Positive Approaches to Challenging Behavior
First Steps in Positive Behavior Support
Before starting a PBS plan:
- Make sure the child or adult has had a physical and/or mental health check with the doctor
- Use a wraparound plan or person-centered plan to begin addressing quality of life
The reason these two steps are important is because treating an underlying physiological condition and addressing problems related to poor quality of life can decrease challenging behavior without the need for PBS.
Starting PBS with wraparound or person-centered planning helps emphasize that all of the efforts taking place are meant to improve quality of life and promote person-driven decision making. Wraparound and person-centered planning highlight the types of quality of life outcomes that are needed in a person's life. Wraparound and other person-driven strategies also gather information about the function that might be maintaining challenging behavior and helps gather information that can be used later during assessment.
The unique cultural preferences, views, and values of the child or adult gathered as part of wraparound or person-centered planning are used during the entire PBS process. Additional strategies for addressing cultural responsiveness are integrated into all steps within the positive behavior support plan. Many plans that fail are implemented in ways that do not take into account how cultural variations among the people involved are influencing the outcome of the plan.
The assessment process is used to understand what social functions are being communicated by the challenging behavior that is observed and what a child or adult may be communicating. Assessing the role of culture and understanding the social functions that are maintaining challenging behavior are part of the design of effective PBS. The visual on this page describes the social functions that maintain challenging behavior.
As you can see in the visual on this page, challenging behavior can occur for social or nonsocial functions. Sinus problems, internal health issues, and illness can all trigger challenging behavior. Nonsocial functions can also include anxiety, depression, psychotic episodes, and other internal physiological experiences.
Challenging behavior can be viewed as a form of communication that has a social function. A person may be seeking to communicate the need to escape or avoid something such as attention from certain people, tasks, or events.
In other cases, challenging behavior may signal that a child or adult is trying to gain or maintain access to what is important to them (reaching out to a person, signaling the need for someone to pay attention) or to gain access to an item or to objects.
A key part of PBS planning is to understand the social functions that are maintaining challenging behaviors.
A small child begins banging her head on the kitchen table at home. The child’s mother schedules a doctor’s appointment and discovers that the child has an ear infection. This form of self-injury often occurs in young children and appears to relieve the pain coming from the earache.
A young person who engages in a repetitive form of behavior called self-stimulation or stereotypy that usually does not result in injury. However, self-stimulation can become a form of self-injury when these behaviors suddenly increase in intensity. For instance, a young person who taps her hand in a repetitive way on her face may start slapping or hitting herself with her hand as this repetitive behavior increases in intensity. A trip to the general physician identifies a possible reason for this increase in intensity - the young person is diagnosed with irritable bowel disorder. The disease has resulted in higher levels of discomfort and pain which has become the function maintaining self-injury. Treating the irritable bowel disorder results in decreases in self-injury.
Kenji is a 55 year old man with an intellectual and developmental disability who recently moved to a city to be closer to his aging parents. Kenji started a new job working as a janitor at a local restaurant. At work, Kenji has been pushing and shoving his supported employment colleagues so that they lose their balance, especially during times of day when the restaurant he works in is really busy.
During Kenji’s person-centered plan it became clear that Kenji really dislikes his job because it is very noisy in the kitchens with everyone yelling out orders and playing loud music. Kenji decided to change jobs and started stocking shelves at a nearby mail order shop. The shop owners are very calm and are introverted like Kenji. They like that Kenji appreciates calm and quiet work settings. Over time, Kenji's challenging behaviors gradually disappeared.