How can we develop a better understanding of behaviors of concern?

All behavior is viewed through a judgmental lens. The observer brings their beliefs, past experiences, expectations, emotions, understanding and knowledge into every situation. We react when we see and experience behavior from the person we support. We have to understand that the behavior we observe is just like the tip of an iceberg; below the surface of the waterline lies the cause of behavior. We need to delve below the waterline and address the root cause, not the behavior itself.

In order to support a person who has behaviors of concern, the observer must change the lens through which they view behavior. This can start with the language used to describe behavior – words like obsessive, controlling, manipulative, or deliberate place the blame on the individual and makes an assumption that it’s within that person’s power and ability to change how they act and respond. When we have a better understanding of why behavior occurs, we can shift our viewpoint and change the lens.

All difficult behavior happens for a reason. Let’s explore some of the possible causes.

Frustration

American psychologist Ross Greene says, “Children do well if they can.” If they aren’t doing well and are frustrated, consider the following possibilities.

• Communication and understanding – what is the individual’s level of understanding and are we communicating appropriately for them? Are we using visual supports to enhance understanding? Is our vocabulary too complex?
• Boredom – Is the person sufficiently stimulated? In a school setting, are they enjoying or engaged by the current task?
• Waiting – Does the individual understand why they have to wait? Or for how long? Can we define waiting in a more concrete manner say with a sand timer?
• Demands – Are they too great? Do we take into account a person’s needs?
• Prerequisite Skills – Do they lack a prerequisite skill for the task?

Physical/Emotional

This is a tricky area because in order to feel things physically and emotionally, interoceptive awareness has to be developed. Interoception, the eighth sense, helps a person understand what is going on inside of the body like hunger, thirst, feeling hot or cold, fatigue, or a full bladder. It also affects the ability to interpret emotions ex. butterflies in the stomach may not be felt as anxiety or nervousness. We need to find out if there is/are:

• Short term physical illness or pain
• Immediate emotional distress
• Longer term physical conditions or disabilities – ex. My son has a rarer form of arthritis that causes him chronic pain.
• Mental health difficulties – ex. anxiety
• Immediate physical needs not being met, such as hunger or thirst. This ties in with interoception.
• Changes in medications, or side effects related to medication

Environmental

Environmental considerations involve understanding an individual’s sensory needs and sensory profile. We can find out a person’s sensory profile through observation and using checklists. With the help of an occupational therapist, creating a sensory diet can meet a person’s specific sensory needs. Reactions to sensory stimulus such as noise levels, light, space, colours, and smells could all be overwhelming for one person and insufficiently stimulating for another.

Other people are part of our environment and can sometimes act in unpredictable ways, or an individual may find that numbers or a mix of others difficult to deal with. In elementary school, when my son needed a break from others he was able to spend time in a one man tent in the classroom to decompress.

Structural Considerations

If the structure of an individual’s routines, environment or education does not work for them, this can become a significant cause of distress or confusion. Most of us struggle with change in our lives. These changes can be seemingly minor issues such as activities being cancelled or altered, or major changes like a completely new environment or a change of support personnel. Transitioning from one activity to another can feel unpredictable, causing anxiety.

We can prepare for changes through advance preparation using visual supports. A structured environment can help a person sort out what information is relevant vs. nonrelevant, provide predictability, give visual cues as to what comes next or what to do, support transitions, and reduce stress and anxiety. Having a structured environment at home, school, or in the workplace increases the likelihood of success.

Ask yourself are there systems in place and does the person you support understand them? What makes sense to us may not make sense to them.

What is a person’s history?

We have to consider a person’s past experiences. Even young children may have had personal experiences that they found traumatic. Does the person’s concept of time work in the same way as our own? Recent events might seem distant and unimportant while things that happened some time ago might still feel quite fresh. My daughter talks about negative school experiences that happened 12 years ago as if they happened last week, recalling events in vivid detail.

The COVID experience is having long lasting effects. Some of my children’s activities, routines, and support personnel changed as a result of COVID.

Loss and grief may also be expressed differently. Reactions may be delayed or more intense than expected. There may also be questions and concerns around making life predictable again, which is needed to provide comfort and a sense of well-being.

Sometimes behaviors are labelled as ‘learned’ or dismissed as ‘attention seeking’. Have we considered why the person continues to use a behavior that has no apparent function? Or why they feel the need to seek attention?

Cyclical Considerations

Life involves cycles. We have to take into account developmental stages rather than chronological age. The weather and the seasons can affect a person’s mood. My son hates the snow and cold temperatures. Both of my children used to struggle switching from winter wear to summer wear.

Many individuals have their day/night cycles reversed or alterations in circadian rhythms. Some autistic people experience insomnia, characterized by waking up frequently throughout the night or staying awake for one of more hours during the night, sleep paralysis (waking but not being able to move), night terrors/sleep terrors, or sleep apnea. A lack of sleep can affect daytime functioning and lead to behaviors of concern such as sleepiness, depression, anxiety, lack of concentration, hyperactivity, increased distractibility, irritability, an increase in repetitive behavior, and poor learning abilities.

Events like holidays, birthdays, festivals and school breaks can alter routines and add unpredictable activities with new people into the mix.

What is our role in all of this?

When it comes to behaviors of concern, we are often the cause without meaning to be. For example, how many times per day do we ask or tell a person we support to do or not to do something? It’s reasonable to think that each of these demands has the potential to be a point of conflict. How we respond when a person refuses could be crucial to the success of the interaction. It would be useful to think of ways we could reduce the overall number of demands placed on an individual. Also, identifying which of those demands that are essential and immediate (or not) is important.

When it comes to needs and wants, how does anyone feel or react when they get to have or do the things that they want, or sometimes need? When considering individuals, we should think about how developed their emotional coping skills are and how well they deal with, for instance, being told ‘no’. It may not be possible or desirable to meet every need, so we need to think about the communication skills we are using when refusing someone. For example, can we show them that the preferred activity will happen afterwards by using a  first/then visual support? We should also give considerable attention to our reasons when not meeting a need or want. Are we doing it for the benefit of the person, or because it’s what works best for us?

Adopting a reflective practice to examine our role in behaviors of concern can be hard because of the emotions we have around our contribution to a challenging or crisis situation. Changing our responses takes time, but we must always strive to do better. The health and well-being of the individuals we support depends on it. There is so much to consider, but the more we strengthen our understanding of the root causes of behavior, the better we will become at both being proactive and providing the right supports.