INFORMATION SHEET

Finding the Causes of Challenging Behaviour:

Part 2

Mark Addison, Consultant Clinical Psychologist, Rapid Intervention Team,

Somerset Partnership NHS and Social Care Trust.

All behaviour happens for a reason, and understanding the causes of challenging
behaviour is vital. In this information sheet we aim to help further your understanding
of the causes of challenging behaviour, and help you to identify times and situations
when the behaviour may be more likely to occur.

We look at the causes, as well as the All our information sheets are
different stages of behaviour, and explain available to download free of charge
how a ‘functional assessment’ can increase because we believe that money
our understanding of challenging behaviour. should not be a barrier to getting the
information you need, when you need
Finding the Causes of Challenging Behaviour it.
is the second information sheet in this series.
It is recommended that it is read alongside The CBF relies on the support of our
‘‘Understanding Challenging Behaviour: Part friends and colleagues to continue to
provide free resources to families.
1’’ and “Positive Behaviour Support Planning:
Part 3’’ Please see below for details of how to
support us.

Understanding why challenging behaviour is happening

Children or adults with a severe learning disability are typically either unable to talk, or
have very limited verbal communication skills. This inability to express needs verbally
can mean that the person may learn to use other ways to get their needs and wants
met, including challenging behaviour. Often, the need that the person wants to have
met is reasonable (e.g. wanting a drink, or wanting to stop an activity that they don’t
like). However, the way they are telling us this is through their challenging behaviour. It
is simply the way that they are communicating their need that is problematic.

People with learning disabilities sometimes have very little choice or control over their
lives, which can lead to challenging behaviour. Anyone who is not given choices, and is
unable to control what happens in their day to day life, is at risk of developing
challenging behaviour, as it can be a very effective way of influencing what happens to
you.

However it is very important to consider the degree of intent that lies behind behaviour.
It may be tempting to think that people “know exactly what they’re doing”, but it is
important to remember that many of our own immediate reactions to situations are fairly
automatic, particularly when we are feeling scared or angry.

Challenging behaviour in children and adults with severe learning disabilities is not
necessarily deliberate or planned. Rather, in situations of need, people with severe
learning disabilities may simply behave automatically in ways which have been

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Registered office: The Old Courthouse, New Road Avenue, Chatham, ME4 6BE. Tel. 01634 838739
 ~2~

successful in the past. People will learn to use what works!

The first step in understanding challenging behaviour is to try and find out why the
behaviour is happening. Common reasons include:

Health

When trying to understand the reason(s) for a child or adult’s challenging behaviour, it
is important to first rule out an underlying medical problem. If the person is experiencing
pain or discomfort, and is unable to tell carers this, challenging behaviour may occur.

Health is one of the first things to check with a medical professional (a GP or nurse) if
someone’s behaviour suddenly gets worse. Common conditions such as ear infections,
tooth-ache, constipation, urinary tract infections or epilepsy, may all cause or contribute
to challenging behaviour, and it is essential to get the right treatment for these health
conditions.

Change

It is also important to consider if there have been any big changes in the person’s life
that could be causing the person to display challenging behaviour. For example, a
brother or sister leaving home, a death in the family, divorce, a house or school move,
or a favourite carer leaving. These are important issues and the person may need
support to understand and come to terms with these.

What purpose (or Function) does challenging behaviour serve?

When challenging behaviour happens it may seem as though there is no obvious

reason, and statements like, “That’s just what John does” or “It just came out of the
blue”, are common. However, there will always be a reason why the behaviour has
happened. The challenge for parents and paid carers is to work out what purpose the
behaviour serves for the person, and how to prevent it from happening again. Although
there are many reasons why a person may display challenging behaviour, there are
four common purposes:

1. Social Attention: We have all heard the saying, “It’s just attention seeking
behaviour”. It isn’t bad to want attention from others. However, for a variety of
reasons (e.g., limited communication skills, boredom, or an inability to occupy
themselves) some people may learn that behaving in a particular way is a
reliable way of attracting others’ attention, even if it is negative attention. For
example:

Sarah finds adult Sarah wets The teacher or Sarah gets 1:1 The function
1:1 interaction very herself assistant take time with an adult. of Sarah’s
rewarding, but at Sarah out of She learns that behaviour is
school Sarah has the classroom when she wants that it gets her
to share the to help her attention from an ATTENTION
teacher or clean up and adult at school
assistant’s time change into dry that she wets
with the rest of the clothes herself then she
class. Sarah is gets attention
sitting unattended.

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Registered office: The Old Courthouse, New Road Avenue, Chatham, ME4 6BE. Tel. 01634 838739
 ~3~

2. Tangibles: Here it is the desire for certain things (e.g., food, drink, objects or
activities) which is providing the motivation for the behaviour. Again, it isn’t bad
to want these things. If you are hungry, it makes sense to try and get something
to eat. If you see something in the shop that you like, it makes sense to try and
get someone to buy it for you. However, it becomes a problem when the person
learns to act inappropriately to get these things. For example:

Tom is thirsty He finds a cup and Tom gets given Tom has The function of
throws it at a drink learned that Tom’s
someone when he behaviour is
wants a drink that it gets him
he throws a something
cup and he TANGIBLE
gets a drink (i.e., a
particular item
that he wants)

3. Escape: Whilst some people like attention, some people would prefer to be left
alone. Rather than behave in a particular way to get people’s attention, some
people will behave in a way that helps them to avoid/escape situations or
activities that they don’t like, or don’t find that rewarding. For example:

Holly doesn’t Holly hits The teacher takes Holly learns that when The function
enjoy/like the person Holly to sit out in the she wants to be taken of Holly’s
group in the group quiet corridor out of a group activity, behaviour is
activities sitting she hits someone, and that it helps
nearest to gets removed from the her
her class ESCAPE

4. Sensory: Sometimes behaviour is internally rewarding, or self-reinforcing, i.e.,

what is happening around the person (externally) is not as important as what is
happening inside the person. For example:

Farhan has Farhan rocks Farhan likes the Farhan learns The function of
been on his back and forth feeling he gets that when he Farhan’s behaviour is
own in the and hums from this, he can has nothing to SENSORY
sitting room loudly do this for a long do he can
for 20 time stimulate
minutes, he himself by
is unable to rocking and
occupy humming
himself

These behaviours may appear pointless, annoying or distressing to the observer.

However, for the person themselves, the behaviour may serve the function of helping
them cope with unpleasant negative feelings such as boredom or anxiety. Although a
challenging behaviour may appear negative to us, the behaviour may serve as a
positive coping strategy for the individual.

© The Challenging Behaviour Foundation. Registered charity no. 1060714. www.challengingbehaviour.org.uk

Registered office: The Old Courthouse, New Road Avenue, Chatham, ME4 6BE. Tel. 01634 838739
 ~4~

Whatever the function of the behaviour is there will be certain times and specific
situations when you could predict that a person may be more likely to display
challenging behaviour. Known as “Setting events” and “triggers” to behaviour these
two key areas are important for carers to understand. Further understanding of what the
setting events and triggers are for the person you care for can help you to avoid certain
situations or put things in place which could help to prevent an incident of challenging
behaviour.

Setting events

A setting event is anything that increases a person’s level of anxiety or makes a person
more sensitive to and less tolerant of people, environments and situations.

A setting event can be something that happened in the past (e.g., being near someone
who was upset or angry; or not getting enough sleep the night before), or it can be
about what is happening now (e.g., feeling ill, hungry or thirsty; or going into a
crowded/noisy room).

Setting events build up over time, and increase the person’s level of anxiety or
sensitivity. The more setting events there are, or the more anxiety they cause, the more
likely someone is to display challenging behaviour in response to a ‘trigger’.

For example, asking a young person to put their shoes on might be fine on a good day,
but on a day when several setting events have occurred, e.g., they’re feeling unwell and
have had little sleep, the same request might trigger a response like throwing the
shoes.

Setting events happen to everybody whether we have a learning disability or not. The
difference is that we usually have a better understanding of what is happening and can
do something about it. For example, if we have a headache we can take paracetamol,
or if the environment is too noisy we can remove ourselves or just cope with it!

Identifying triggers

A trigger is the event that happens immediately before the challenging behaviour to
‘cause’ it. This is also known as an ‘antecedent’.

Being aware of the potential triggers for challenging behaviour can be the first step in
reducing the behaviour. Knowing what the triggers are can help you to avoid them, or
help you to predict specific times that challenging behaviour may be more likely to
happen, so you can help the person to cope with them better.

Some common examples of triggers are:

• Being asked to do something - or told to stop doing something

• Being told you can’t have or do something you want
• A particular individual or activity
• Noisy, hot, or crowded environments
• Being bored, or not being spoken to or involved

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Registered office: The Old Courthouse, New Road Avenue, Chatham, ME4 6BE. Tel. 01634 838739
 ~5~

Knowing the triggers for the person you care for e.g., crowded places, can help you to
put things in place to reduce their anxiety. For example, you could identify quieter times
to go shopping and teach the person a way to communicate that they are anxious and
want to leave. Providing the person with more control over their environment and a way
to communicate key messages could help them to manage their anxiety and prevent an
escalation into challenging behaviour

Different stages of behaviour:

Challenging behaviour is unlikely to come ‘out of the blue’, or happen without warning,
but it can happen very quickly or with signals that are hard to spot. Behaviour develops
in stages as shown in the ‘arousal curve’ diagram below.

Red
(Reactive phase)
Incident

Amber
(Active phase) Blue
Anxious, aroused,
(Post reactive
agitated or
phase)
distressed
Calming down but
still need to be
careful

Green
(Proactive phase)

Happy, calm and

contented

Figure 1: Arousal curve showing different stages of behaviour

The Green ‘Proactive’ phase is where the person is feeling mostly calm and relaxed
and is able to engage positively with you in a meaningful way. The aim is to try and
support the person to stay in this phase as much as possible. It is important to think
about what it is that is helping the person to feel calm and relaxed.

The Amber ‘Active’ phase is where the person may be starting to feel anxious or
distressed and there is a chance that he/she may need to challenge you in some way.
Here we need to take swift action to support the person to return to the Green Proactive
phase as quickly as possible to prevent challenging behaviour.

The Red ‘Reactive’ phase is where challenging behaviour actually occurs and we
need to do something quickly to achieve safe and rapid control over the situation to
prevent unnecessary distress and injury.

© The Challenging Behaviour Foundation. Registered charity no. 1060714. www.challengingbehaviour.org.uk

Registered office: The Old Courthouse, New Road Avenue, Chatham, ME4 6BE. Tel. 01634 838739
 ~6~

The final Blue ‘Post Reactive’ phase is where the incident is over and the person is
starting to recover and become calm and relaxed again. We still need to be careful here
as there is a risk of behaviour escalating again.

Identifying the different stages of behaviour can help you to make sure the person has
what they need on a day to day basis. This provides an opportunity for those caring for
the person to teach them useful skills to help them get what they want and need.
It also provides information that acts as ‘early warning signs’ (in the Amber ‘Active’
phase) that the person is expressing that they are anxious; wanting something they are
unable to ask for; not liking something; feeling bored, etc. These early warning signs
provide the opportunity to intervene before the behaviour escalates to a full blown
incident of challenging behaviour.

Functional Assessment

An assessment of challenging behaviour is usually called a ‘functional assessment’ or

‘functional analysis’ and aims to provide some answers about the causes of an
individual’s behaviour.

By conducting a functional assessment, you are learning about people before you
intervene in their lives. Rather than basing support strategies simply on ‘hunches’, ‘trial
and error’, or ‘what seemed to work for someone else’, a functional assessment should
guide the development of a more individualised behaviour support plan. A functional
assessment is usually carried out by a Psychologist or other behaviour specialist in
collaboration with parents/ family carers or primary carers. How you access this service
will vary in different parts of the UK, but your GP or Social Worker will advise you.

As a family carer, you are likely to be asked questions about the challenging behaviour
of your family member. This may be in a face-to-face interview, by questionnaire, or you
may be asked to fill in rating scales. You may also be asked to keep a recording chart
(see next section). In addition to this, the person carrying out the functional assessment
may also observe the behaviour where it usually happens e.g., in the family home, the
school, or the supermarket.

The professional conducting the assessment will analyse all of the information collected
to come to a conclusion about the most likely function(s) of the challenging behaviour.

Recording Behaviour

Keeping a record of challenging behaviour can help us to identify its function. It is

important to record:

1. A clear definition of the challenging behaviour in question: Before

conducting a functional assessment, it is essential to have a clear definition of
the behaviour of concern – a description of what the behaviour looks like,
which may include specific examples of the behaviour, as well as how often it
happens.

For example: Rather than saying “John has tantrums” which does not provide a
clear description of the actual behaviour, it is better to agree a specific
description such as, “John pulls another person’s hair with one or two hands”

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Registered office: The Old Courthouse, New Road Avenue, Chatham, ME4 6BE. Tel. 01634 838739
 ~7~

As a functional assessment may consider information provided by more than

one person, it is important that everyone has exactly the same definition of
behaviour in mind.

2. Early warning signs: In addition to defining the challenging behaviour itself, it

can be helpful to define the ‘early warning signs’. These simply refer to any
physical signs or behaviours that tend to happen before the challenging
behaviour occurs. For example, someone becoming red in the face and
starting to pace up and down quickly may be a typical sign that they are feeling
anxious which could lead to aggressive behaviour.

3. An assessment of the trigger/antecedent (i.e. what happens before)

events: Certain things often appear to trigger challenging behaviour. They can
be more immediate triggers (e.g., being told “no”, or being refused something),
or ‘setting events’, which refer to situations where the person is more likely to
resort to challenging behaviour (e.g., crowded/noisy environments, the time of
day, unpredictable routines, pain, or illness).

4. An assessment of the consequence (i.e. what happens after): What is the

person getting, or not getting from the behaviour that motivates them to do it
again, and again and again?

Many consequent events are externally motivating e.g., the consequence of

banging your head may be that you gain more or less attention from people;
get a desired object, food or drink; or escape from an activity or task.

Consequent events may also be internally motivating e.g., the consequence of

banging your head when you are feeling bored, may be that you feel more
stimulated.

There are lots of different methods of recording information about an individual’s

behaviour, and a commonly used tool is known as the ABC chart; where A stands for
‘Antecedent’, B for ‘Behaviour’ and C for ‘Consequence’.

The aim of ABC charts is to identify links between the behaviour and its antecedent and
consequent events, to aid understanding of the function that a particular behaviour
serves for an individual.

• Appendix 1 provides a blank chart which may be photocopied

• Appendix 2 provides an example of an ABC chart which includes suggestions
about the type of information that may be useful to include under each heading
• Appendix 3 Provides an example of a completed ABC chart, showing good and
bad examples of recorded information

Although the process of using ABC charts is relatively straightforward, it can be

complicated by the fact that the recording is often done by more than one person (e.g.,
parents, respite carers and teachers). In addition, a person’s behaviour may actually
serve more than one function, be used for different purposes in different locations and
be responded to in different ways by different people. Again, this makes it really
important for all concerned to decide on a good clear definition of the behaviour before
people start recording.

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Registered office: The Old Courthouse, New Road Avenue, Chatham, ME4 6BE. Tel. 01634 838739
 ~8~

Outcomes of Functional Assessment

The aim of a functional assessment is to understand what the purpose of the behaviour
is, so that we identify better ways for the person to get their needs met.

Once you have a good idea about the function of the behaviour, you can start to think
about how to respond to that behaviour. The results of the functional assessment
should inform any strategies that are introduced, with the aim of stopping, reducing or
encouraging alternatives to challenging behaviour.

Ultimately, the aim is to support the person to learn better ways to get their needs met,
that are equally, if not more effective, than challenging behaviour. However, it is
important to recognise that challenging behaviour can occur for very complex reasons,
and there will be individuals for whom those reasons remain unclear, even after a
functional assessment has been carried out. Nevertheless, even behaviour support
plans based on tentative theories can prove useful in the long-term.

Positive Behaviour Support Plans

The next step is to use the information gained from the Functional Assessment to plan
how to reduce challenging behaviour or lessen the impact on the person and those
caring for them. A Positive Behaviour Support Plan draws together all the information
from the assessment to create an individualised plan to help keep everyone safe, and
to identify where the person would benefit from being taught additional communication
or other skills. For example:

• Teaching a person another form of communication such as signs or picture cards

to indicate they have finished an activity or to ask for a drink
• Teaching a person who has difficulty waiting strategies to cope better with
waiting
• Helping someone to develop skills that will enable them to be more involved in
day to day things, such as domestic chores, getting dressed and personal care

A good behaviour support plan can ensure that everyone involved with a person’s care
and support has a shared plan, based on an agreed understanding of the causes of the
person’s challenging behaviour. This provides a consistent approach, to helping people
with severe learning disabilities feel secure and happy, and to increase their
independence skills.

Further information about Positive Behaviour Support Plans can be found in the Challenging Behaviour
Foundation’s information sheet “Positive Behaviour Support Planning”

Last updated July 2013

© The Challenging Behaviour Foundation. Registered charity no. 1060714. www.challengingbehaviour.org.uk

Registered office: The Old Courthouse, New Road Avenue, Chatham, ME4 6BE. Tel. 01634 838739
 ~9~
Appendix 1

TIME
DATE &

NAME:
Location, people,
ANTECEDENT
activity
Describe what you saw
BEHAVIOUR

ABC RECORD CHART

the person react
What did the carer do/how did
CONSEQUENCE
POSSIBLE REASON/
PURPOSE

© The Challenging Behaviour Foundation. Registered charity no. 1060714. www.challengingbehaviour.org.uk

Registered office: The Old Courthouse, New Road Avenue, Chatham, ME4 6BE. Tel. 01634 838739
 How to complete the ABC CHART
~ 10 ~

© The Challenging Behaviour Foundation. Registered charity no. 1060714. www.challengingbehaviour.org.uk

ANTECEDENT BEHAVIOUR
CONSEQUENCE
A B C

Registered office: The Old Courthouse, New Road Avenue, Chatham, ME4 6BE. Tel. 01634 838739
Location, people, activity Describe what you
saw What did the carer do/how
did the person react
Record the ANTECEDENT events (Things that Record a detailed description Record the CONSEQUENCES of the
happened BEFORE the behaviour) of the actual BEHAVIOUR behaviour. (What happened AFTER)
Record things such as: (what did it look like?). This This involves recording:
involves documenting:
• Where was the person? Exactly what were they • Exactly how did you
doing? • Provide a step-by-step respond to the
• Was anyone else around or had anyone just description of exactly behaviour? Give a step-
left? what happened e.g. he by-step description
• Had a request been made of the person? ran out of the living room, • How did the person
• Had the person asked for, or did they want stood in the kitchen respond to your
something specific to eat or drink? doorway and punched his reaction?
• Had the person asked for, or did they want a head with his right hand • Was there anyone else
specific object or activity? for approximately 1 around who responded
• Had an activity just ended or been cancelled? minute to or showed a reaction
• Where were you? What were you doing? to the behaviour?
• How did the person’s mood appear? E.g.
happy, sad, withdrawn, angry or distressed Did the person’s behaviour result in
• Did the person seem to be communicating them gaining anything they did not
anything through their behaviour e.g. I want/ have before the behaviour was
don’t want something? exhibited, e.g. attention from
• Were there any obvious triggers e.g. too noisy, somebody (positive/negative); an
sitting on own for some time? object; food or drink; or escape from
an activity of situation?
Appendix 2

Are there any obvious setting events e.g. feeling ill,

bad night’s sleep, missing their mum or dad?
 Example of how to observe behaviour, with a bad example and a good example shown
~ 11 ~

© The Challenging Behaviour Foundation. Registered charity no. 1060714. www.challengingbehaviour.org.uk

DATE TIME ANTECEDENT BEHAVIOUR CONSEQUENCE POSSIBLE REASON/

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Location, people, Describe what you What did the carer PURPOSE
activity saw do/how did the person
react
Bad AM Asked Tom to Temper Tantrum. Told off. Out of the blue
example clean up a drink He is aggressive
he had spilt. Spoilt
Monday Wants his own way.
Good 9.15am Tom got up late Tom looked John shouted ‘No’ Tom had a poor night’s sleep.
example and the bus was confused; he loudly and asked Tom John is new.
waiting for him, made a loud to stop. Tom did not understand what
Monday radio was grunting noise Tom ran out of the John was asking him to do.
6.11.09 playing, toast and grabbed kitchen crying. Tom was trying to escape from
was burnt, John John’s glasses. the kitchen, when he
(new staff) accidentally knocked the glass
asked Tom to over.
finish his
breakfast.
Tom spilt his
drink. John
asked Tom to
clean up the
Appendix 3

mess.
 ~ 12 ~

The Challenging Behaviour Foundation

We are the charity for people with severe learning disabilities who display
challenging behaviour. We make a difference to the lives of children and
adults across the UK by:
• Providing information about challenging behaviour
• Organising peer support for family carers and professionals
• Giving information and support by phone or email
• Running workshops which reduce challenging behaviour

To access our information and support, call 01634 838739, email

[email protected], or visit our website: www.challengingbehaviour.org.uk

If you have found this information useful, please consider making a donation.

You can show your support at www.challengingbehaviour.org.uk

Make a £5 donation by texting CBFD05£5 to 70070
Or email us to get involved at [email protected]

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Registered office: The Old Courthouse, New Road Avenue, Chatham, ME4 6BE. Tel. 01634 838739