Challenging & complex behaviours: Positive Behaviour Support techniques
The wide variety of strategies available
within the Positive Behaviour Support approach give us many ways to
respond effectively to challenging behaviours.
Positive Behaviour Support is a very effective and proven way to
respond to challenging behaviours that can arise from brain
disorders such as traumatic brain
All of the strategies involved rely on basic foundations of
respect for the person involved - we may dislike a certain
behaviour but will maintain respect for the person, and look for
positive ways to encourage appropriate behaviour instead of using
punishment or coercion:
- Develop a positive rapport
- Establish consistent routines
- Remain calm and respond positively during a behaviour
- Involve the person in discussing behaviour issues.
Managing the triggers for behaviour
Using the ABC approach to challenging behaviour, we can manage
the antecedents, or triggers, to reduce the chances of a behaviour
- Avoid or minimize known triggers
- Use distraction or redirection away from the trigger
- Discuss these triggers with the person
- Work together on possible coping strategies
- Suggest and encourage these strategies when a trigger
Graduated exposure to triggers
This is useful when antecedents can't or shouldn't be avoided.
With time and patience, it can be a powerful technique. For
example, Kirsten starts screaming in supermarkets due to sensory
overstimulation. Her mother says they will just stand outside the
supermarket for 30 seconds then go home. The next time, they go in
for 30 seconds then go home. This is gradually lengthened until
Kirsten has adapted to this difficult environment.
This is generally the most effective strategy. An incentive is
given immediately when a desired behaviour occurs. For
example, Glen usually becomes quiet when anxious then suddenly
starts shouting at everyone. He is learning to tell family members
when he is getting anxious and do his deep breathing exercises.
Every time he remembers to do this, his actions are
Positive reinforcement is not bribery - reinforcement comes
after a task is completed, bribery is offered before. Try to make
sure the reinforcer is practical, ethical and valid for the
behaviour being targeted. Timing is critical - ensure the positive
reinforcement happens immediately after the desired
Making agreements about behaviour
Where a person's short-term memory and self-awareness allow, a
powerful technique can be to form a contract about behaviour,
- What are the desired behaviours
- Which behaviours are inappropriate
- Discussing the consequences of each behaviour
- Writing down the agreement.
After a brain injury, a person may become unaware of what is
appropriate and inappropriate behaviour. They may also have trouble
interpreting facial expressions or non-verbal language that others
are upset. We need to provide immediate clear feedback on
Redirection can involve distracting a person when a trigger for
behaviour occurs, or redirecting them when a behaviour is
occurring. It is often used for repetitive behaviours such as
constantly talking about the same topic. It is often effective when
combined with positive reinforcement as well.
Ignoring the behaviour
In some cases, behaviour occurs to get attention, so the best
strategy may be to ignore it. As with many of these techniques,
tactical ignoring is best linked with positive reinforcement. For
example, a child is ignored during an angry outburst, but is
rewarded with praise, a treat or favourite activity once the
outburst is over.