Communication Skills (Advanced)

Week 5

Context

Communication is the main way we interact and express our needs, likes and dislikes. If communication is a problem then it can be very frustrating for the person involved and may result in challenging behaviour. If this behaviour leads to a desired outcome, it may be repeated again and again.A person’s behaviour can be defined as “challenging” if it puts them or those around them, (such as their carer), at risk or leads to poorer quality of life. It can also impact on their ability to join in everyday activities. Challenging behaviour can include aggression, self-harm, destructiveness and disruptiveness.

Content

Behaviour

"Despite all the complexity of definitions associated with modern behavioural science, in today's context, the words 'human behaviour' essentially means: 'the way in which one human conducts themselves relative to other human(s)' (O'Collins, 2009). When does behaviour become challenging? "The term ‘challenging behaviour’ was introduced in North America in the 1980s, and was originally used to describe problematic behaviours in people with ‘mental retardation’ (learning disabilities). Challenging behaviour can, however, occur across the intellectual spectrum, being particularly prevalent in populations with psychiatric disorder" (Xeniditis, 2001).

A widely accepted definition of challenging behaviour is: "culturally abnormal behaviour 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).

A five point definition of challenging behaviour (Clements and Zarkowska, 2000), is behaviour that is:

Inappropriate in its severity, or for the age or stage of the persons development
Dangerous to the person or others
Constitutes additional disability, interefers with learning new skills, or excludes from learning
Causes significant stress to those living and working with the person
Impairs the quality of a persons or other persons life to an unreasonable level or degree
Is contrary to socially acceptable norms

When in Carols story does her behaviour speak louder than her words?
When does Carols behaviour become challenging?
What is happening at these points in Carols story, before, during and afterwards?
How might you measure Carols behaviour?
What does Carols behaviour tell us about her emotional state?

Guidelines from the British Psychological Society (2004) emphasise that challenging behaviours are socially defined, that is, they are defined to be challenging by virtue of another person’s perspective of, or reaction to, those behaviours. The recent paper ‘Challenging Behaviour: a unified approach’ (2007) produced by the Royal College of Psychiatrists, British Psychological Society and Royal College of Speech and Language Therapists, places strong emphasis on the need for the label ‘challenging behaviour’ to be reclaimed as a way of viewing behaviours within their interpersonal context, rather than as a diagnostic label applied to the person.

Causes of challenging behaviours in a mental health context

NHS Protect (2013) has listed the following as potential causes of behaviour which might fall into the definition of challenging:

Physical	Cognitive	Psychological/ Emotional	Environmental/ Social
Hypoxia Hyperglycaemia Hypoglycaemia Electrolyte abnormality Dehydration Constipation Infection Pain Visual or hearing impairment Sleep deprivation Medication (effects) Illicit drugs or alcohol Drug or alcohol withdrawal Pre or post- operative Hunger, thirst Incontinence, urgent toilet needs Earache Epilepsy	Communication problems (expression and understanding) Memory loss Difficulty with language or dialect Reduced spatial awareness Learning disabilities Disorientation Poor executive function (reasoning, planning, foresight) Loss of insight Autism	Fear Anxiety Anger Depression Social isolation Mania Fixed beliefs or current thinking Separation anxiety Loss of self worth	Noise Lights Temperature Overcrowding, or busy environment Inappropriate signage Lack of information Long waiting times Cultural factors Lack of continuity of staffing, or care Loss of routine Unfamiliar surroundings Pace of surroundings Lack of meaningful activity Over-stimulation Under-stimulation Imposed boundaries or routine Stopping a habit/ behaviour (e.g. smoking)

Triggers

What triggers behaviours? Learned behaviour – when behaviour leads to positive outcome, it is then repeated until it becomes associated with positive rewards. Internal triggers – conditions or events occurring within the body, internal to the person. External triggers – conditions or events which occurs in the environment, external to the person

Functional Analysis

Functional analysis is based on the assumption that behaviour serves a function and meets a need. Behaviour cannot be changed unless we understand its function – the need doesn’t go way. Events are identified that predict when the behaviour is likely or not to occur, and hypotheses are developed about the function of the behaviour (Gates, 2007).

Watch Carol Price in the shop again. Consider the potential triggers for her behaviour. Consider the communication, emotions, messages she is trying to convey (function). How do people around her respond to meet the need of her behaviour? Have they read her behaviour correctly? Did anyone seek clarification?

Collecting Data: Download this ABC chart Download ABC chart to analyse the situation in the shop.

References and Further Reading

British Psychological Society (2004) Challenging Behaviours: Psychological Interventionsfor Severely Challenging Behaviours Shown by People with Learning Disabilities. British Psychological Society.

Clements J. and Zarkowska E. (2000) Behavioural Concerns and Autistic Spectrum Disorders. Explanations and Strategies. London: Jessica Kingsley.

Emerson, E. (1995) Challenging Behaviour. Analysis and Intervention in People with Learning Difficulties. Cambridge: Cambridge University Press.

NHS Protect (2013) Meeting needs and reducing distress Guidance on the prevention and management of clinically related challenging behaviour in NHS settings Download Meeting needs and reducing distress Guidance on the prevention and management of clinically related challenging behaviour in NHS settings

. London: NHS

O'Collins, F. (2009) The concept of human behaviour [WWW] http://www.ucadia.com/uca/u18/180600.htm Links to an external site.

Royal College of Psychiatrists, British Psychological Society and Royal College of Speech and Language Therapists (2007) Challenging behaviour: a unified approach: Clinical and service guidelines for supporting people with learning disabilities who are at risk of receiving abusive or restrictive practices. London: Royal College of Psychiatrists

Xeniditis, K. Russell, A. and Murphy, D. (2001) Management of people with challenging behaviour. Advances in Psychiatric Treatment 7: 109-116