How Do You Deal with Challenging Behaviors?

ASK A DIRECT SUPPORT PROFESSIONAL: John*

My Son is My Teacher

My son Joe has given me a lot of experience as a parent that I use in my work as a Direct Support Professional (DSP). Joe has an intellectual disability and autism. He uses few words, but communicates in other ways (smiles, occasional behavior disturbances). Over the years, we have learned that emotional disturbances are usually caused by sinus infections or allergies.

Behavior is Communication

In general, we have a warm relationship and enjoy each other’s company. I’ve taken a few blows over the years, but I don’t take it personally. I just think to myself ‘What is Joe telling me?’ That’s how I look at challenging behaviors with the six young men in our care. What are they telling us? Instead of thinking about behavior as bad, what can we do to provide better support? I encourage our support staff to look at things this way as well.

Problem-Solving

If the aggressive behavior is dangerous or if it happens a lot, we go to a behavior consultant for help. She helps us figure out what is causing the behavior and writes up a positive behavior plan. Many times, however, it’s something we can figure out on our own. We sit down with our support staff and write up a team plan addressing what’s going on, what we think are the causes, and what we can do to make the problem better. I’ll use Joe as an example:

• What does he do? Joe hoots and bangs on the wall.
• When does it happen? Usually when he isn’t feeling well.
• What do we think it means? He has a sinus infection and wants to tell us that he’s in pain.
• What have we tried that works? Ask him if he hurts anywhere. If he says yes or points, we can try to help him feel better. We might ask him if he would like to go for a walk, get some air, or lay down.
• What do we need to do differently next time? Nothing at this time, we just need to stick with the plan.

The important thing is to keep doing what works. If you need to change the plan and try something new, make sure you keep doing it for several weeks before you give up on it. Stick with it and you’ll find something that works for everyone!

John’s Suggestions for Building and Keeping Positive Relationships with the People You Support

1. Know and honor the person’s needs, desires, and preferences.
2. Be friendly and smile a lot. Have a sense of humor. Be enthusiastic, positive, and respectful.
3. Don’t forget that body language (for example, a smile or frown) might say something you don’t want to say.
4. If the person has limited use of language, spend time to figure out the best way to communicate.
5. Avoid “my way or the highway” thinking. If you need to present a choice, make sure that it’s based on the person’s needs and preferences, as well as available resources (for example, staff, finances, etc.).

*John and his wife Patty serve six young men in their home in Napa, CA. John’s son Joe lives across town with two friends in a supported-living arrangement. The three receive support from a live-in housemate and other personal assistants.

Depression and Bipolar Disorder: Recognize the Signs

Words and Body Language

We all use words and body language to showhow we are feeling inside. This man is folding his arms and using his face to show that he’s mad. Behavior can often tell others about a person’s general mood. Two very important moods for caregivers to know about are depression and bipolar disorder.
Everyone feels sad, “blue”, or down sometimes. Usually, sadness lasts a short time – a few hours or a couple of days. When sadness lasts for a long time it can interfere with daily life and cause pain for the person and the people who know him or her. This is called depression.
Depression gets in the way of normal activities. It can change how we sleep, eat and how we feel about ourselves. Depression makes it hard to work, concentrate, be with other people, and enjoy life. It can also lead to health problems like heart disease, alcohol and drug abuse, or suicide.
Bipolar Disorder (or manic depressive illness) is when a person’s mood swings between times of depression and times of extreme happiness and high activity (mania). Bipolar disorder affects how people act and think. It can lead people to make bad decisions.

Signs of Depression and Bipolar Disorder

People with developmental disabilities may not be able to explain why they feel sad. As a direct support provider, it’s important to pay attention to changes in behavior. Here are some things you might see people do if they are depressed:

• Act sad or cry without a reason you can see
• Talk about or try hurting themselves
• Complain of aches and pains without obvious cause
• Spend more time sitting or lying down
• Refuse to eat or eat more than usual
• Show no interest or pleasure in favorite activities
• Spend more time alone than usual
• Act irritable or aggressive without an obvious cause
• Talk about people who have died

What Should You Do If You Notice These Signs?

If you think someone you support is depressed or bipolar, try the following steps:

• Talk with the individual about what is happening in their life.
• Watch for any signs that they may be thinking of hurting themselves (for example, talking about death).
• If someone doesn’t use words to communicate, provide extra support to make sure they get good health care.
• Set up a visit with the individual’s primary care doctor.
• Get ready for a doctor’s visit by writing down changes in the individual’s behavior and any recent changes in the person’s life.
• Refer the person to a counselor or support group.