What is challenging behaviour?

Challenging behaviour can be defined as:

Any non-verbal, verbal or physical behaviour exhibited by a person which makes it difficult to deliver good care safely.

When and where does it occur?

Challenging behaviour can take place anywhere. It can occur in any care environment and affect individuals with a range of clinical conditions, such as dementia, delirium, head or brain injury, tumour, substance abuse or withdrawal, mental health conditions and learning disabilities. It may also be linked to adverse reactions to treatment.

Clinically related challenging behaviour is often an expression of distress or an attempt by the person to communicate an unmet need. It can be the result of someone feeling afraid, threatened, frustrated or anxious, or suffering delusions or hallucinations. It may be a response to a difficult or confusing situation. It may also simply be an attempt by someone to express that they are hungry, thirsty or in pain.

Many individuals who exhibit challenging behaviour are vulnerable and may have problems with communication. A person who is challenging in this way may not be responsible for their actions.

What behaviours could be considered challenging?

Examples of challenging behaviour can include:

    • grabbing
    • biting
    • scratching
    • pinching
    • poking
    • hair pulling
    • punching
    • hitting
    • kicking
    • slapping
    • self-injury

Consequences of not addressing challenging behaviour

The impact of challenging behaviour on the delivery of care can be serious and can result in:

    • Ineffective delivery of treatment and care
    • An over-reliance on anti-psychotic medication, seclusion and  physical interventions
    • Physical injuries and psychological ill health among patients/service users and staff
    • Higher staff sickness and absence
    • Reduced staff morale and confidence (particularly if it seems that nothing is being done to prevent or manage challenging behaviours)
    • Higher staff turnover and more bank or agency staff cover
    • Inability of an organisation to meet its legal duties to protect staff and vulnerable people
    • Inability to deliver important national initiatives for improving patient care (e.g. Dementia Challenge, Compassionate Care, and care for vulnerable older people)
    • Diminished organisational reputation and negative publicity
    • An increased number of complaints.