Download The Different Meanings of Behaviours

The Different Meanings of
Behaviours
Stephanie Carr, Clinical Specialist Speech and Language Therapist
Stephanie Fenwick, Clinical Nurse Specialist in Positive Behavioural
Support
Dr Mark Lovell, Consultant Child and Adolescent Intellectual
Disability Psychiatrist
Tees, Esk and Wear Valleys NHS Foundation Trust
Version date: October 2016
Introduction: Transformation Champion Project
• This powerpoint presentation is designed to be used with
DisabilityMatters session as part of supported blended
learning.
• Designed as part of ACAMH/MindEd/YoungMinds CAMHS
Transformation Champion project, 2016-2017.
• Health Education England funded project.
• It is free to use (20 minute e-sessions and 1 hour powerpoint
talks).
• The MindEd content in these slides is based on the MindEd
session and remains ©RCPCH 2016. You may not copy or
reproduce the content without acknowledging the source.
You may add your own details, examples etc. and space has
been allowed for this. You should use your own personal
judgement in making changes, and you remain solely
responsible for their use.
Learning Objectives
By the end of this presentation you will:
• Gain a basic knowledge about the meaning of
behaviours.
• Know where to get help and advice.
• Understand that behaviours are generally not just
naughtiness or to be blamed simply on parenting.
• Provide an overview of the meaning of behaviours
from a variety of perspectives as indicators of
physical illnesses and as behaviours secondary to:
development, communication, mental illness,
behavioural disorders and the external environment.
Task 1: The words we use…
• Lots of different words are used to
describe behaviours that occur within the
context of Intellectual Disabilities and
neurodevelopmental conditions.
• Reflect on the types of words you might
have heard in the past when describing
behaviours.
Task 2: Responding negatively to situations
• The context of behaviour which challenges.
• What makes YOU more likely to respond
negatively to situations?
Considering reasons for behaviours- What?
• What is the behaviour?
• Behaviours should be accurately described
• Clues will be there to help- obvious
- subtle
- changes
Considering reasons for behaviours- Who?
• Who is affected?
• Who is an intervention for?
Considering reasons for behaviours- Where?
• Where does the behaviour happen?
Considering reasons for behaviours- When?
•
•
•
•
Time of day?
Days of the week?
Times of the month?
Times of the year (anniversaries, festive
seasons?
• After certain events e.g. going to respite,
school etc.?
Considering reasons for behaviours- Why?
Who? + What? + Where? + When? = Why?
Physical reasons for behaviour- Pain
• Where is the pain?
• Why is there pain?
Physical reasons for behaviour- Discomfort
•
•
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•
•
•
Constipation
Urinary retention
Haemorrhoids
Infection
Itching
Sensory Sensitivities
Physical reasons for behaviour- Hunger and Tiredness
• Hunger
• Sleep quality
Physical reasons for behaviour- Substances
•
•
•
•
Medication
Alcohol
Illegal drugs
Legal highs
Physical reasons for behaviour- Sensory Issues
•
•
•
•
•
Vision
Touch
Hearing
Taste
Smell
Epilepsy
•
•
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•
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Seizure type
Before a seizure
During a seizure
After a seizure
Medication side effects
Behaviours as communication
Communication of…
• Needs
• Wants
• Desires
= Behaviour
Mental health reasons for behaviour
• Cause of behaviour
• Caused by an event e.g. grief, chronic illness
Mental Illness: Presentation may differ in Intellectual Disabilities
• Simpler symptoms
• More biological than psychological
Mental Health Diagnosis vs formulation
• Diagnosis
• Formulation
Mental health reasons- Anxiety
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•
•
•
•
•
Common
Phobias
Post Traumatic Stress Disorder
Obsessive Compulsive Disorder
Generalised Anxiety
Triggers: Transitions, communication
Mental health reasons- Mood
• Depression
• Bipolar Affective Disorder
Mental health reasons- Adjustment to grief
• Grief
• Loss
• Life events
Mental health reasons- Psychosis
• Positive symptoms
• Negative symptoms
Mental health reasons: Temperament/Personality
• Temperament
• Personality
Mental health reasons: Behavioural disorders
• Oppositional Defiance Disorder (rule breaking)
• Conduct Disorder (law breaking)
• Behaviours that challenge others (ID)
Neurodevelopmental reasons- ADHD/Hyperkinetic Disorder
• Hyperactivity
• Impulsivity
• Attention difficulties
• Above and beyond those expected due to the
intellectual disability
Neurodevelopmental reasons- ASD
• Communication difficulties
• Social skill difficulties
• Repetitive behaviours
Neurodevelopmental reasons- Sleep
• Common
• Effects :- mood, concentration and irritability
• Effect on carers/family
Neurodevelopmental reasons- Intellectual disabilities
•
•
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•
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•
Behaviours that challenge….
Communication
Comprehension
reasoning skills
memory difficulties
slower processing speeds
difficulties with adaptive behaviours (daily living
skills).
• Mental health
• Physical health
Neurodevelopmental reasons- Behavioural Phenotypes
• Behavioural patterns
• Linked to a genetic disorder
Neurodevelopmental reasons- Other Reasons
•
•
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FASD
Fetal Valproate syndrome
Head Injury
Attachment disorders
Red Flags for mental illness
• Biological changes (sleep, appetite, weight,
energy etc)
• Perceptual differences (auditory or visual
hallucinations, tactile ‘sensations’ etc)
• Paranoia
• Delusions
• Crying
• Untriggered aggression
Task 3- Case example
Where to get help?
Review of learning objectives
• To add to the learning from the DisabilityMatters
session.
• To gain an overview of The Different Meanings of
Behaviours.
• To gain insight into the evidence base.
• To understand the urban myths and controversies.
• To be aware of current relevant guidance or
legislation.
Summary – 1 of 2
It is important to consider mental health reasons for a change in
behaviour
These might be in response to something else e.g. physical
illness or environmental/social reasons e.g. grief.
In summary, mental health reasons and neurodevelopmental
problems are common causes for a change in behaviour. These
may be stand alone, or in response to social reasons or physical
illness.
It is important to assess behavioural changes thoroughly and
more than one service might be involved in the assessment and
treatment
Summary – 2 of 2
Behaviours have meaning.
They may involve multiple systems and require investigation and
thought to elicit the reason(s) and potential solutions.
Behaviours can be explained by physical health, mental health,
choice, communication, developmental level,
neurodevelopmental conditions and environmental influences
(past and present).
Help and advice are available and should be sought.
Next steps?
• Generate a personal learning plan.
• Put evidence based knowledge into practice.
• Reflect upon this learning experience.
Thank you and any questions?
Presenter Biography
• <insert here>
ACAMH / MindEd / YoungMinds information
• ACAMH is a UK organisation that aims to further
scientific study of the mental health of children,
young people and their families, through
conferences, meetings and its journals – the JCPP
and CAMH.
• MindEd is a free educational resource on children
and young people’s mental health for all adults.
• YoungMinds is UK’s leading charity committed to
improving the emotional wellbeing and mental
health of children and young people.