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Difficult behaviour, Challenging behaviour, Behaviours of Concern, Unacceptable behaviour – the name changes but the issue remains.

It is a BIG topic. It is a commonly requested topic.

And if the experience is new to you it can be quite confronting. I have seen it become a ‘make or break’ issue for support workers continuing or not.

Changes in behaviour is a potential outcome after brain injury. This can be distressing for family particularly if it is quite different behaviour from before.

An older gentleman who was caring for his wife with dementia told me sadly “In all the time I knew her she never said a bad word. Now what comes out of her mouth is worse than anything I heard working on the wharfs in my young days”.

Discussion is often focussed on “the behaviour” and how to “stop it”. Yes to stop it, is often the desperate hope of many of us.

What if we were to begin the discussion about behaviour by looking at our own, and others, reactions to what is “challenging” behaviour to us?

 

Why Start with Me, When Looking At Challenging Behaviour?

In conversations and observations of support workers I noticed that the same degree of challenging behaviour would affect the way a person responded to it differently. This was curious and also helpful. Some support workers tolerated and managed behaviours without concern and were a positive influence for the person.

Seeing the different impact of behaviour on support workers, families and others lead to some thinking and research about why.

Maybe it was an odd place to start, but supporting people to learn about and manage their OWN response to the behaviour of others seemed to help. Starting with myself.

What Can Influence Our View of Behaviour?

This is a summary of factors that might influence our view of another person’s behaviour I have discovered over the years. I would welcome any comments or discussion in the Comments below:

 

Social Attitudes

Our view of what is appropriate, or not, can be affected by general attitudes of the time. These views can change with time. Behaviours of the past can seem unacceptable now.

The young boys smoking (in the image above) would generally seem shocking today. In the future some of what we do now will no doubt seem unacceptable.

 

Culture and Beliefs

The culture and beliefs we are part of can influence how we view behaviour.

In some cultures it is not acceptable to smack a child, while in others it is an acceptable method of behaviour control.

Support workers, from a culture where smacking a child was reportable, were confronted with what to do when a child they were supporting was smacked by his Dad.  Within this father’s culture his was considered a normal part of child rearing.

 

Environment

Where we are when the behaviour is experienced can influence our views of what is challenging or not.

Loud raucous yelling may be acceptable at a football match but become challenging in the middle of a supermarket.

 

Context

Similar to where you are the circumstances of the behaviour can determine whether it is OK or not.

Swearing and making jokes about other people may be acceptable on stage at a comedy show but not acceptable when a person is presenting at a business meeting – well most business meetings.

 

History and Rules

The framework of the country we have learned our rules from can shape our view of behaviour. Whether or not a behaviour is tolerated as a country. Is it acceptable? Is it legal?

Spitting in public places is illegal in some parts (such as United Kingdom, Singapore) and therefore not tolerated. In other countries it maybe tolerated even accepted.

 

Family History

Our experiences and ‘rules’ within our own family of origin and subsequent family experience can influence the way we view behaviour.

A person growing up in a family where loud talking and argument was not permitted might see rowdy behaviour as challenging. A person who grew up in a family where rough and tumble, loud and boisterous argument might not even notice this kind of behaviour in others.

 

Past Experience

Our previous experience and exposure to behaviours over time may mean we are more tolerant than if it is a new experience.

When I first moved from years of worker with older people. I found the upfront, and often colourful language of many of the people with brain injury I met challenging. The older people I met were generally more sedate, their language less likely to contain swear words. This changed over the years since.

 

Skills and Knowledge

Building skills and knowledge can build confidence, competence and also influence our perceptions of behaviour. Having skills and knowledge related to behaviour can give confidence and therefore increased tolerance to behaviours.

A female worker new to the support role seemed very comfortable working with men who were physically aggressive. When I asked her how this came about, she explained she had studied self defence for years to be able to make herself safer and was less challenged by physical aggression.

 

Our Own Physical and Mental Health

No matter how experienced and tolerant (or not) we are, how we feel on the day can influence our ability to manage behaviour.

Think about times you are ill, in pain, or having a difficult time. Do you find you are not as tolerant as you are when well and happy?

Most parents know how the fluctuations of health and mood can affect how we respond to the behaviour of our young children. A sleepless night or a cold can reduce our ability to cope.

 

Understanding of brain injury and its impact on a person

Someone who has not had experience with a person who has brain injury may be less able to understand the outcomes and therefore less tolerant and likely more confronted than someone comfortable with, and who understands brain injury.

It has been my experience that people who personalise behaviour and have more difficulty coping are those who are new and have little knowledge, or who have been supporters for a long time but ceased learning about brain injury. Yes I know it’s a generalisation, I did add it’s my experience.

 

The Extent or Degree of a Behaviour

We may have differing limits according to the factors above. For most there is a degree of behaviour that is unacceptable.

There are types and levels of behaviour that are challenging whether or not there are other factors such as those above.

Behaviour that appears dangerous or violent is rarely acceptable. Serious self injurious behaviours are often difficult to accept whether experienced or not.

 

Attribution

This fascinating theory might one day have an article all to itself.  I found it a difficult concept to grasp in the beginning yet relevant to our understanding of behaviour.Attribution theory is described as a way

In particular Fundamental Attribution Error (FAE)  which describes the emphasis each of us places on behaviour.

In brief: Generally when looking at our own behaviour we will attribute something good as having an internal cause (we did it ourselves), and we attribute bad events or behaviors as external (something or someone else caused it).

I did well in that race because I am so fit and fast. I yelled at Tom because I was unwell and tired.

The opposite is so when we are looking at others; something good will often be because of an external cause. Bad events or behaviour will be because the person is responsible, they are “bad”.

Jim ran a really fast time in that race because the wind was helping him. Tom yelled because he has a short fuse and is not a good person.

This can lead to differences in understanding the cause and impact of behaviour both in ourselves and our view of others.

 

Please share any other examples or any comments at all in the Comments below.

 

Our Response to Challenging Behaviour. Key Points:

Well that is a lot of factors to think about. A lot of influences on how we view others behaviour. It is helpful to remember:
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• Each of us responds differently to different behaviours
• Our own views of what is challenging (or not) can change over time.
• Our view of behaviour is influenced by many things including our culture and background.
• We respond differently on different days
• We respond differently according to factors we talked about above
• We will each find some behaviour more challenging than others – we each have limits.

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Five First Steps

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1. Carefully and constantly examine the influences (such as those listed above) on your behaviour.
2. Be open and honest with yourself understand your reactions and responses to behaviours. Look at the assumptions you carry that might influence your response e.g. “All people from X are violent”.
3. Know what “pushes your buttons” – what do you manage well, what behaviours do you struggle to tolerate. You can then work on managing your reactions or even avoid those that are too distressing.
4. Put yourself in the other person’s shoes – how would you behave in the same situation? This might help you understand the situation better, minimise blaming, and help you build good strategies.
5. Look at how the environment, context and situation are affecting the behaviour of yourself and others.

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And Finally

Often in “behaviour management” the focus is on just that; managing THE behaviour, I believe this denies the whole picture and therefore can limit our ability to respond safely and effectively.

Our view of behaviour is influenced not only by what is done (the behaviour of the other person) it is also influenced by how it is received (the way you view that behaviour based on your own experiences).

Recognising our own feelings, thoughts and beliefs about what is “challenging” can help us manage our own reactions, seek to understand the behaviour better, and hopefully de-personalise our responses.