Behaviour as communication

Changed behaviour and distress responses are not personality flaws. They can signal an unmet need, discomfort or a reaction to the environment. Language matters here: we describe what the person did and what may be behind it, rather than labelling them.

• Pain, fear, loneliness or boredom.
• Hunger, thirst, toileting needs or fatigue.
• Being too hot or too cold.
• Noise, crowds or overstimulation.
• Unfamiliar people, unfamiliar places, or not being able to make themselves understood.
• Personal care that feels rushed, exposed or unexpected.

One helpful way to observe is the ABC approach. Antecedent: what happened before. Behaviour: what the person did or said, described in plain terms. Consequence: what happened afterwards. Patterns often become clear when we write these down.

Look at the environment, the time of day and the approach used, as well as the person. Sometimes the most useful change is to how we offer support, not to the person.

• Antecedent: what was happening just before?
• Behaviour: what exactly did you see and hear?
• Consequence: what happened next, and how did the person respond?
• Write what you observed, not what you assume. Use objective language.

Start with safety, then comfort. Pause, give space, reduce noise, and check whether a need has been missed. Use approaches that respect the person's dignity and control, and avoid responses that punish or shame.

If distress continues, escalate for clinical review and follow the person's care plan and any behaviour support plan. Physical or chemical restraint is a serious matter governed by law and organisational policy, and is not something to improvise. Follow your organisation's requirements and seek guidance.

• Check immediate safety for the person and others.
• Look for causes: pain, needs, environment, approach.
• Try calm, respectful, least restrictive support first.
• Document objectively and escalate concerns to the right person.