What Are Behaviours That Challenge? A Guide for Families and Care Commissioners
The phrase ‘behaviours that challenge’ sometimes called challenging behaviour is used across health and social care to describe actions that can put the safety of an individual, their carers, or others at risk, or that significantly affect the quality of life of the individual or those around them. It is a term that families often encounter for the first time during an assessment or a placement review, frequently without adequate explanation of what it means or, more importantly, what can be done about it.
This guide, written for families and commissioning professionals, explains what behaviours that challenge are, what causes them, how the sector approaches them, and what good, evidence-based support actually looks like.
Defining Behaviours That Challenge
The most widely used definition in UK health and social care comes from the work of Professor Eric Emerson: behaviours that challenge are ‘culturally abnormal behaviour(s) of such intensity, frequency or duration that the physical safety of the person or others is likely to be placed in jeopardy, or behaviour which is likely to seriously limit or delay access to and use of ordinary community facilities.’
Important: the term ‘challenge’ in behaviours that challenge is deliberately chosen to emphasise that the challenge is to the services and systems around the person not to the person themselves. The behaviour is a communication, often the only available communication channel for an individual with limited verbal ability, that something in their environment, their relationships, or their internal experience is not working for them.
What Do Behaviours That Challenge Look Like?
Behaviours that challenge take many forms. They can include:
- Self-injurious behaviour head-banging, hitting oneself, biting, skin-picking, or hair-pulling
- Physical aggression toward others hitting, biting, scratching, spitting, or throwing objects
- Property destruction damaging furniture, equipment, or the physical environment
- Stereotyped movements repetitive rocking, hand-flapping, or vocalising that is excessive and self-limiting
- Inappropriate social behaviour undressing in public, sexualised behaviour, or pica (ingesting inedible objects)
- Extreme withdrawal refusing to engage, communicate, eat, or leave a room
The same behaviour can be challenging in one context and entirely functional in another. The context, the impact, and the frequency not the behaviour in isolation determine whether it meets the threshold of ‘challenging’.
What Causes Behaviours That Challenge?
Behaviours that challenge are almost never arbitrary. Research consistently shows that they serve one or more communicative functions:
| Function | What It Communicates | Example |
| Escape/Avoidance | I want to get away from this person, place, or activity | Hitting out when asked to do something difficult |
| Attention | I need interaction, engagement, or connection | Vocalising loudly in a quiet environment |
| Access to tangibles | I want something specific | Throwing objects when a preferred item is removed |
| Sensory stimulation | This feels/sounds/looks good to me | Rocking, spinning, or self-stimulatory movements |
| Communication of pain or distress | I am in physical pain or emotional distress | Increased aggression associated with dental pain |
| Environmental response | My environment is overwhelming, confusing, or unpredictable | Meltdown in an overstimulating sensory environment |
This functional analysis of behaviour — understanding what need the behaviour is meeting — is the foundation of the evidence-based approach to supporting people who exhibit behaviours that challenge.
What Good Support Looks Like: Positive Behaviour Support
The National Institute for Health and Care Excellence (NICE) Guideline NG11, ‘Challenging behaviour and learning disabilities,’ recommends Positive Behaviour Support (PBS) as the primary framework for supporting people with behaviours that challenge. PBS is not a technique or a set of interventions it is a comprehensive, evidence-based framework that:
- Begins with a functional behavioural assessment understanding what is driving the behaviour before attempting to change it
- Focuses on the quality of life and inclusion of the individual, not just on reducing the behaviour
- Redesigns the environment, routines, and relationships around the person to prevent triggering situations
- Teaches new skills and communication strategies that meet the same need as the challenging behaviour
- Only uses reactive strategies (de-escalation, planned physical interventions where absolutely necessary) as a last resort, within a proactive framework
What Families Should Ask Any Provider
- Do your staff receive PBS training, and to what level? (PBS Practitioner certification is the sector standard)
- Will you conduct a functional behavioural assessment before developing a behaviour support plan?
- Who writes and reviews the behaviour support plan and is the family involved?
- What is your policy on restrictive practices, and are you working toward reducing them?
- How do you measure whether the behaviour support plan is working?
AESN Care’s Approach to Behaviours That Challenge
AESN Care provides specialist support for adults and young people who display behaviours that challenge, including those with learning disabilities, autism, dual diagnosis, and complex trauma histories. Our support teams are trained in PBS principles and work alongside families and multidisciplinary teams to develop individualised, person-centred behaviour support plans. We do not use generic approaches every support plan starts with a proper assessment of the individual.
Contact AESN Care to discuss specialist support: contact AESN Care today.
