Health_problems.jpgChallenging behaviour and health

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Key facts

Challenging behaviour means that something is not right for the person.  There can be many causes.  Some of these are health problems - the person may be sick or in pain or have a mental health problem. When a person has challenging behaviour, family and support workers will want to find and try to fix the causes.  A behaviour support practitioner can help with this.  It is also important to get the person’s doctor to check for any health problems causing the behaviour. 

Challenging behaviour and its causes

A person’s behaviour is challenging if it causes serious risk to the person or other people or prevents the person having normal access to the community.

Challenging behaviour can have many different causes. For example, the person:

  • Wants something but cannot explain it.
  • Is bored.
  • Does not like something that is happening.
  • Is unsettled by a change in his or her life.
  • Is grieving the loss of someone close.
  • Is in pain.
  • Has a mental disorder, eg anxiety or depression.

What to do when a person’s behaviour is challenging

Family and support workers should usually do two things:

  1. Get the person’s doctor to check for any medical cause of the behaviour.
  2. Seek help from a behaviour support practitioner.

You should usually pursue both these things at the same time.

Behaviour support

Where a person has challenging behaviour, family and support workers need help from a behaviour support practitioner like a psychologist.  In NSW, you can find a behaviour practitioner at the Community Support Teams of ADHC.  Some non-government disability services also have behaviour support practitioners.

The behaviour practitioner should assess the possible reasons for the behaviour and what function the behaviour has for the person.  For example, the reason might be that the person is unsettled by a change in routine and the function might be to express anxiety about this.   The practitioner should work with the person, family, any advocate and disability workers to find strategies to minimise the challenging behaviour.  The practitioner may also arrange other assessments such as a communication assessment by a speech pathologist.

The behaviour support strategies should include:

  • Ways to prevent the behaviour occurring.
  • Changes to the person’s environment and lifestyle to fix reasons for the behaviour.
  • Teaching the person skills so that he or she does not need to use the behaviour.
  • What to do when the challenging behaviour happens.

The behaviour practitioner should show family and support workers how to carry out the strategies. The practitioner should usually write down the strategies in a behaviour support plan.

The practitioner should regularly check if the strategies are being used, if they are working and if they need to be changed. 

 Checking for medical causes

As well as considering behaviour support, you should get the person’s doctor to check for any medical problem that is causing challenging behaviour.  This is very important if the person has limited communication and is not able to explain symptoms of illnesses. The challenging behaviour may be the way the person is expressing pain.  Often, the doctor should do a full medical review just like the person’s annual health assessment.

For example, the doctor may find:

  • The person is in pain from a tooth abscess, constipation or a broken bone.
  • A urinary tract infection, a thyroid disorder or diabetes.
  • A woman has painful periods.
  • Medications the person is taking are having side effects or not working well together.
  • A person in their 50’s, who has become less cooperative, may have early dementia.

The doctor may find that the person has a mental health problem that is contributing to the behaviour.  See the Mental health fact sheet for information on diagnosis and treatment of mental disorders, including the use of psychotropic medication.

A GP may refer the person to see a medical specialist, eg a neurologist if the GP suspects that the person has epilepsy or a psychiatrist for a mental disorder.

For more information

Community support teams, ADHC www.dadhc.nsw.gov.au/dadhc/Contact+DADHC/DADHC+Regional.htm
Phone (02) 8270 2000 or TTY (02) 8270 2167

Behaviour support policy and practice manual, ADHC www.dadhc.nsw.gov.au/dadhc/Publications+and+policies/People+with+a+disability/Behaviour_Support_Manual.htm

You might be interested in these fact sheets

Adults – signs of illness
Ageing and health
Annual health assessments
Children – signs of illness
Mental health

This fact sheet was written in May 2010. See www.nswcid.org.au for updates.

The fact sheet contains general information only and does not take into account individual circumstances.  It should not be relied on for medical advice.  We encourage you to look at the information in this fact sheet carefully with your health professional to decide whether the information is right for you.