Challenging Behaviour

Fela has autism, severe learning difficulties, and lacks Mental Capacity, these all result in his being susceptible to challenging behaviours, which always result from difficulty in communication.

Either Fela cannot communicate to others, or he is unable to process fully or quickly what is being said to him, or support staff are failing to understand what he is trying to communicate.

Challenging Behaviour is not Fela being naughty or prone to violent behaviour, it is not that he doesn’t like those around him, basically it is an unfortunate symptom of his disabilities resulting from understanding or communication issues.

These will include some/all/combinations of – being very vocal, agitated, sweating, making guttural sounds, increasingly violent rocking, stomping, head banging against a wall, damage to property, self-harming and hitting, biting or similar actions against family, staff or members of the public.

Thankfully, the incidence and severity of these incidences is low – BUT do not allow complacency to take root. Some of his triggers are difficult to identify and may result in rapid changes in Fela.

Sometimes when very agitated Fela may appear to be laughing, do not mistake this for some enjoyment he is taking from the situation, this is more like an embarrassment laugh. Fela may take himself to the bathroom in order to try and self-regulate, allow him space for this, do not constantly ask if he is ok but from time to time show concern and ask him. Though at over six feet and board shouldered Fela is big by most standards, try not to be intimidated, he is generally a gentle giant.

Recording Arousal/Agitation

Team Fela records his arousal state, on a scale of 1 to 6, at the beginning and end of each shift, and if his state changes during the shift this too is to be recorded and observations made:

Arousal Levels

1 Baseline

2 Vocal: normal or unhappy

3 Very Noisy, Frown on face, Demands for food and drink, Objecting to too quick changes between activities

4 Agitated Frowning/Scowling, Hot & Sweating, Excessive Rocking,
Fast & Jerky movements, Grabbing staff hands to direct them to his desires, demanding pointing at TV screen,

5 Very Agitated Stomping, Guttural sounds, Violent Rocking, Slaps Arms, Large Jerky Movements, Withdraws to bathroom, Very Sweaty, Excessive spittle/salivation

6 Aggressive Hitting, Biting, Slapping, Property Damage, Self-harming, Head Banging

Be attentive to the changes in his arousal levels, and up to Level 4 seek to use de-escalation techniques. At Level 5 it may well be too late but if you choose to attempt de-escalation do so with great caution.

If his arousal passes Level 4 you must put on the ‘BitePro’ protective jackets if you are not already wearing them. /they are to be worn at all times.

If his arousal passes Level 5 into Level 6 then do not try to intervene, either at home or in public. Allow him as much space as possible and keep yourself safe. If in public do not feel pressured to ‘do something’ it may be embarrassing but this is better than making the situation worse.

Possible Triggers

  • Fela’s demands for food or drink not being met.
  • Being shouted at.
  • Being unwell, not just sick but the impact of hay fever and similar allergy symptoms.
  • In need of a bowel movement.
  • A poor nights’ sleep
  • A noisy environment in the house or in the community.
  • Discord and arguments in the house between staff.
    • Whilst this may not manifest in immediate behaviour but may exhibit later, even days later, when something is said or done which triggers the memory.
  • Coming up behind him unexpectedly, especially if he is seated and you tower over him. Let him know you are there before you get too close.
  • If you rush him with many instructions.
    • He may be struggling on a day and repeated instructions to put on his shoes may trigger a challenging behaviour, in his mind he is trying to do it, and repeated instructions makes him think – “Hey I am trying why don’t you give me space and time”
  • Pollutants – in the house this is unlikely as the materials used are closely controlled, but not so in community amenities.
  • Artificial additives, ‘E numbers’, in foods, sweets, drinks.

When Fela becomes agitated and vocal for extended periods, this can be confusing and emotionally draining on those who are supporting him, as well as exhausting for Fela.

Proactive Responses

  • Try to remain calm. Speak calmly and use few words to re-assure him he’ll be fine and you are giving him 5 minutes to calm down. Keep repeating this at intervals as required.
  • If you suspect what may have caused his agitation, try to address the issue by reassuring him that it is “finished” (use the makaton sign) e.g. an activity he may not want to do.
  • Give Fela some space, if he is at home.
  • If in public – try to guide him to a safe place nearby e.g. a local park/field where he can stretch his legs and move his arms without injuring others.
  • Stay close at hand but allow him some personal space and keep a safe distance.
  • If outside, it may be possible to get him into the car whilst you remain outside but not sat beside him, but refrain from driving until he has calmed down.
  • Give him a towel to dry himself as he sweats profusely, and when he is calm, prompt him to change his wet clothes (a towel must be kept in the car at all times).
  • Use lavender oil from the homely remedies for him to sniff and on his temples. This has a calming effect.
  • Make him half a cup of camomile tea but allow to cool slightly before he drinks as when agitated, he is likely to spill on himself; wait until he is sufficiently calm to prompt him to drink. This has a calming effect.
  • If possible, play him some calming music e.g. classical, nature sounds in the background e.g. in the car, on computer/mobile.
  • When he is calm, he will be tired so make few demands and adjust his activities as you see fit.
  • Ensure he has plenty of fluids as he may be dehydrated.
  • If arousal passes Level 5 then do not try to intervene, either at home or in public. Allow him as much space as possible and keep yourself safe. If in public do not feel pressured to ‘do something’ it may be embarrassing but this is better than making the situation
    worse.
  • Always have the ‘Autism cards’ available in case a member of the public becomes concerned.

When Fela is agitated, AVOID:

  • Offering him food – he likes food, and this may reinforce challenging behaviours.
  • Offering to read to him.
  • Using too many words.
  • Doing HANDLE – unless he requests.
  • Noisy environments e.g. pause tv, keep background chatter to a minimum.
  • Driving.
  • Touching him.
  • Being in his personal space.

Allow him the time he needs.

In the event of an incident:

  • The second member of staff who has not been injured needs to telephone Management i.e. person on call or Carla/Michael. One of them should arrive at the house within 30 – 60 minutes depending on where they are.
  • The second member of staff needs to take the injured member to a safe place, examine the injury, apply first aid measures e.g. disinfect injury, administer plaster, bandage
  • Ensure Fela is in a safe place
  • Keep a safe distance whilst re-assuring Fela everything will be okay
  • Keep checking on Fela every 5 minutes but keep a safe distance
  • If in house, make Fela a cup of camomile tea, ensure some calming music is playing in the background on low volume
  • Offer words of re-assurance to the injured person who may be in shock
  • When Fela is calm, you can offer to bring the tea closer to him.
  • If in car, Place next to Fela a hankie with a few drops of lavender oil (kept in glove compartment). Do this from the front of car or outside the car at a safe distance. The vapours will help to calm him.
  • If in the public, and the incident involves a member of the public, your priority has to be to get Fela to a safe place, preferably the car. One staff member can supervise him in the safe place whilst the other member returns to injured member to offer help (for no more than 20 minutes). Ensure an autism card is left with the injured party. If necessary, leave the injured party in the hands of another member of the public who has demonstrated concern, call emergency services, then return to Fela asap. 
  • The person left with Fela can stand outside the car until he calms – use hankie with lavender oil, calming music on low volume to help Fela calm.
  • Once Fela is calm, offer to change his clothes (if in car just tops); ensure he is offered a drink as he may be dehydrated; if it’s his snack time, offer him a snack.