What is challenging behaviour in a person with developmental disability?

Some people with developmental disability will exhibit challenging behaviour, sometimes referred to as behaviours of concern or behaviours that challenge. Prevalence varies according to populations and definitions of behaviour, but challenging behaviour is likely to be an issue for at least 20% of people with intellectual disability.

Challenging behaviour can be defined as any behaviour that:

• is a barrier to a person participating in, and contributing to their community (including both active and passive behaviours)
• undermines, directly or indirectly, a person’s rights, dignity or quality of life, and
• poses a risk to the health and safety of a person and those they live and work with.

Challenging behaviour can take a variety of forms, and be either:

• externalised; involving damage to objects, aggression directed towards people, or causing self-harm
• internalised; resulting in the person being withdrawn, inattentive and unresponsive, or not engaging in activities that they might otherwise be expected to do.

Challenging behaviour in a person with developmental disability may be acute or longstanding. It is often best understood to be a means by which the person, intentionally or unintentionally, is communicating something that is important to them; for example, they may:

• need or want something, and be unable to achieve this for themselves
• not like or not want something, or want something or someone to go away, and be unable to communicate this
• be feeling something such as pain or an emotion (eg confusion, frustration, anger, fear, anxiety, depression) and not have the skills to express it.

These circumstances can be accentuated for people who are unable to communicate using spoken language, and for those with an underlying physical health or psychiatric condition that they do not themselves understand; see also Communicating with people with developmental disability.

Challenging behaviour may manifest differently depending on the person’s age and stage of psychosocial development, lifetime trauma history, type of disability, their ability to understand, accommodate and respond to change, and to tolerate when their needs cannot be met. Intervention and support must take into account the interaction of these issues and the subsequent complexities, including multidisciplinary assessment together with the formulation and implementation of a behaviour support plan.

Challenging behaviour can have serious consequences for the person with disability. The behaviour can mask underlying physical health and psychiatric conditions, and consequently confound the diagnostic process (ie diagnostic overshadowing). Challenging behaviour in people with developmental disability can result in limited opportunities, social isolation, poor health outcomes, injury and premature death. It can also lead to fatigue, depression, burnout and injury to family members or support staff.