Managing challenging behaviours Flashcards
1
Q
IDD
A
- IDD = Intellectual and Developmental Disability
- An umbrella term for a variety of disorders and disabilities
- A group of conditions with onset in the developmental period
- Characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning
- Cognitive impairment based on standardized testing results
- Adaptive functioning difficulties requiring support for daily tasks
- Age of onset before age 18
Deficits in mental ability:
- reasoning, problem solving, abstract thinking, judgment, academic learning, and learning from experience
- 2nd percentile and below as a general benchmark
Resultant deficits in adaptive functioning:
- Failing to meet the standards of personal independence and social responsibility
- Difficulties perform IADLs and ADLs
- Communication, social participation, academic/occupational functioning, independence at home and in community
2
Q
ASD
A
- Autism spectrum disorder
- Persistent deficits in social communication and interaction across multiple contexts
- Restrictive or repetitive behavior, interests or activities
- Movement, behavior, insistence on sameness, restricted Interests, differences in sensory processing
Severity defined by level of support needs:
Level 1 – Requires support
Level 2 - Substantial support
Level 3 – Very substantial support
3
Q
How challenging behaviour impacts health
A
- Access to healthcare
- Can make it challenging to engage in behaviours that benefit health (i.e. brushing teeth)
- Encompasses lots of populations other that IDD; dementia, stroke, brain injury, etc.
4
Q
Types of aggression
A
- Organic aggression as a result of medication side effects, delirium, pain, encephalitis
- Learning through consequences (contact with environment)
- We are really good at looking at organic causes of aggression
- Not good at when all of those have been ruled out
- We rule out organic causes, make sure there is no physical issues, prescribe med and send home
- We don’t look at the environment and why this person is acting this way and what their goals are
5
Q
4 Functions of behaviour
A
1) Escape
2) Attention
3) Tangible
4) Automatic
6
Q
Escape behaviour
A
acting out to get out of whatever situation they don’t want to be a part of
7
Q
Attention behaviour
A
can be positive or negative behaviour to gain attention
8
Q
Tangible behaviour
A
acting out to get access to something
9
Q
Automatic behaviour
A
- internal state
- some situation internally that you’re trying to satisfy.
- Can be separated into two categories
1) for pain/discomfort (doing something top try and relieve pain)
2) stimming; any behvaiour you do because it feels good (i.e. playing with hair, flapping, etc.)
10
Q
HELP Framework
A
- A framework that helps you rule out potential causes of behaviour H - heath E - environment L - lived experience P - psychiatric disorder
11
Q
HELP - H
A
Health
- First is health; ruling out medical conditions that are causing this behaviour
- Constipation, dental health, sleep, mood
- Making sure there is no health issues that may be contributing to the behaviour
- If present, treat the condition
12
Q
HELP - E
A
Environment
- ER are bright, loud, scary, new which can contribute to behaviour
- Moving, changing routine
Different demands he has to do
- Changing expectations
- How often are they accessing things they like
- If present, adjust supports of expectations
13
Q
HELP - L
A
Lived experience
- What are their life events
- Trauma; really vulnerable population
- Of all adults with IDD, 2/3 will experience some form of abuse in their life; if you’re non-verbal how can you communicate that?
- If present, address the issues
14
Q
HELP - P
A
Psychatric
- Not medication
- Often treated for ‘aggression’; not a psychiatric disorder and treated with a range of meds
- If psychiatric disorder can be treated with specific medications with outcomes
- With autism, 60% have depressive episode and almost 70% have anxiety
- Looking at patterns, changes; specific situations that make them nervous, repetitive behaviours that are new
- If present, treat the disorder
15
Q
3 Term contingency; ABC
A
Setting event
1) Antecedents
2) Behaviour
3) Consequences
16
Q
ABC; setting events
A
- things that are before the antecedents
- internal or external (how much sleep you had the night before, if you’r hungry, physical environment like brightness loudness, meds taking, physical pain, mood)
- All of there things are in the environment or internal but are not right before the behaviour
- We can treat setting events, antecedents and consequents to stop the behaviour from occurring
17
Q
ABC; A
A
A – antecedents
Whatever happens right before the behaviour happens
18
Q
ABC; B
A
B – behaviour
Whatever behaviour you’re trying to produce
19
Q
ABC: C
A
C – consequences
Whatever happens right after the behaviour occurs
20
Q
Treatment for setting events
A
- Medication
- Changing schedules
- Sleep
- Constipation pain
- Not assuming
- For a non-verbal patient have to do more detective work
- Asking parents and caregivers about patterns
- Lots of interventions available if pt is non-verbal
- Physical environment: own room in acute care; quite area in ED
21
Q
Treatment of antecedents
A
- Altering task difficulty / response effort
- Offering choices; even with the little things
- Behaviour momentum; lots of breaks, building up to the task they don’t like
- Preferences
- Prompting strategies to perform a task
- Using visuals; show steps and where rewards are given throughout
- Behaviour contracting; a contract they sign with caregiver/HCP
- Non-contingent attention procedures
- Stimulus control
22
Q
Treatment of consequences
A
- Response blocking; preventing them from hitting – keep them safe and teach them that they can’t when they try to, may reduce or stop behaviour
- Redirection; change them to something they can do well, then bring back to difficult task (diffuses behaviour and gives them time to calm down before trying again)
- Positive attention; anytime the patient is not engaging in the challenging behaviour; tons of attention on the behaviours we want to see so they don’t have to act out with behaviour for attention
- Planned ignoring
- Token economies; token boards, breakdown tasks into steps, each successful step gets a token and once finished gets rewards of something they like
- Habit-reversal
- Flooding
- Systematic desensitization; go slowly over time, build success at every step so they are desensitized at every step, get something they like at every successful step
- Contingency contracts; way to reward less successful and some success (smaller reward for less than perfect day; big reward for successful day)
- Want to help the person be as successful as possible so they get good stuff from you
- Keep doing stuff you want them to do
- Equate it with good things
23
Q
Same behaviour, many functions
A
- The same behaviour can be triggered by different functions or a combination of functions
- How to determine what it is
- With automatic, it’s a bit harder
- Usually how we figure out if something is automatic is that there is no pattern
- If we have good ABC data, we can start to look for patterns or in the care of an automatic function, no pattern
- Always go back to the HELP framework to being to rule out things
24
Q
Analyzing ABC data
A
- What are the common antecedents, consequences, setting events, for each specific behaviour?
- Are there differences from one caregiver/environment to another?
- Does a specific antecedent trigger one or many behaviours?
- What are possible functions for the behaviour?
- Do different behaviours serve the same function ?
- Looking for patterns or lack of pattern
- What is occurring/happening consistently that is setting off this behaviour
- Behaviours have have the same function, or multiple functions
- If we have good ABC data we can track functions
25
Interventions for challenging behaviours
- Graphics, lots of people with IDD know this look
- One program used that makes pictures like this
- Can also use regular pictures instead of cartoons
- Open ended activity; visual timers
- Edible reinforcement; because it ends (i.e. you eat the candy then it’s over)
- Most people with IDD have had removal of their preferred item
- Countdowns; lots of warnings so they know the end is coming
- Helpful to have it happening again somewhere else; they know they’re going to get it again
- Making sure the person understand that even though you’re taking away something they like, it’s not forever
- Useful through graphics
26
First-then strategies
- Showing that they are going to do something they don’t really like; then they get to do something they do like
- Can be general
- Helps motivate them to do things they don’t like
- Can also be used to break down specific steps
- Important to develop trust – follow through with promise
- Don’t delay the reward; they won’t trust you
- Can also make visual calendars; know when it’s coming up and see that there’s both bad and good
- Make sure the patient is picking the “then” portion
- Talk to the caregiver to coordinate the reward; makes the specific reward so motivating
- Ask the individual or the caregiver if they know what the “first-then” is
27
Tips for communication for an individual with an IDD
1) Make sure the patient is paying attention. Close proximity, eye contact.
2) Be specific “hands down” “stop”
3) Give short simple directions “walking feet” “stay with worker”
4) Give one direction at a time “stand up” “hold my hand”
5) State the direction positively “nice hands’ instead of “no hitting”
6) Tell, don’t ask – not “do you need to go potty” but “time for potty” not “are you finished” but “all done”
7) Give extra assistance – repeat direction, show pictures
8) Repeat, practice and praise – make it habit or routine
- Each person with an IDD is different; best thing to do is ask
- Ask the person how they like to communicate, ask caregiver
- Watch how interact with their caregivers
