RESPONDING

EFFECTIVELY to
DIFFICULT or
CHALLENGING
BEHAVIOR
FACTORS INFLUENCING
CHALLENGING BEHAVIORS
1. Physical factors
 individual conditions that predisposes to
distress
 could be unpleasant symptoms, pain,
discomfort that causes irritability and
agitation
FACTORS INFLUENCING
CHALLENGING BEHAVIORS
2. Cognitive factors
Include the inability to remember new
information, to understand explanations or
instructions, poor judgment and planning
and importantly, communication problems
FACTORS INFLUENCING
CHALLENGING BEHAVIORS
3. Psychological/ emotional factors
Include a person’s emotional status and
those with personality disorders
FACTORS INFLUENCING
CHALLENGING BEHAVIORS
4. Social/ environmental factors
noise
Lights
Temperature
Overcrowding
Loss of routine
Essential Traits that a
Caregiver should Possess
1. Shows empathy
2. Genuine
3. Concrete and specific
4. Respectful
5. Immediacy of relationship
6. Keeps promises
Essential Traits that a
Caregiver should Possess
7. Tolerant
8. Trustworthy
9. Honest
10.Industrious
AUTISM
Different Challenging Behaviors
Autism
• More common in boys than girls
• Delayed development of self-help skills such
as feeding, eating, and dressing and has
difficulty or inability to expressive
communication
• Engages in self stimulated plays and is aware
only of himself/herself and can play alone for
hours
• Obsessive desire for sameness
Key to an effective care
• Always address the child by name
• Learn to recognize signals that can
proceed to negative behaviors like hand
flapping to know when to intervene to
prevent tantrum outburst
• Engage the child in his or her favorite
activities
• Take the child to a walk and place
him/her in a less stimulating place
Key to an effective care
• Reward the child with a tangible object
for every desirable behavior he or she
shows like food or toys
• Make the new environment familiar to
the child
 ATTENTION
DEFICIT
HYPERACTIVITY
DISORDER
(ADHD)
Different Challenging Behaviors
ADHD
• Is the habitual inability to pay attention
for more than a minute or two despite
repeated requests or even punishments
Characteristics of Children
with ADHD
1. Have difficulty staying focused on a task
or activity
2. Have short attention span
3. Get easily distracted
4. Get lost along the way through a story,
direction or place
5. Do not seem to listen when talked to
Characteristics of Children
with ADHD
6. Make careless mistakes in schoolwork
or other activities
7. Impulsive which makes them hard to
manage their immediate reactions
8. Do not follow through on instructions
9. Have difficulty organizing tasks
10.Often forgetful of daily activities
Characteristics of Children
with ADHD
11.Often fidget with hands or feet or
squirm on seat
12.Talk excessively
13.Have difficulty waiting their turn
14.Often interrupt conversations
15.Frequently run and climb
Characteristics of Children
with ADHD
16.Fail to finish a certain task and find it hard to
learn something new
17.Always in motion and may feel intensely
restless
18.Hyperactive wherein they cannot keep still,
be seated or observed a quiet behavior when
expected
19.Have tendencies to hurt anyone when they
are upset or grab a toy from a playmate or
another child
What a caregiver should do
1. Try encourage self control
2. Establish simple house rules and help
the child adhere to the rules
3. Be positive and reward the child if
he/she exhibits good behavior
4. A child with ADHD may benefit from
music therapy
What a caregiver should do
5. Since a child with ADHD easily gets
lost, a permanent ID tag should be put
on his/her garment or school bag
6. Lead the child to a place without
distractions
7. Arrange home furnishings in such a way
that the child will not get hurt when he
or she runs around the house
 Mental
Retardation
Different Challenging Behaviors
Mental Retardation
• A disorder in which a person’s
intellectual functioning is below the
average
• IQ is around 72 or below
Characteristics
• Show motor/physical development later
than other children
• Late speech development or have
difficulty starting to talk
• Poor school performance
• Emotional immaturity
• Score 72 or below in an IQ test
Characteristics
• Have difficulty understanding social rules
• Have difficulty remembering things
• Have difficulty understanding the
consequences of their actions
• Have difficulty solving simple problems
• Can progress to about Grade II in academic
skills
• Can do self care skills alone at the age of
adolescence
• Can perform simple tasks
What a Caregiver Should Do
• Accept that the child will have a hard
time learning new skills
• Let the child play with children whom he
or she can enjoy and keep up with even
if they are far younger than him or her
• Give playthings that appeal to the child’s
mental age
What a Caregiver Should Do
• Be patient in teaching the child physical
tasks such as walking with shoes on,
balancing, and running
• Do not force the child to do things
beyond his/her mental capacity
• Because the child has difficulty
interacting with others, be always on
guard against strangers influencing the
child
What a Caregiver Should Do
• Do not allow the child to bring valuable
things or wear expensive accessories as
he or she could be easily tricked by
playmates
• Never ask the child very complicated
questions which he or she could not
understand or answer.
• It is wise to remind about rules often
What a Caregiver Should Do
• Remember to keep dangerous things out of
the child’s reach like medicines, sharp or
pointed objects, lighted candles, electrical
switches, matchboxes, etc
• Assist the child in cleaning up by lining up
the things he or she will need
• Teach the child self care skills on at a time
• Teach the child the basics of eating alone
AGGERESSIVE
BEHAVIOR AND
MANIPULATIVE
BEHAVIOR
Different Challenging Behaviors
Aggressive behavior
• Defined as behavior that causes or
threatens to cause physical or emotional
harm to other
• Always keep in mind to maintain your
self control in dealing with them
Managing Assaultive/Aggressive
Behavior
1. Communicate effectively
2. Talk at their level
3. Reflect fact and feelings
4. Paraphrase and clarify what has been
said
5. Be sure to ask open ended questions
6. Avoid making too many demands on
the patient
Managing Assaultive/Aggressive
Behavior
7. Use brief and easy instructions
8. Before beginning any care activity,
make sure the patient is always
informed
9. Try not to take their rude comments
personally
10.If hostile, excuse yourself and leave the
person in a safe place
Manipulative behavior
• Characteristics:
a) Uses threats, demands, bargains or
intimidation to set his or her own way
b) Ability to identify and use other’s
weaknesses and use it against them
c) Makes consistent, unrealistic demands
d) Pretends to be sorry and helpless for
the behavior
Manipulative behavior
e) Fond of telling lies to gain sympathy
from others
f) Uses flattery, charms, and excessive
compliments to have needs met
g) To gain control over others, they uses
sexuality
What a caregiver should do
• Allow the patient to make his or her own
decisions
• Be consistent and firm in setting limits on
his or her behavior
• Never accept flattery, gifts or favors from
the patient
• Do not be influenced by clients charming
ways
• Answer questions only, not statements
DEPRESSED/
WITHDRAWD

Different Challenging Behaviors

Characteristics
• Looks sad
• Looks ill sometimes
• Often slouched in posture with head
down and rarely make eye contact
• Has slow body movements
• Slow in thinking or processing his or her
thoughts and in conversation
Characteristics
• Does not answer in detail
• Gets easily frustrated
• Angry of himself or herself
• Sad at times or no emotional expression
What caregivers should do
• Reorient the client to person, place, and
time as indicated
• When approaching the client, use
moderate level tone of voice. Avoid being
overly cheerful
• Use silence and active listening when
interacting with the client
What caregivers should do
• Communicate your interest and concern
through the active listening and silence
• When first communicating with the client,
use simple, direct sentences; avoid
complex sentences or directions
• Encourage your client to communicate
through open ended questioning
What caregivers should do
• Clients verbalization of feelings must be
accepted as real
• Help the client express hos or her
feelings in whatever way is comfortable
for him or her
• Allow and encourage client to cry
• Start a conversation with the client on
topics he or she is comfortable
 COGNITIVE
IMPAIRMENTS

Different Challenging Behaviors

Cognitive Impairment
• Happens when a person has trouble
remembering, learning new things,
concentrating or making decisions that
affect his or her everyday life
Common sings
• Memory loss
• Frequently asking the same question or
repeating the same story over and over
• Cannot recognize familiar people or
places
• Having a hard time making decisions,
more specifically in an emergency
decisions
Common sings
• Changes in behavior or moods
• Having hard time performing task like
keeping track of monthly bills and
following a recipe
DEMENTIA

Cognitive Impairments
Different Challenging Behaviors
CHARACTERISTICS
• Inability to make a sound and a
reasonable judgments
• Memory loss
• Executive functioning, disturbed planning,
organizing, sequencing and abstracting
• Personality change
• Frequent wandering behavior
• Disturbance in perception such as
hallucination, delusion and illusion
Hallucination
• Experience involving the apparent
perception OF SOMETHING THAT IS
NOT PRESENT

• Visual or auditory
Delusion
• Is a belief held strong conviction despite
superior evidence that it is not true

Illusion
• False idea or belief
What a caregiver should do
• Create a safe environment to prevent
falls and wandering
• Establish an effective verbal
communication
• Address wandering
• Reorient to reality