Case Studies

Case 10: Challenging behaviour

Charles is 47 years old and lives in a residential home for people with moderate and profound learning disabilities. He lives with four men and attends day services 5 days per week. He is unable to communicate verbally and demonstrates his frustrations by biting and slapping himself. He does not readily mix with people and prefers to sit quietly in his room or the living room. Charles does not like listening to music or enjoy watching television, and this sometimes causes issues when the other residents want to do these activities in the communal living room. Charles does not like being touched without warning.

On this occasion, a member of staff asks Charles to go into the dining room and tries to guide him there. At this, Charles starts to scream and slap himself. When he is near a wall, he hits it hard with his head, before he is guided away.

• 1. What are the possible triggers for Charles' behaviour?

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  Correct answer:

  • He may not like the member of staff.
  • Charles may not be hungry.
  • He may not like the food that has been prepared.
  • He may not want to be in the company of the other residents.
  • Charles may not be feeling well.

• 2. What can the learning disability nurse do in this scenario?

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  Correct answer:

  • Keep a safe distance and do not force or hurry Charles into moving quickly.
  • Do not touch or guide Charles without telling him first that this is the intention.
  • Be aware of personal body language: stand to the side of Charles and do not stare at him for a prolonged period of time.
  • Do not shout at Charles, as he is not yet ready to listen.
  • Talk to him about his behaviour when he is calm.

  Establish an antecedent, behaviour, consequence (ABC) chart to identify the potential triggers in this scenario and discuss with the multi-disciplinary team (MDT) the possible causes of Charles' behaviour, in order to develop a management plan.

• 3. What should you think about when responding to behaviours that may pose a challenge?

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  Correct answer:

  • Analyse the environment: is it too noisy/cramped/busy? Is it uninspiring?
  • Is there too much or too little stimulus?
  • Provide appropriate strategies to enable Charles and his peers to learn new skills and more appropriate ways of expressing their needs.
  • Ensure that all staff adhere to agreed behaviour guidelines to promote consistency of approach to such challenging behaviour.