Factors Contributing to Behavioural Concerns
The people we support may be in situations where they are not full members of their communities because of the behavioural concerns. Individuals being referred to Valor & Solutions’ clinical services present with challenging behaviours and complex needs that impact their overall quality of life.
Currently, there is no universal definition of behaviour problems, however Tassé & collab (2010) define it as actions that are judged as problematic because they defy social, cultural and developmental norms, and are damaging to the person and their social or physical environment. They define severe behaviour problems as a behaviour that puts the individual or others at potential or actual physical or psychological risk, or that places the environment at risk and/or compromises the person’s freedom and social integration.
Many factors can contribute to these behavioural concerns:
Social Isolation / Rejection
Social isolation is widespread in the lives of individuals with a developmental disability. Beth Mount and David Pitonyak explain that isolation is at the base of the difficulties that individuals with developmental disabilities face (Pitonyak, 2007). Often, individuals with developmental disabilities only have paid supports in their lives and have not been given the opportunity to develop the skills needed to maintain friendships (Wolfensberger, 1998). We are relational beings and social isolation can have a great impact on mental health, physical health, and behaviours (Pitonyak, 2007).
Individuals with intellectual disabilities often have limited opportunities for inclusion, participation and integration in their communities. This can lead to a sense of rejection resulting in the individual communicating feelings of distress through behaviour that is deemed inappropriate.
Lack of Opportunities to Develop Skills
Individuals experiencing behavioural concerns are less likely to be included in community activities (Emerson & Einfeld, 2011). Exclusion from social participation can have an impact on the development of a person’s skills and competencies (Wolfensberger, 1998). Generally, most people want to be able to contribute and be good at something. Having opportunities to develop abilities, skills and talents are considered to be some of the good things in life.
Lack of Autonomy, Choice and Control
Many individuals who have a developmental disability have not had the opportunities to exercise control over their lives. Typically, we have the availability to schedule our own agendas for the day, decide who we interact with, what we eat, what we do with our days, etc. Many of the individuals with developmental disabilities do not have such control. Specifically in group homes, individuals generally have scheduled eating times, it is pre-determined who they will live with, what time they will take their medications at or shower, etc. At times, individuals who lack control may act in inappropriate ways in order to exert control (Wolfensberger, 1998).
Lack of Valued Social Roles
Social Role Valorization (SRV) suggests that there is a universality to the things that humans consider to be important in their lives. These include: a home to call their own, choice and control, meaningful employment, health, etc., which are named “The Good Things of Life” (Wolfensberger, 1998). It is the social roles (i.e. being a mother, a friend, a painter, an athlete, etc.) that we as humans occupy, which allow us to experience and have access to these good things in life. We must work on helping people to develop the competencies they need in order to create and obtain social roles.
Environment
Further to the other possible contributing factors, the environment may contribute to the occurrence of particular behaviours. The environment is not limited only to the physical space a person occupies but also includes social factors. In addition to ensuring the physical space is appropriate for the individual, it is also important to ensure there is consistent communication amongst supports. The individuals need to be afforded opportunities to engage in meaningful activities, develop skills, have positive social interactions and maintain relationships, while having opportunities for real choice (National Institute for Health and Care Excellence, 2015).
Non-Addressed Medical Needs
When compared with the general population, adults with intellectual disabilities have a lower life expectancy and higher rates of unmet health needs (Balogh, Ouellette-Kuntz, Bourne, Lunsky & Colantonio, 2008). Individuals with an intellectual disability can develop a variety of health problems that include epilepsy, cardiovascular disease and obesity (Lennox, Taylor, Rey-Conde, Bain, Boyle & Purdie, 2004). At times, for example, individuals may not have the ability to communicate their distress; they could become aggressive in order to avoid being touched if they are in pain.
Trauma
Incidences of abuse in individuals with developmental disabilities is much higher than for the general population this includes neglect, emotional and sexual abuse (Berney & Allington-Smith, 2010 and Joyce, 2006). According to Fletcher et al., trauma can be a result of developmental changes, such as being surpassed by siblings, and other life events, such as a move to a new environment (Fletcher et al., 2007). These events may not be recognized as a source of trauma by the individual’s supports (Ontario Centre for Excellence for Youth and Mental Health, 2012). According to Karyn Harvey, some ways to overcome trauma include activating the parasympathetic nervous system, changing the individual's environment, or determine a support who could act as a "safe person" (Harvey, 2012). Valor & Solutions considers how the effects of trauma can impact an individual's behaviour.
References
Balogh, R., Ouellette-Kuntz, H., Bourne, L., Lunsky, Y., & Colantonio, A. (2008). Organising healthcare services for persons with an intellectual disability (Review). Cochrane Database of Systematic Reviews, Issue No. 4, 1-39.
Berney, T., & Allington-Smith, P. (2010). Psychiatric Services for Children and Adolescents with Intellectual Disabilities. Royal College of Psychiatrists. College Report CR163.
Emerson E., & Einfeld S.L. (2011). Challenging Behaviour (3rd ed.). New York: Cambridge University Press.
Fletcher J.M., Lyon G.R., Fuchs L.S., & Barnes M.A. (2007). Learning Disabilities: From Identification to Intervention. New York: The Guilford Press.
Joyce, Theresa. (2006). Functional Analysis and Challenging Behaviour. Psychiatry, 5(9), 312 -315.
Lennox, N., Taylor, M., Rey-Conde, T., Bain, C., Boyle, F., & Purdie, D. (2004). Ask for it: Development of a Health Advocacy Intervention for Adults with Intellectual Disability and their General Practitioners. Health promotion international, 19(2), 167-175.
National Institute for Health and Care Excellence. (2015). Challenging Behaviour and Learning Disabilities: Prevention and Interventions for People with Learning Disabilities whose Behaviour Challenges (NICE Guideline). NG11, 1-59.
Ontario Centre of Excellence for Child and Youth Mental Health. (2012). Evidence In-Sight Request Summary: Trauma in Children and Youth with Dual Diagnosis. Evidence In-Sight Report, May 2012, 1-13.
Pitonyak, David. (2007). Toolbox for Change: Loneliness is the Only Real Disability. Dimagine, 14.
Tassé, M.J., Sabourin, G., Garcin, N., et al. (2010). Définition d’un trouble grave du comportement chez les personnes ayant une déficience intellectuelle. Canadian Journal of Behavioural Science, 42(1) : 62–69
Wolfensberger, W. (1998). A Brief Introduction to Social Role Valorization: A High-Order Concept for Addressing the Plight of Societally Devalued People, and for Structuring Human Services. (3rd ed.). Syracuse University, New York: Training Institute for Human Service Planning, Leadership and Change Agency.