Home > Behavior, Strategies > ABCs of Challenging Behaviors

ABCs of Challenging Behaviors

One problem that caregivers of persons with dementia frequently come up against is that of inappropriate, or otherwise challenging, behaviors.  Many caregivers have been known to tear their hair out when their loved ones do things like rearranging their sock drawer or repeatedly calling for help, or any of a number of different things.  I’ve encountered this list in various professional workshops I’ve attended, and have also seen it in different places around the web.  It’s a good way of analyzing problem behaviors that are exhibited by an individual with dementia, and determining what to do about them.

Identify the Antecedent:  What happens right before the problem behavior, that acts as the trigger?

Describe the Behavior:  What, when, where, who?  (What is the behavior?  When does it occur?  Where does it occur?  Who is the behavior directed toward, or who else is involved in the behavior?)

Identify the Consequences:  What is the result of the behavior?

Here’s an example of this in motion.  Let’s say that your father repeatedly walks out the front door of the house and starts down the driveway after he finishes breakfast.  You’re worried that one day he’s going to get out before you see him, and get lost.  When you do try to stop him, he becomes agitated and combative.  Now, let’s analyze this behavior:

After a few day’s scrutiny, you discover that this behavior happens at 6:30 every morning.  Your father hears you making breakfast, and gets out of bed to put on his shoes and his coat, and walks out to the end of the driveway.  You then realize that, for 40 years, he hopped out of bed and got ready for work, quickly ate his breakfast, and then rushed out the door just in time to meet the car pool.

In this case, the antecedent is the sound of you making breakfast, a typical early morning activity.  The “what” is your father getting up from the table and rushing out the front door.  The “when” is every morning, at 6:30.  The “where” is the kitchen, or perhaps the front door.  The “whom” is a bit more unclear on this one — it could be that you remind him of your mother as she bustled around the kitchen in the morning.  The consequence is you, running after him to stop him from going to work to provide for his family.  He fears that he will lose his job, and be unable to provide for his family.  It all seems very logical, doesn’t it?  But knowing this doesn’t necessarily lead to a workable solution for this problem.  How do we arrive at that?

There are two ways we can change a behavior.  We can either eliminate the antecedent(s), or we can change the consequences.  In the case of the man who is still trying to leave for work, let’s think about ways that we can break the pattern.  Perhaps it might help to allow your father to sleep in, and serve him breakfast in bed while you sit and talk about the day to come.  Or ask your father to go for a walk with you before breakfast, then talk to him about what you saw as you eat.  Better yet, tell him that today you’re going to go to work with him, and when you get to the end of the driveway keep on going and divert his attention by what you see along the way.  Or you can tell him that his boss called, and said he didn’t need to go in to work that day.  (I’ve found that a little white lie sometimes does no harm, and can even be quite helpful.)  You can be imaginative here.

Not every behavior can, or should, be changed in this way.  It’s something that you will have to determine as you go along.  It may be that the person’s behavior is a very valuable way of telling you that something is wrong, or that there is some sort of action that needs to be taken.  Remember that most behaviors are a form of communication.  Your father can no longer speak our language; we need to learn to speak his.

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