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Challenging & complex behaviours: Positive Behaviour Support techniques

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Behaviour

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 injury. 

 

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 occurring.

  • 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 occurs.

 

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.

 

Positive reinforcement

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 praised.

 

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 behaviour. 

 

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, involving:

  • What are the desired behaviours
  • Which behaviours are inappropriate
  • Discussing the consequences of each behaviour
  • Writing down the agreement. 

 

Giving feedback

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 inappropriate behaviours. 

 

Redirection

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.

 

 

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