Assessment and Management of Challenging Behaviors

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People with challenging behaviors need utmost care and understanding. These help a lot in making them fit in the community. It is noteworthy that when these individuals are not well taken care of they end up being a nuisance to the community. Most importantly, the response of those around them either to their behaviors or to them as individuals envisages how they relate to the community. For instance, if the response is encouraging, the patient will behave well, but if the response depicts a sense of desertion and marginalization, the patient will feel discarded, and, as a result, they will not relate well with those around them.

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My response to the challenging behaviors

Donovan (2005), states that it is essential to understand the patient’s suffering from challenging behavior, as this provides them with a good environment to relate well with those around them. The patient in my case study suffers from Alzheimer’s disease. Personally, I acknowledge the fact that developing challenging behaviors like Alzheimer’s disease is not an individual’s deliberate act but a disability. As a result, I respond to this patient’s challenging behaviors one at a time. On most occasions’ he becomes aggressive and assaults people around him. Although he is a mature man of 45 years, I make sure I restrict him from this act without intimidation or being disrespectful.

Whenever he displays aggressive characteristics, I use positive distractions like engaging the patient in a conversation. As a result, he feels comfortable and accepted. The other distraction strategy that I employ is the use of music. Thus, he shifts his attention from those around him to the music playing. I use these distraction techniques after I have discovered the issue that triggered his behavior. Furthermore; my main objective in doing this is to keep the patient and those around him safe from injury. Distractive techniques are mostly used by nursing homes on those patients suffering from memory loss (Donovan, 2005: 16).

The other challenging behavior displayed by the patient is his inability to identify friends and relatives. This does not often happen, but when it does I talk to the patient a lot about the past events involving him and his family members. Thus, he ends up remembering his family members and friends gradually. More so, this strategy has been shown to help the patient recognize his family members and friends easily. Alien (1999) reveals that caregivers face the risk of encountering a new behavior that the patient has never shown before.

Hence, they are at risk of getting hurt. When in the house, the patient jumps from one seat to the other looking afraid and extremely confused. In addition, he does not seem to recognize those around him and where he is. At this time, I try to make the patient stay calm by speaking to the patient to make him comfortable. As a result, he feels appreciated and the fear in him fades. Most importantly, the moment he realizes someone cares for him, he relaxes and calms down (Alien, 1999: 326).

This patient can not cross the road on his own. This behavior is displayed whenever he is taken out for evening strolls. Thus, I take this as my responsibility to make sure he has crossed the road carefully. As a result, I have trained him to wait until he is prompted to cross the road. The patient is not able to carry out tasks that entail several steps, and at certain times require the help of others to complete certain tasks. This applies when he is entitled to perform duty at home.

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As a result, he ends up messing with himself or the apparatus he is using. Here, I take the patient one step after the other until he has completed his duty compellingly. It is noteworthy that poor communication ability results in challenging behavior, which can make a patient unable to follow the instruction on his own (Tsiouris, Mann, Patti and Sturmey 2003: 15).

The patient lacks the ability to cope with new situations. In addition, when in an unfamiliar environment, he tends to grab, hold or lean on clients and staff. He may try to grab those adjacent to him when traveling in a van and for this reason, he seldom travels using the public transport system. In most cases, I talk to the patient about his surrounding whenever he portrays this behavior. I never want him to feel secluded by those around him; as a result, I encourage those around him to engage him in a conversation. This makes the patient feel appreciated and he ends up relating well with those around him.

Alzheimer’s disease denies the patient the chance to use facilities around, for example, washrooms. This is because he has suffered memory loss which makes him not realize the essence of such facilities. As a result, he ends up messing the place around him with human waste whenever there is no one around to attend to him. Thus, I guide the patient on how to use toilets and bathrooms. In most cases, what I have taught the patient the previous day will not stick with him, as he forgets them. The possibility of developing Alzheimer’s disease becomes eminent as one grows older.

Response of others to the challenging behavior

The response of those people involved with the patient varies, as in similar situations his friends responses may differ from his family’s and the healthcare providers’ responses. This is because most people do not view Alzheimer’s disease as a disability but rather as a calamity and burden in the community. These people respond differently to the patient’s challenging behaviors mentioned above. For instance, whenever he becomes aggressive, the family members will always try to calm the patient down while most of his friends keep their distance for fear of assault. It is noteworthy that my colleagues just like me, have perfected the skill to deal with the patient whenever he is in such a state of aggression. It is noteworthy that the more a patient develops an intellectual disability, the more likely he can undergo depression (McBrien, 2003: 6).

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It annoys his relatives and friends whenever he becomes incapable of recognizing them. As a result, they force him to do so by mentioning to him so many things about their past. Thus, they end up confusing the patient and making him exasperated resulting in aggression. Tsiouris (2010) insists that aggression is caused by repeated provocation. Similarly, they are not patient with him as they seem to push him to be in a state that pleases them. In the end, such responses make the patient afraid and violent whenever they are around. The patient also has the tendency to jump from one seat to the other whenever he is in the house. As a result, the people around him see this as a disturbance.

Hence, some shout the patient down or even lock him in a confined room. This is mostly done by his friends who feel irritated with this behavior. On the contrary, his family tend to calm him down in a quiet way as they want him to be comfortable when in their midst. Aggressive behavior involves those activities that might cause harm to the patient and the people around him (Tsiouris, 2010: 4).

His friends and relatives respond positively whenever he fails to cross the road in the appropriate way. In addition, they do not allow the patient to walk on his own as they are concerned about his safety. This is one of the positive responses that I have noticed from his friends and family members. Another positive response is that whenever he is carrying out tasks that entail more than one step, his family members and friends’ assists him accomplish it. As a result, he becomes satisfied with the care he receives; thus, becomes comfortable. This positive response is what a patient suffering from Alzheimer’s disease needs to make him feel loved and appreciated. Most importantly, those patients with intellectual disability tend to portray a lot of challenging behaviors (Deb, Thomas and Bright, 2001: 506).

The patient’s inability to cope with new situations triggers unpleasant response from his family members and friends. They tend to introduce him to different environments with different people and objects. As a result, he ends up grabbing objects and people he sees around; thus his friends and family members shout him down. Hence, these responses make the patient agitated and afraid. I have realized they still do not understand the impact of negative response on his emotions. Loss of memory as a result of Alzheimer’s disease makes the patient mess himself with human waste as he can not use the toilets.

It is evident that whenever this takes place his family and friends will always shun him. The patient, as a result, feels rejected and marginalized to the extent that any attempt to make him feel better by anyone who is not his family or friend makes him annoyed and violent. Hence, he develops low-self esteem.

My response to the person

Personally I handle the patient in a professional way to make sure I do not exhibit any form of deficiency in my codes of practice. I acknowledge the fact that the patient need utmost care and supervision to enable him relate well in the community. Thus, I handle the patient with care, as a result, he fits so well and tends to follow the instructions I give to the latter. Further more, he is very comfortable whenever I am around as he feels loved and appreciated.

I give the patient maximum attention to ensure he does not find any difficulty living with people around him. I believe giving him undistracted attention will make him relate well and try to contain himself whenever aggregated. Hence, Incidents of violence are reduced, and he is friendly to people around him.

Response of others to the person

Responses of those involved like his family and his friends tend to differ in various situations. In most cases, these people tend to shun the patient, as they consider him to be violent and unbearable. As a result, they fan his inability to recognize them in most occasions. The patient at times feel marginalized when his family and friends keep away. He thus ends up getting used to the care givers than his family and friends.

The family and friends seem to be impatient with the patient’s condition, as in most occasions they do not give him the chance to register changes gradually. Hence, their constant pressure on the patient makes him develop a repulsive attitude towards them. It is noteworthy that their responses vary with the situation. For example, they respond positively in situations that are manageable, like helping him complete his tasks. On the contrary, in a situation like helping him use the toilet facilities appropriately, they shy away as they consider it an embarrassment. Thus, would not want to associate with him. In most cases, such rejection might cause the patient to develop mental illness. Furthermore, research has proved that people with intellectual disability are at more risk of developing mental illness (Moss, Emerson, Bouras and Holland, 1997: 440).

Effective management programme for the challenging behavior

It has been evident recently that the non-pharmacological interventions help a lot in the management of challenging behavior and provision of a good environment for patients with Alzheimer’s disease. Thus, I have designed a non- pharmacological programme for the management of the challenging behaviors by the patient in my case study. Medical experts have depicted that if a management therapy does not yield any results, it should be withdrawn (Brylewski and Duggan, 1999: 360).

Non-pharmacological interventions

Behavioral therapy

Hatton, Emerson, Kirby, Kotwal, Baines, Hutchinson, Dobson and Marks (2010), believe that having a person with challenging behavior in a family is very challenging. As a result, behavioral therapy plays a vital role in the eradication or containment of the challenging behavior. Thus, the patients’ behavior will be analyzed and most importantly the antecedents are identified. These are the triggers of the challenging behavior. In addition, the behaviors are also identified; as a result, one will know how to deal with the patient. Lastly In behavioral therapy, the consequences of behavior are also identified.

The interventions will then be manifested in accordance to this analysis. The challenging behaviors by the patient in my case study are clearly displayed thus I will use this to identify the antecedents, behaviors and consequences (Hatton et al., 2010: 63).

Reality therapy

This form of therapy is used by most healthcare providers for the management of the challenging behaviors. As it is considered to be one of the most effective forms of management of people who suffer from memory loss. The patient in my case study suffers from Alzheimer’s disease thus this therapy best suit him. Here, he will be reminded of the facts about his life and the surrounding. Furthermore, this therapy can be applied in a group of patients as they will remember events in their lives easily when they are in a group. Analysts have noted that patients with Alzheimer’s disease bring about unusual ethical difficulties (Oliver-Africano, Dickens, Ahmed, Bouras, Cooray, Deb, Knapp, Hare, Meade, Reece, Bhaumik, Harley, Piachaud, Regan, Ade Thomas, Karatela, Rao, Dzendrowskyj, Lenôtre, Watson and Tyrer 2010: 17).

Validation therapy

This form of therapy helps in relieving the patient from stress, loneliness and boredom. As a result, the patient becomes comfortable with his environment and relates well with everyone. This therapy helps the patients to identify their hidden feelings and relieves them from the pain they feel on the outside. Cudré-Mauroux (2010), affirms that emotions play a key role in the determination of challenging behavior. Thus, this therapy has proved to result in a number of positive outcomes such as less behavioral disturbances, makes the patient realize his external reality, and lastly it brings about contentment. This form of therapy employs behavioral and cognitive measures (Cudré-Mauroux 2010: 26).

Reminiscence therapy

This therapy helps a patient with memory loss to remember past activities or occasions in his life. For instance, it makes the individual remember those events that are significant in their lives. These events can be weddings, birthdays or even graduations. Furthermore, it can also be used in groups or on individual patients. Patients who have undergone this therapy register cognitive improvement. Other evident outcomes of this therapy include improvement in self care and motivation and the patients’ social interaction. Hastings, Tombs, Monzani and Boulton (2003), insist that other materials should be used to stimulate the patients. Some of the things used in this therapy include music and artifacts; these are used to provide stimulation to the patient (Hastings et al., 2003: 59).

Administration of all these therapies in the management of challenging behaviors has yielded positive outcome on the patients. In addition, the patients are introduced to non-pharmacological modes of treatment that are more friendly and encouraging. Thus, the patients respond positively to these modes of treatment as it does not infringe pain. It is noteworthy that of late people with intellectual disabilities are being moved from institutional based treatment to the community based treatment (Balogh, Ouellette-Kuntz, Bourne, Lunsky and Colantonio, 2008: 1).

List of References

Allen, D. (1999), Mediator analysis: an overview of recent research on carers supporting people with intellectual disability and challenging behavior. Journal of Intellectual Disability Research, 43: 325–339.

Balogh R, Ouellette-Kuntz H, Bourne L, Lunsky Y, Colantonio A. (2008), organizing health care services for persons with an intellectual disability. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD007492.

Brylewski, J. and Duggan, L. (1999), Review: Antipsychotic medication for challenging behavior in people with intellectual disability: a systematic review of randomized controlled trials. Journal of Intellectual Disability Research, 43: 360–371.

Cudré-Mauroux, A. (2010), Staff attributions about challenging behaviors of people with intellectual disabilities and transactional stress process: a qualitative study. Journal of Intellectual Disability Research, 54: 26–39.

Deb, S., Thomas, M. and Bright, C. (2001), Mental disorder in adults with intellectual disability. 2: The rate of behavior disorders among a community-based population aged between 16 and 64 years. Journal of Intellectual Disability Research, 45: 506–514.

Donovan, S. (2005). Understanding and responding to challenging behavior. Cardiff. Web.

Hastings, R. P., Tombs, A. K. H., Monzani, L. C. and Boulton, H. V. N. (2003), Determinants of negative emotional reactions and causal beliefs about self-injurious behavior: an experimental study. Journal of Intellectual Disability Research, 47: 59–67.

Hatton, C., Emerson, E., Kirby, S., Kotwal, H., Baines, S., Hutchinson, C., Dobson, C. and Marks, B. (2010), Majority and Minority Ethnic Family Carers of Adults with Intellectual Disabilities: Perceptions of Challenging Behaviour and Family Impact. Journal of Applied Research in Intellectual Disabilities, 23: 63–74.

McBrien, J. A. (2003), Assessment and diagnosis of depression in people with intellectual disability. Journal of Intellectual Disability Research, 47: 1–13.

McClintock, K., Hall, S. and Oliver, C. (2003), Risk markers associated with challenging behaviors in people with intellectual disabilities: a meta-analytic study. Journal of Intellectual Disability Research, 47: 405–416.

Moss, S., Emerson, E., Bouras, N. and Holland, A. (1997), mental disorders and problematic behaviours in people with intellectual disability: future directions for research. Journal of Intellectual Disability Research, 41: 440–447.

Oliver-Africano, P., Dickens, S., Ahmed, Z., Bouras, N., Cooray, S., Deb, S., Knapp, M., Hare, M., Meade, M., Reece, B., Bhaumik, S., Harley, D., Piachaud, J., Regan, A., Ade Thomas, D., Karatela, S., Rao, B., Dzendrowskyj, T., Lenôtre, L., Watson, J. and Tyrer, P. (2010), overcoming the barriers experienced in conducting a medication trial in adults with aggressive challenging behaviour and intellectual disabilities. Journal of Intellectual Disability Research, 54: 17–25.

Tsiouris, J. A., Mann, R., Patti, P. J. and Sturmey, P. (2003), Challenging behaviors should not be considered as depressive equivalents in individuals with intellectual disability. Journal of Intellectual Disability Research, 47: 14–21.

Tsiouris, J. A. (2010), Pharmacotherapy for aggressive behaviors in persons with intellectual disabilities: treatment or mistreatment? Journal of Intellectual Disability Research, 54: 1–16.

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PsychologyWriting. "Assessment and Management of Challenging Behaviors." March 15, 2022.