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Despite its simplicity, the ABC model for understanding challenging behaviour and developing suitable responses.

It can be very stressful dealing with behaviour issues, but the ABC model is a handy way to understand what is happening, and respond instead of just reacting. It involves looking at the:

• Antecedents (what happened before the behaviour?)
• Behaviour (what is the actual behaviour?)
• Consequences (what happens afterward?)

This is an effective technique for taking the emotions away from challenging behaviours, analyzing these behaviours, then creating effective responses. When creating a behaviour support plan, it will be important to work out which strategies you will use. These strategies are not to be used occasionally, but will need to be applied consistently by everyone who encounters the targeted behaviours. While they may be difficult at first, your chosen techniques will eventually become second nature.

Antecedents

What occurs before the behaviour (and may have triggered it)?
The antecedents are simply all the relevant things that happened before the behaviour occurred. They can also be considered as triggers for the behaviour, such as:

• things that other people did or said
• emotional state (e.g. depressed, tired, anxious etc.)
• the environment (e.g. hot, noisy, cramped, smell, bright lights).

Managing these antecedents, or triggers, is a proactive way to avoid behaviours occurring in the first place. Here are some useful strategies:

• Build and maintain good rapport
• Avoid or minimize known triggers
• Sometimes a distraction or redirection away from the trigger may be all that is necessary
• Involve the brain-injured person in discussing triggers
• Work together on possible coping strategies in dealing with triggers
• Suggest and encourage these strategies when a trigger occurs.

Graduated exposure to the antecedent

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.

Preparing for the antecedent
An inability to cope with chaos, unpredictability and lack of routine is common after a brain injury. For example, if Chris finds the activity and noise of a supermarket unpleasant, it can help to talk about expected reactions and ways to cope before the event.

Behaviour

What happens during the behaviour (what does it look like?)

Before you respond to an actual behaviour, the key is to understand the purpose of the behaviour and what it may be expressing about unmet needs. Although emotions can be running high, there are still strategies that can prove useful during the behaviour itself:

• Stay calm and speak in an even tone
• Give simple directions and prompts about coping mechanisms
• Use non-threatening hand gestures
• Manage your personal safety and remember the strategies agreed on for dangerous incidents
• Recognize when it's time for disengagement/exit strategies for crisis situations.
• 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 a tantrum, but is rewarded with praise, a treat or favourite activity once the tantrum is over.

Consequences

What are the immediate & delayed reactions from everyone involved? The consequences, or our responses to a challenging behaviour, are very important. For example, a pleasant consequence can simply reward the behaviour, while a negative consequence may discourage it. 

Pleasant consequence: "When I yell everyone gives me what I want".

Negative consequence:  "When I yell everyone ignores me completely").

When we use the ABC technique to analyze behaviour, we tend to stop reacting emotionally in ways that often make the situation worse. A consistent response from everyone to challenging behaviour can have a very strong effect over time.