Behaviour

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
Last Reviewed : 05 September 2008
Writer : Cheoh Siew Tin

 

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