Adult Social Care Glossary, v 0.6

Behaviour that may cause harm to the person or to those around them, and may make it difficult for them to go out and about. It may include aggression, self-injury or disruptive or destructive behaviour. It is often caused by a person's difficulty in communicating what they need - perhaps because of a learning disability, autism, dementia or a mental health problem. People whose behaviour is a threat to their own wellbeing or to others need the right support. They may be referred by their GP to a specialist behavioural team. The specialist team will work on understanding the causes of the behaviour and finding solutions. This is sometimes known as positive behaviour support.

Words that blame: Challenging behaviour

The ‘challenging behaviour’ label is, well – challenging.

The phrase labels the person’s behaviour as problematic, as something that must be controlled or managed so the person behaves more ‘appropriately’. But who defines what is ‘appropriate’?

“Somebody has decided that my behaviour, or the person’s behaviour, needs to be modified. Needs to be improved, mainstreamed, made less extreme. So, there’s a power differential right there, isn’t there? And the person’s agency to behave in the ways that are most comfortable for them is taken away”. Alexis Quinn [4]

‘Problems’ require solutions, and too often having identified ‘challenging behaviour’, our response is to increase medication or restriction or restraint. Separation. Seclusion. The classic medical model of treating and fixing rather than understanding what’s happened to – and what’s happening around – the person.

All behaviour is a form of communication. If I suggest your behaviour is ‘challenging’, I’m either failing to understand – or deliberately ignoring – what you’re communicating, and why. Maybe you’re scared? Excited? Frustrated? In pain? Angry? Bored? Lonely? Hungry? Sad? Maybe something has happened or there’s something going on around you that’s causing you to lash out or to retreat? Maybe it’s my behaviour that’s challenging you?

Even when we do acknowledge the communication element of a person’s behaviour, we still manage to twist this to blame the person, whose ‘challenging behaviour’ is attributed to their difficulty in communicating what they’d like or need – not our failure to meet their communication needs, and in turn their human rights, and our legal duties.

And no, ‘behaviour that challenges’ or ‘behaviours of concern’ aren’t any better, because they’re still loading blame onto the person. And while referring to ‘distressed behaviour’ (hopefully) shifts the focus to understanding the reason for the distress and (hopefully) prompts some wider changes to relieve it, it’s still a label. And anyway, maybe the person isn’t communicating distress at all.

“I can remember meeting an Afro-Caribbean man having treatment on a mental health ward. He told me that one day he was starting to feel better, so he started singing loudly in the corridor. For him this was an expression of joy. But in reserved Britain, staff interpreted this as unusual behaviour and upped his medication.” Claudia Hammond [5]

[4] The problem with behaviour support, Alexis Quinn, Rightful Lives, You Tube, 14 April 2022

[5] D for diagnosis: Ever changing labels, Claudia Hammond, BBC Radio 4, Wed 22 Jan 2020