Introduction

• Behaviour problems or ‘challenging behaviours’ and adaptive skill deficits are common among disabled children and adults, particularly those with severe learning difficulties.
• Problem behaviours include:

• Aggressive / violent behaviour
• Noncompliant / oppositional behaviour
• Social dependence behaviour
• Avoidant behaviour
• Passive behaviour

Causes

What causes behaviour problems?

• Most behaviour is learnt. Some are due to deficiency in involuntary brain function as well as chemical imbalance in the brain.
• If a behaviour is problematic, it is usually learnt from some situation.
• People with disabilities have behaviour problems due to common difficulties in adaptive skills such as communication, daily living skills and social-emotional skills.

Incidence

What is the incidence of behaviour problems?

• 45.8% of disabled children aged 6 – 10 years present complaints of behaviour problems
• These children will grow up into adults with behaviour problems if they are not intervened early.

Conditions

What conditions are associated with behaviour problems?

• Autism spectrum disorders
• Attention Deficit Hyperactive Disorder (ADHD)
• Alzheimer’s Disease
• Dementia
• Learning disabilities (e.g. intellectual impairment, dyslexia)
• Difficulties in verbal and nonverbal communication

Signs & symptoms What are the signs and symptoms?

• Any socially inappropriate behaviour can be considered challenging behaviour if it poses a great deal of effort to manage it
• Obvious challenging behaviours are those that are a threat to life and limb and puts people in danger
• Majority suffers impairment in

• social interaction
  • Sustained play and special interest with certain toys or objects
  • Prefers to be alone
  • Difficulty in mixing with other people
  • Unable to relate to others in the right way
  • Over sensitive or under sensitive to pain
  • No real fears of danger
• Communication (verbal and non-verbal)
  • Difficulty in expressing needs
  • Uses gestures instead of words

Problems faced

What are the problems faced by the client?

Activities and interests

• Engages in odd ritualistic movements such as rocking
• Laughs, cries or shows distress for reasons not apparent to others/temper tantrums
• Not responsive to normal teaching methods
• Not responsive to verbal cues/acts as if deaf although hearing tests are in the normal range
• Difficulties in motor activities
  • Physically over active or under active
  • Destructive

• Sleep problems
• Poor academic performance
• Difficulty in communication with others
• Difficulties in making friends and building close relationships
• Securing and maintaining jobs
• Problem solving

How parents and carers feel and cope?

• Confused, overwhelmed and helpless
• Hard to cope with odd behaviour
• Feel guilty, anger, shame and responsible for the child
• Financial stress of the therapy
• Frustrations at lack of facilities

Management

Who should be involved in diagnosis?

Ideally a multidisciplinary team consisting of

• Psychiatrist
• Clinical Psychologists
• Developmental Psychologists
• Paediatrician (i.e. Neurologist, Developmental)
• Ear, Nose and Throat surgeon
• Audiologist
• Speech Pathologist
• Occupational Therapist

Who should be involved in the management of disabilities?

• Carers
• Clinical Psychologist
• Speech therapist
• Audiologist
• Physiologist
• Occupational therapist
• Psychiatrists
• Social Worker
• Specialist nurse (e.g. mental health)
• Medical specialist (e.g. paediatrician)
• Any other agencies who are involved with the person who has challenging behaviour.

Treatment

• Drug therapy for severe behaviour problems
• Behavioural Management Therapy
• Adaptive Skills training (Daily living, social, self-care, communication, problem solving, coping)
• Parenting/Carer Skills for carer
• Parent/carer support

Rehabilitation

When to start rehabilitation?

• As soon as possible.

How to register?

• Once diagnosis is confirmed, get the “Borang Pendaftaran dan Cadangan Penempatan” from Health Centre, State Social Welfare and Education Department.

Who will assist in the registration?

• Attending Doctor will fill the relevant forms.

What benefits you will get on registration?

How to find job placement?

• Refer to
  • http://www.jkm.gov.my/perkhidmatanoku.htm

Prevention

• It is impossible to totally prevent any challenging behavior from happening,but you need to analyse why the behaviour occurs.
• Prevention come in the form of changing or preventing the triggering factor and consequences of the behaviour so as to modify the behaviour.
• Need to reduce opportunities for the behaviour to happen.

Support groups

• National Autistic Society of Malaysia (NASOM) 4, Jalan Chan Chin Mooi, 59100 Kuala Lumpur  Tel: 03-40223744
• Bethel Centre
• 5, Jalan Kenarai 10, Bandar Puchong Jaya, 47100 Puhong, Selangor. Tel: 03-80753978
• Dignity and Services P.O. Box. 498, Jalan Sultan, 46760 Petaling Jaya, Selangor. Tel: 03-77830849
• Hua Ming Autistic Society No.2, Jln. 20/8, Paramount Gardens, 46300 Petaling Jaya, Selangor. Tel: 03-79587385 http://www.autism.org.my/about_society.htm

References

• Autism Understanding and Assisting, Dr. Teoh Hsien-Jin, HoPak S/B,  No.1, Jalan TPK 1/6, Taman Perindustrian Kinrara, 47100 Puchong, Selangor, Malaysia
• Living with Autism, Dr. Sung Min Lena Heng, Times Editions, Singapore
• Understanding Difficult Behaviours, Geriatric Education Center Of Michigan
• Introduction to Dementia Care, Making Connection – Course Workbook, Sir James McCusker Training Project
• http://www.adultadd.com/2_2_recognizing/screener.jsp?ccd=kwstra594
• http://www.umme.edu.my/fom/research/psycho med/psy 03 02.htm
• http://www.autism.org.my/q$26amp;a.htm