Frequently Asked Questions: the term "challenging behaviour"

Challenging Behaviour – what does it mean and why is it difficult?

Challenging Behaviour is a term that refers to any behaviour which presents a serious risk to the person themselves and / or a challenge to those supporting them. Challenging behaviours can be many and varied, but aggression towards others, self-injury, and environmentally destructive behaviours tend to be the most reported. Whilst these behaviours may be distressing, they are functional for the person concerned – i.e., they “do something” for the person. This could be one or more of a range of different things. For example, an outcome for the person might include:

• gaining or switching off the attention of others,
• stopping something the person doesn’t like, or finds too difficult
• being able to access favourite objects or pastimes,
• increasing or decreasing levels of stimulation

Viewing challenging behaviour as a form of non-intentional communication has therefore become a popular metaphor and fits with the original meaning of the term – it often represents a person’s best (or only) way of communicating an unmet need, and getting that need met.

Surely everyone’s behaviour can be described as challenging at times?

The term “challenging” is widely used. “Challenging behaviour” has a specific use in relation to people with a learning disability or other groups who might have challenges communicating. There is a specific formal definition that sets out that it is behaviour that puts the safety of the person or others at serious risk of harm (see definitions here). The purpose of the term is to better direct us to ways of understanding and meeting a person’s needs.

Is it a diagnosis? Or a label?

“Challenging Behaviour” can be a difficult term to understand and use.  Some people can read it as labelling someone as challenging, and a chance to label and repress behaviour which might be inconvenient or seen as unusual or embarrassing when they are a part of how someone expresses themselves.

When we talk about challenging behaviour we certainly don’t want to label people. We use the term as the definition intends- in relation to the challenge the behaviour gives to us as carers to understand and support a person better.

Does describing a person as displaying “challenging behaviour” mean you just want to change people, who and how they are?

We don’t advocate trying to constrain anyone’s behaviour just because it feels a little unusual or uncomfortable or embarrassing. What we do want to address is when behaviours have a negative impact on someone’s quality of life because they:

• Are a way that person is communicating distress, pain or a need which is not being met.
• Stop someone accessing services or living a full life in their community.
• Put that person or people around them at risk of serious harm
• Result in other people’s responses that would not typically be viewed as helping to understand what the person needs even in a crisis situation – for example the use of restraint or other restrictive practices

One example of this might be hand flapping. The flapping might not be an issue, it might be a signal someone is happy or excited, it might be a way of communicating for that person. If it’s not causing harm, communicating distress or pain, or fulfilling another communication purpose for that person then why change that? But If someone is hand flapping all day every day to the extent that they hurt themselves, that they don’t interact with other activities, that they can’t  be supported  to do things they need or would like to because of it,, or that is masks getting support for a wider health or other need, then it becomes an issue for us. WE need- to understand why that behaviour exists, what needs are not being met and if new ways can be found for that person to fulfill that need or get support to minimize any negative impact hand flapping has on their life.

Aren’t there better terms to be used?

We aim always to support carers to describe their experiences in any way that they feel best represents their and their relative’s situation. We are keen to understand new ways of defining and understanding behaviour, but we stick to using challenging behaviour because it is a term which presents us with a challenge to understand someone fully. It is a defined and recognized term in academia and service design and delivery as well as a term families hear often from professionals and are likely to use to search for additional support and services. Using the term challenging behaviour therefore helps us do what we are here for: to reach and support families, to support the understanding of behaviour and its impact, and drive change in support and services to meet the needs of people with a severe learning disability better.

When using the term we promise to

• Ensure we always refer to the challenge the behaviour presents to us and the support and services around a person. The person themselves is not challenging
• Support people to understand what function behaviour might be fulfilling for a person and ensure behaviours are addressed when they need to be, not because they are unconventional
• Help people understand where behaviour is challenging and additional support might be needed.