Behaviour 1.
Presentation 1 – Introduction:
Challenging Behaviour (CB)
• The presentation series on CB will:
• Develop your understanding of the definition of challenging
• Highlight how they develop and continue
• Develop your ability to understand what challenging behaviours
may be trying to communicate
• Help you to identify proactive and reactive strategies to managing
challenging behaviour
Challenging Behaviour (CB)
• Challenging behaviour has been defined as:
“Any behaviour, or lack of behaviour of such intensity,
frequency and/or duration that has the potential to cause
distress or harm to clients/carers/staff or one which creates
feelings of discomfort, powerlessness, frustration, fear or
anxiety. It is also behaviour, which delays or limits access to
ordinary community facilities and is outside socially
acceptable norms.”
Eric Emerson (1995)
Challenging Behaviour (CB)
• And:
“All behaviour has
Challenging Behaviour (CB)
• CB is often subjectively determined:
• Personally – someone may view some behaviours as challenging,
whereas another person may not.
• Situationally – some behaviours (e.g. Sexualised behaviour) are
only challenging if it occurs in inappropriate contexts or
• Socially/Culturally – some behaviours may be culturally
determined and may be acceptable in one culture, but not
Spend a minute or so on the following
• List some CBs which are ‘challenging’ because they:
• Happen too often
• Do not happen often enough (or at all)
• List some CBs which are ‘challenging’ because they are:
• Too intense/severe
• Not intense enough
• List some CBs which are only ‘challenging’ because they
happen out of context (e.g. wrong time, place, people)
Causes of Challenging Behaviour
• CB can arise for many reasons, and are seen in populations
across society. For our purposes, we will restrict our
presentation and exercises to CBs when they typically occur in
a hospital setting and with stroke patients.
• Challenging behaviours can be caused and maintained by
many things:
• Medical/physical e.g.:
pain, physical hypersensitivity to noise or light (or reduced
sensitivity), medication effects, illness/respiratory problems,
insomnia, confusion/delirium, nausea, reduced mobility, dysphasia,
dysphagia, dysarthria, reduced vision or hearing.
Causes of Challenging Behaviour
• Environmental e.g. - Light or darkness, temperature, noise,
silence, lack of sensory stimulation, overstimulation (including
too much interaction), uncomfortable furniture, overcrowding,
isolation, poor food, wrong type of food, Ward ‘routine’.
• Social & Communication - Boredom, social isolation, difficulty in
communication with others or overstimulation through social
contact (e.g. Too many visitors, too many or too complicated
questions or too many conversations going on).
Causes of Challenging Behaviour
•Psychological – Each person obviously brings their own
personalities and past experiences with them, as they adjust to the
effects of their stroke and some people manage this adjustment
process in different ways. People may experience depression,
anxiety, grief & loss and frustration and these psychological
experiences may be responsible for some challenging behaviours.
•Cognitive – Brain injury from the stroke can lead to impaired
insight into difficulties, impaired reasoning ability, impulsivity, mood
swings, hyperemotionality and reduced motivation (including poststroke apathy syndrome which may be mistaken for depression or
poor motivation, but is actually a neurological condition).
Challenging Behaviour
• To complete the ‘Challenging Behaviour’ module, proceed to
the following presentations:
• Challenging Behaviour 2. – Assessment
• Challenging Behaviour 3. - Interventions
Thank you for your

Challenging behaviour has been defined as