Why I’m still using the term challenging behaviour

Published by Jo on 29th April 2022

I was interested to read a recent LinkedIn post by Rachael Dodgson, CEO of care provider Dimensions about her moving away from using the term challenging behaviour.  Rachael says:

“Dimensions now talks about behaviours of distress rather than challenging behaviours, for example. It’s a critical change, a way of emphasising the cause of the behaviour rather than its consequence. This language helps people understand that by understanding and tackling the distress, there may be no further need for the behaviour. It’s powerful stuff.”  

This caught my attention, as Dimensions have always been a leader in the field, and one of very few care providers I thought we should aspire to be like when we first set up Green Light 12 years ago.

I believe language is important too, and agree this influences our attributions and relationships with other people.  But, I still use the term challenging behaviour.  Not in the derogatory sense some might mean these days, but because it continues to have a specific meaning for me.  One that I still see as being valuing and respectful of the individual.  

I was reminded of what behavioural psychologist BF Skinner said about meanings:

“One of the unfortunate implications of communication theory is that the meanings for speaker and listener are the same, that something is made common to both of them, that the speaker conveys an idea or meaning, transmits information, or imparts knowledge, as if his mental possessions then become the mental possessions of the listener. There are no meanings which are the same in the speaker and listener. (Skinner, 1974, pp. 103) 

So, what do I mean when I say challenging behaviour?  

I use the term challenging behaviour in the way I understood it to mean when it first started to come into use.  

In the 1987 Kings Fund publication Facing the Challenge: An Ordinary Life for People with Learning Difficulties and Challenging Behaviours  researchers,   Roger Blunden and David Allen, explained the term challenging behaviour:

“emphasises that such behaviours represent challenges to services rather than problems which individuals with learning disabilities in some way carry around with them” (p.14).&”

The message, for those involved in helping people with learning disabilities get an ordinary life was clear.  The challenge was ours to face.  It was up to us to understand what behaviour means for each person.  That was the challenge then and it is still a challenge today.  It was a welcome and pretty radical message at the time.      

In his introduction to Services for People with Learning Disabilities and Challenging Behaviour or Mental Health Needs (revised edition) (aka Mansell II) in October 2007 Jim Mansell stated:

8. The phrase “challenging behaviour” is therefore used in this report to include people whose behaviour presents a significant challenge to services, whatever the presumed cause of the problem. Wherever it is used, it includes behaviour which is attributable to mental health problems. As a working definition, that proposed by Emerson et al 15 has been used 

“Severely challenging behaviour refers to behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit or delay access to and use of ordinary community facilities.” 

When the term ‘challenging behaviour’ was introduced, it was intended to emphasise that problems were often caused as much by the way in which a person was supported as by their own characteristics. In the ensuing years, there has been a drift towards using it as a label for people. This is not appropriate and the term is used in this report in the original sense. 

It’s in this original sense that I still use the term today.  

Early in my career, as a support worker, I wanted to understand why the people I was trying to help get an ordinary life sometimes behaved in harmful ways.  Harming themselves.  Hurting other people.  Seemingly not learning from their ‘mistakes’.  

Having no way to communicate effectively with one another, it was impossible to learn why.  The person themselves couldn’t tell me why.  Although we had no explanations, there was no shortage of opinions or best guesses.  Some opinions carried more weight than others.  Invariably of course, we guessed wrong, meaning practices based on faulty assumptions emerged.  And, failing to tune into the message being sent – at a functional ‘frequency’ – many of our (well-intended) responses fell short of the mark.  Looking back now I’m pretty sure we unwittingly reinforced challenging behaviour at times. 

When the Emerson definition of challenging behaviour came to our attention it was an eye-opener.  We had a way to translate what we were experiencing in objective, observable, measurable ways.  We could ask sensible questions of what we were seeing.  We had an ‘operational definition’ for the challenge presented:

‘culturally abnormal behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit use of, or result in the person being denied access to, ordinary community facilities’.  Emerson, 1995

Of course now, the word ‘abnormal’ ‘raises my hackles’ as much as the next person.  But, the meaning here is as valid as ever.  Behaviour is socially defined.  What’s ok here may not be ok over there.  Your hand gestures may be ok here, but may not be ok in another part of our world.  What’s lauded (or reinforced) in one context, may be frowned upon (or punished) in another.  As Temple Grandin and Sean Barron put it in their Unwritten Rules of Social Relationships book, social “rules are not absolute: they are situation-based and people-based.”    

The Emerson definition was a yardstick, to ask the right questions before coming to conclusions.  We could ask things like:

  • What exactly is happening here?  
  • How often is this happening exactly?  
  • How long is it happening for?  
  • When exactly does it not happen?  
  • What impact does this happening have on the person and those around them? 
  • What impact does this have on the person’s quality of life?  

Our findings added to our understanding of the person and their needs.  

Operationally defining challenging behaviour allowed us to set aside assumptions and speculation, so a functional view of behaviour could come to the fore.  We knew what behaviour to exclude.  We had clear lines of enquiry for what was included.  The definition allowed us to be definite.  Solutions could be found.  Our findings could support arguments for resources, for people whose needs might have otherwise have been overlooked.    

The process of asking the right questions of behaviour, to understand its meaning, and what help we might offer to those who need it has moved on considerably in the last 25 years.  Education and training has moved on.  We now have students of behavioural science from Graduate and Masters level courses who can apply their practical understanding of this science to the challenge we continue to face.

So, while I continue to use the term challenging behaviour, it’s with this definition and meaning in mind, not any other.  

 

Jo Pyrah 

Managing Director

 

Further reading:

Challenging Behaviour Foundation information on definitions from The Challenging Behaviour Foundation