of life interventions. According to a founding father of PBS, Ted Carr, PBS is ‘an applied science that uses educational and systems change methods to enhance quality of life and minimise problem behavior’ ( Carr et al., 2002a ). According to McGill (in press) , the characteristics of the ‘capable’ environment include positive social interactions, support for communication, support for meaningful activity, provision of predictable and consistent environments, support to establish and maintain relationships with family and friends, provision of choice, encouragement of more independent functioning, support for personal healthcare, an acceptable physical environment, mindful and skilled carers, effective management and staff support, and effective organisational context.

2.6. Current care in the UK

Every area of the country has designated services, intended to provide assessments and interventions for children, young people and adults with a learning disability and behaviour that challenges. However, in the past, these services have often been less than effective (leading to the Mansell report, 2007 ). This was especially so for children, whose services have been fragmented and at times ineffective and unresponsive to family needs, to the point sometimes of being abusive ( Mencap & Challenging Behaviour Foundation, 2013 ). Typically, for children and young people with behaviour that challenges, services have been provided within education (through their school and the educational psychology service), as well as through generic child and adolescent mental health services (CAMHS). CAMHS are run by the NHS and consist of a variety of professionals (such as nurses, psychologists, psychiatrists, occupational therapists and speech and language therapists), seeing any local children and young people with mental health needs (considered to include behaviour that challenges), not just those with disabilities. In some CAMHS teams, there have been professionals (usually clinical psychologists) who specialise in seeing children and young people with a learning disability; occasionally, in some parts of the country, there are completely separate teams with a full range of allied health professionals for children and young people with a learning disability. Social workers meanwhile have operated in yet other teams: the Child in Need teams for any child with a disability, and children and families (including child protection) teams for those children at risk. In addition, some applied behaviour analysis interventions may be provided by Board Certified Behaviour Analysts, though most of these are independent practitioners (not based in the NHS or social services). Families find the number of unrelated services bewildering and report that it is all too easy to find that none of them will offer help. Moreover there are very few early intervention services routinely available for children with a learning disability. The government's Joint Improvement Programme following the Winterbourne View scandal and the new Children and Families Bill aim to improve this fragmented situation by requiring improved commissioning of better services at all levels, and by legislating that all children with disabilities must have an Education, Health & Care plan and ensuring that local authorities (education and social care) and health work together.

In the past, referral pathways for children with a learning disability, who were showing behaviour that challenges, have been very complex. At school, when behaviour that challenges began to emerge, the schools provided individual educational plans and they sometimes sought the advice of an educational psychologist. Where the behaviour also occurred at home, schools provided support for families through a family-liaison worker, but this was unlikely to involve more than 1 visit per term. Many families would therefore seek help elsewhere, such as from their local general practitioner (GP). The GP could refer them either to their local paediatrician (usually for younger children) or to their local CAMHS team. The professional most likely to provide assessment and treatment for behaviour that challenges, in either case, would be the psychologist, who would typically visit and assess the child at school and at home, and construct an intervention that would aim to be effective across home and school. Other professionals likely to be involved included speech and language therapists, occupational therapist and nurses, each of whom may contribute to part of the assessment and intervention. In practice, however, families of the children with severe behaviour that challenges frequently found generic CAMHS teams workers insufficiently expert, and even unhelpful, and if the school placement also broke down, the families often ended up being told that their son or daughter had to be placed in a residential placement many miles from the family home ( McGill et al., 2006 ).

Meanwhile for adults, in all areas, there are community learning disability teams (CLDTs), again consisting of a variety of professionals, typically learning disability nurses, psychologists, psychiatrists, occupational therapists, physiotherapists and speech and language therapists, all working as a team. In many areas, social workers are co-located and integrated into the CLDTs. However, in some areas they are located at separate social services offices, so that there is effectively an NHS-based and social services-based CLDT, which is unhelpful. For adults with a learning disability, their day services, or their residential/supported living service (if they are no longer living with families), may first try to deal with behaviour that challenges themselves (many independent day/residential services now employ their own ‘challenging behaviour workers’). These services should refer them to the CLDT if they continue to show behaviour that challenges and/or their families may also access the CLDT through the local GP or other agencies. Again, the most likely professional to work with them is the psychologist but speech and language therapists and occupational therapists may be involved, and many teams also have behaviourally trained nurses and ‘challenging behaviour support workers’ (who would typically work under the supervision of psychologists).

For both children and adults, the CAMHS or CLDT team psychiatrists may also provide assessments and interventions, when the person with a learning disability is thought to have underlying mental health needs. Good practice would involve joint working by psychologist, psychiatrists, speech and language therapists and others, as described in the RCP/BPS document ‘ A Unified Approach ’ (2007). However, for adults, as for children, with behaviour that challenges, the experience of carers has too often been that there is insufficient support from professionals, who are often not expert enough, providing help that arrives too late (or even never), that is poorly coordinated ( Griffith & Hastings, 2013 ), and that where services and /or families cannot cope, the likely outcomes may include over-medication of the individual with a learning disability, disengagement by professionals, and eventually ‘out-of-area’ placements, often very far removed from families, some with restrictive practices and very high costs (many ‘assessment and treatment’ units cost in the region of £250,000 per person per year). As a result of such experiences, the Challenging Behaviour National Strategy Group drew up the ‘ Challenging Behaviour Charter ’, with ‘Rights and Values’ and ‘Actions to be Taken’, to better support families and people with a learning disability whose behaviour is said to be challenging.

In good services, full assessments, including functional assessments (such as functional analysis, see ( Beavers et al., 2013 ) were offered, together with interventions designed to increase skills and decrease behaviours that challenge. Often the interventions employed the LaVigna and Willis multi-element model, and were based on PBS ( LaVigna & Willis, 2012 ). PBS combines the science and practice of applied behaviour analysis with the values base of normalisation and the individual focus of person-centred planning. It has been defined in a variety of ways, but a widely accepted definition is that of Bambara and colleagues (2004) who said that PBS is:

‘characterised by educational, proactive and respectful interventions that involve teaching alternative skills to problem behaviours and changing problematic environments. It blends best practices in behavioural technology, educational methods and ecological systems change with person- centered values in order to achieve outcomes that are meaningful to the individual and to his or her family.’

However, all too often services fell short of these standards and the events at Winterbourne View reflect the kinds of dislocation and poor quality of services that can occur for children, young people and adults with a learning disability whose behaviour challenges services, with restrictive practices replacing any kind of positive assessment or intervention. As part of the Government's response to Winterbourne View ( Transforming Care: A national response to Winterbourne View Hospital ) ( Department of Health, 2012 ) there was a resolve to improve commissioning and the Joint Implementation Team has now produced a draft of Core Principles Commissioning Tool to be used for the development of local specifications for services supporting children, young people, adults and older people with a learning disability and / or autism who display or are at risk of displaying behaviour that challenges. This, alongside the proposed ‘ Education, Health and Care Plans ’ for all people younger than 25 years identified with Special Educational Needs (specified in the Children and Families Act 2014 ), better transition to adult services, which is the focus of the Preparing for Adulthood Programme , personal health budgets which will be available to those in receipt of continuing healthcare, and better integration of services, are intended by the Government to improve services for all people with a learning disability and behaviour that challenges.

2.7. Economic costs

Behaviour that challenges exhibited by people with a learning disability can place an additional strain on resources across a range of budgets. Given the diverse sectors of society in which care and support are provided for people with a learning disability, additional financial costs may be borne by families, charities, local or national governments. Though the link between behaviour that challenges and resource use makes strong intuitive sense little data exists to explore and quantify the association in the UK.

In an attempt to quantify the financial impact of psychiatric and neurological issues in the UK, Fineberg and colleagues (2013) found learning disabilities to be the 10th most costly issue costing €5975 million (2010 prices). The study took into account productivity losses and direct non-medical costs though it did not link the costs associated with learning disabilities to behaviour that challenges.

A number of studies have assessed the predictors and costs of out-of-area placements for people with a learning disability and behaviour that challenges in the UK, as out-of-area placements are often perceived as one of the most substantial cost elements of care provided to this population. Predictors of out-of-area placements include young age, behaviours resulting in physical injury to self, staff or others and exclusion from service settings, a history of formal detention under the mental health act, the presence of mental health problems, a diagnosis of autism, a higher total score on the Adaptive Behavior Scale and multiple health problems ( Allen et al., 2007 ; Hassiotis et al., 2008 ). In contrast to the perception that out-of-area placements impose considerable costs to the public purse, research shows that out-of-area placements have in fact similar or lower costs compared with within-area placements for people with a learning disability and behaviour that challenges ( Allen et al., 2007 ; Hassiotis et al., 2008 ; Perry et al., 2013 ).

In order to investigate the relationship between service costs and the severity of behaviour that challenges, Knapp and colleagues (2005) analysed data on characteristics and service receipt from 1120 people with a learning disability and behaviour that challenges living in residential accommodation, and found a complex relationship between cost, severity of learning disabilities and levels of behaviour that challenges. At moderate levels of learning disability a linear relationship with service costs was observed. At higher levels of learning disability this relationship appeared to decrease but costs remained higher for people who exhibited more severe behaviour that challenges. The largest component of service costs was, as anticipated, accommodation, accounting for 85% of the total cost. Service costs tended to be higher in NHS settings (including long-stay hospital settings, hostels and NHS-provided residential care in ordinary housing) compared with private and voluntary settings. However, people living in NHS settings scored more highly on both learning disability and behaviour that challenges indicators, which may partly explain the higher costs in NHS settings

Doran (2012) used self-completed questionnaires to estimate the cost of learning disabilities to both families and the government in Australia. This was reported to reach $14,720 billion annually (AUS$, 2006 prices). Though the independent impact of behaviour that challenges on resource use was not estimated in the study, components of financial cost such as replacing broken toys/furniture and respite care were highlighted as associated with the occurrence of behaviour that challenges. The study reported that families carry the majority of the financial burden and are insufficiently compensated by the government, with an annual net loss per family of approximately $37,000 and $58,000 for mild and severe/profound learning disabilities, respectively.

Using the same Australian data set Einfeld and colleagues (2010) investigated the relationship between patient characteristics as measured by the demographic behavioural checklist and the costs associated with behaviour that challenges displayed by people with a learning disability. The aggregate outcome of total behavioural problem score was significantly related to both direct costs (replacing damaged toys, expenses for care) and opportunity costs (reduced time in employment to provide care) to families. Disruptive and self-absorbed behaviour (which includes self-injury) subscales were statistically related to out of pocket and opportunity costs respectively.

Though measurement of the independent financial effect of behaviour that challenges could not be carried out, these studies illustrate the link between behaviour that challenges and the distribution of these costs in society.

In addition to the measured financial impacts, it is acknowledged that intangible costs represent a significant component of burden that is not possible to capture ( Doran et al., 2012 ). Among others these costs include loss of both role performance and social participation.

Although it is difficult to quantify the contribution of behaviour that challenges to the costs associated with learning disabilities this is likely to be substantial. Because these financial costs are borne by a variety of stakeholders, public policy must be devised and applied sensitively to responsibly provide value for service users, families and society in general.

  • Cite this Page National Collaborating Centre for Mental Health (UK). Challenging Behaviour and Learning Disabilities: Prevention and Interventions for People with Learning Disabilities Whose Behaviour Challenges. London: National Institute for Health and Care Excellence (NICE); 2015 May. (NICE Guideline, No. 11.) 2, Introduction.
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School Bullying: a Challenging Behaviour in a Primary Classroom Setting

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Challenging Behavior: Dealing with Elementary-Level Children with Aggressive Behavior Research Paper

Intervention strategies, works cited.

When a child obsessed with a particular challenging behavior comes into the limelight of the family and school environment, parents and teachers often find themselves at a loss, sometimes completely incapable of turning things around or assisting the child to behave suitably. Often they encounter feelings of frustration, stress, and defeat (Kaiser & Rasminsky 3).

Some of the challenging behaviors observed in elementary level children include attention seeking, low self-esteem, withdrawal, aggression, and refusal to cooperate. This paper, however, will concentrate on aggression as a challenging behavior, basing the discussion on comprehensive research and interviews conducted on two teachers of elementary-level children.

Aggressive behavior among children is largely conceived as a byproduct of insecure parent-child attachment especially during the first years of the child’s life, though current research reveals that aggressiveness may also be exhibited due to some innate predispositions (Kaiser & Rasminsky 6).

From the interviews, it was noted that children with aggressive tendencies have a high risk of school failure, rejection by peers, expulsion from pre-school programmes, and mostly develop punitive and unpleasant contacts with teachers and parents respectively. In the absence, of proper correctional interventions, their adult lives are likely to be characterized by violence, unemployment, depression, and substance abuse.

According to the interviews and research, children who are more likely to engage in violent behavior exhibit other characteristics such as severe learning disabilities, aloofness, visual or hearing impairments, socialization difficulties, and sleep disturbances (Male 163).

Other indicators, according to Male, include “…attention seeking, demand avoidance, communication problems, stress, interference with routines, and provocation” (163). A common misconception of this behavior is that children are always conscious of what they are doing and, therefore, deserves to be punished.

Although many teachers report feelings of frustration, upset, exhaustion, anger, and stress when dealing with aggressive children, it is imperative to develop a framework that will utilize problem-solving and understanding capacities to assist the child out of the problem (Male 168).

According to the interviews, separating the child from the problem and attempting to comprehensively understand the issues hidden beneath the problem so as to offer practical solutions to the child works in many instances. Research has demonstrated that aggressive behavior can effectively be prevented when teachers work to comprehend the risk and protective aspects in the minors’ lives and develop a responsive learning environment.

Within the family setup, family members needs to understand the child’s situation and the factors behind such aggressive behavior so as to develop a responsive social environment which encourages the child to communicate freely and share problems (Kaiser & Rasminsky 23).

More importantly, teachers should develop a functional assessment model for the child with aggressive behavior to assist them understand where the behavior comes from, the rationale behind exhibiting such aggressive tendencies, and why the behavior happens at a particular time or when certain conditions exists. It is only by addressing these factors that the problem can be successfully dealt with.

The functional assessment strategy should also be extended to the home environment so that the behavior is addressed from all fronts (Kaiser & Rasminsky 25).

When all the factors behind the aggressive behavior have been analyzed, teachers and parents should engage in positive behavior support to reinforce positive behavior and open up avenues through which the child will be able to effectively communicate arising problems and issues.

Lastly, the ‘Working Effectively with Violent and Aggressive States’ (WEVAS) approach can be employed to assist teachers and parents recognize the warning indicators of aggressive behavior, perceive issues from the child’s perspective, and effectively match their responses to the needs projected by the child (Kaiser para. 5). The WEVAS approach stresses the use of open and non verbal communication and planned responses to detect and diffuse aggressive behavior before directing the child to behave appropriately.

Kaiser, B., & Rasminsky, J.S. Challenging Behavior in Young Children: Understanding, Preventing and Responding Effectively. New York, NY: Allyn & Bacon. 2002.

Kaiser, B. Challenging Behavior in Young Children: Understanding, Preventing and Responding Effectively. 2007. Retrieved from < http://www.sanguineconsulting.com/workshops/ >

Male, D. Challenging Behavior: The Perceptions of Teachers of Children and Young People with Severe Learning Disabilities. Journal of Research in Special Educational Needs 3.3 (2003): 162-171. Retrieved from < http://www.isec2005.org/isec/jorsen/JORSEN%20Article%203%20-%20ISEC%20Content.pdf >

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IvyPanda. (2023, December 9). Challenging Behavior: Dealing with Elementary-Level Children with Aggressive Behavior. https://ivypanda.com/essays/challenging-behavior-dealing-with-elementary-level-children-with-aggressive-behavior/

"Challenging Behavior: Dealing with Elementary-Level Children with Aggressive Behavior." IvyPanda , 9 Dec. 2023, ivypanda.com/essays/challenging-behavior-dealing-with-elementary-level-children-with-aggressive-behavior/.

IvyPanda . (2023) 'Challenging Behavior: Dealing with Elementary-Level Children with Aggressive Behavior'. 9 December.

IvyPanda . 2023. "Challenging Behavior: Dealing with Elementary-Level Children with Aggressive Behavior." December 9, 2023. https://ivypanda.com/essays/challenging-behavior-dealing-with-elementary-level-children-with-aggressive-behavior/.

1. IvyPanda . "Challenging Behavior: Dealing with Elementary-Level Children with Aggressive Behavior." December 9, 2023. https://ivypanda.com/essays/challenging-behavior-dealing-with-elementary-level-children-with-aggressive-behavior/.


IvyPanda . "Challenging Behavior: Dealing with Elementary-Level Children with Aggressive Behavior." December 9, 2023. https://ivypanda.com/essays/challenging-behavior-dealing-with-elementary-level-children-with-aggressive-behavior/.

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Sample Essay On Challenging And Appropriate Behaviors

Type of paper: Essay

Topic: Behavior , Students , Teacher , Challenges , Psychology , Children , Special Education , Model

Words: 1100

Published: 01/01/2022


It is appropriate to regard Leonard’s behavior as challenging. This conclusion is indicated by many behavioral characteristics from the evaluation of Ms. Alison and the special education consultant. There is evidence that Leonard’s behavior impedes his learning. Firstly, Leonard cannot concentrate during the presentations to benefit from the teacher’s lecture. Secondly, when he is prompted to do some problems, he does them hurriedly. The result is a messy and incomplete work. Ms. Alison also noted that mathematics and writing are Leonard’s least favorite periods (Chandler& Dahlquist, 2014). The behavior is also challenging because it interrupts the learning of the other students in class. His several movements during class are a distraction for the other students. The special education consultant noted that when he was requested to sit down, he would strike conversations with his peers, something that disrupted them from learning (Chandler& Dahlquist, 2014). Additionally, his disruptive behavior takes up much of the teacher’s time; time that could have been spent teaching the other students. There are many indications in the notes made by Ms. Alison and the special education consultant where the teacher has to ask Leonard to sit down constantly. The special education consultant also noted that Ms. Alison had to run after Leonard for running in the class. All these disruptions impede learning for the other students (Chandler& Dahlquist, 2014). Leonard’s behavior is not an interference or impediment to social relationships. Ms. Alison notes that Leonard likes school, the teacher and the teaching assistance. Leonard also engages in conversations with her peers in class (Chandler& Dahlquist, 2014). Although this is a disruptive behavior, it is an indication of social activity. It is also inferable from the fact that physical education and recess are some of favorite periods for Leonard that his social relationships are not impeded by his behavior. This is because these are periods where pupils interact with their peers (Chandler& Dahlquist, 2014). The effects of the student’s behavior have a negative influence on his self-esteem. Ms. Alison notes that Leonard receives bad grades. This is concerning, especially because Crocker, Karpinski, Quin & Chase (2003) found that low grades affect the self-esteem of students negatively. The fact that he is already scoring low grades, he dislikes periods where writing and mathematics are taught, and that he does not concentrate in class could contribute to a low self-esteem for Leonard (Chandler& Dahlquist, 2014). There are no overt indications that Leonard’s behavior puts him at immediate risk of physical danger. There are also no indications that the other students are in immediate physical danger because of the behavior of Leonard. However, actions such as rocking the chair, climbing on the chair and the desk, and balancing in the legs of the chair are not consistent with safe behavior for the children of his age (Chandler& Dahlquist, 2014). Nonetheless, the actions are more likely to bring physical harm to Leonard than the other children in the class (Chandler& Dahlquist, 2014). Leonard’s behavior occurs on a frequent basis. There are several indications from the notes made by Ms. Alison and the special education consultant. Ms. Alison uses adverbs such as repeatedly to show the frequency with which Leonard engages in the disruptive behavior. For instance, Ms. Alison says, “Leaves his seat and wanders in the classroom repeatedly.” She also says, “Repeatedly drops and picks up his pencil,” “Repeatedly sharpens his pencil,” and “Repeatedly ask questions” (Chandler& Dahlquist, 2014, p.26). The use of repeatedly in those notes by Ms. Alison shows that Leonard’s behavior is frequent. Anderson (2011) reports that some of the characteristics of third graders is that they are full of enthusiasm, energy, and are curious. This implies that they are willing to attempt new things when instructed. Leonard’s inability to take instruction is inconsistent with this behavior. Anderson (2011) also argues that the attention span of third graders is not in keeping with their enthusiasm. As a result, third graders will often take up projects that they will not necessarily finish. While some aspects of Leonard’s behavior are typical for his age, the poor performance and the low attention span are oddly inconsistent. Leonard’s behavior should be changed by applying the functional assessment and intervention model. This is because the model is built on practical assumptions that explain how appropriate and challenging behaviors are developed and maintained. By understanding the factors that lead to the development and maintenance of appropriate and challenging behaviors, one can design interventions that discourage the development of challenging behaviors and encourage the maintenance of appropriate behavior (Chandler& Dahlquist, 2014). For instance, this model assumes that the current environment supports the development and maintenance of challenging and appropriate behaviors. Designing interventions would then take into consideration the antecedent triggers and consequences for the challenging behavior in order to yield appropriate behavior (McDougal, Chafouleas & Waterman, 2006). The model also assumes that environmental conditions present in the period leading to and after the challenging behavior predict behavior change. The implication is that functions of behavior such as sensory regulation and stimulation, negative reinforcement and positive reinforcement can be used by the child to get their desired outcomes (Chandler& Dahlquist, 2014). For instance, when a teacher reprimands a child for using profanity when the teacher attends to other students in the class, the function of the teacher’s behavior in this instance is a positive reinforcement because the disruptive child was able to obtain the teachers attention. The recommendation by Chandler& Dahlquist (2014) is to consider the child’s perspective when designing interventions. What was designed as a punishment for profanity by the teacher was a positive outcome for the student in the above example because it gained the attention of the teacher. This would imply that the continued use of this intervention by the teacher would not help develop appropriate behavior in the student. It is the intuition of this model that makes it appropriate for achieving behavior change in Leonard.

Anderson, M. (2011). What every 3rd grade teacher needs to know about setting up and running a classroom. Turners Falls, MA. Northeast Foundation for Children, Inc. Chandler, L. & Dahlquist, C. (2014). Functional Assessment: Strategies to Prevent and Remediate Challenging Behavior in School Settings. Upper Saddle River. Pearson. Crocker, J., Karpinski, A., Quin, D. and Chase. S. (2003). When grades determine self-worth: consequences of contingent self-worth for male and female engineering and psychology majors. Journal of Personality and Social Psychology, 85(3): 507-516 McDougal, J. L., Chafouleas, S., & Waterman, B. B. (2006). Functional behavioral assessment and intervention in schools: A practitioner's guide : grades 1-8. Champaign, IL: Research Press.


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