Module 9 - Challenging Behaviours

Case Examples


John is a 40 year old man with a moderate intellectual disability who is non-verbal. He has worked at a factory packing boxes for the past 2 years. In the last 2 months he has been increasingly agitated and has started to hit one of his co-workers. Staff thought that he might be responding to hallucinations as they could see no other explanation for his odd behaviour. Psychiatric assessment did not support this and a subsequent behavioural assessment revealed that when John hit the other worker he received increased attention from staff. It emerged that two new workers had recently commenced at the factory and needed considerable attention from staff , which meant that John was no longer getting the attention he was used to.  This insight enabled staff to organise things so that they spent more time with John at times that were  not linked to  him hitting other people and the aggressive behaviour very quickly ceased as a result.


Algernon is a 24 year old man with a moderate learning disability and autism who for the last 6 months had been engaging in severe head banging. He had assaulted staff when they tried to prevent him from doing so. He had also started talking to himself and appeared distracted and distant. It was thought that he may have developed a psychotic illness and was responding to auditory hallucinations (voices). He had been started on antipsychotic medication and was now receiving very high doses of medication.  Initial physical review was normal and no major illnesses were identified. He was found to be experiencing severe unwanted adverse effects (“side effects”) from the medication and so the dose was reduced This lead to some improvement in his behaviour.  A behaviour analysis was undertaken but could not identify any obvious motivation for the behaviours described above.  Provision of extra staff with him to help him engage in activities lead to a further improvement in his behaviour although the problems did not resolve completely. In view of the ongoing problems more comprehensive physical investigations were instigated which required Algernon to have a general anaesthetic. During these investigations a large stomach ulcer was identified. This was treated and his behaviour problems resolved.


Robert is a young man of 16 with a mild intellectual disability who was living with his grandparents. He had stopped going to school over a period of weeks and began to spend more and more time in his room. He could be heard talking to himself and became very irritable if anyone tried to ask him questions about this. One day he smashed up his computer and hit his grandfather who was trying to prevent him from doing so. The police were called and he was taken to hospital. During a psychiatric assessment, he described that his computer had taken over his mind and was making him think things that he didn’t like. He described hearing the voices of aliens in his head whom he thought were controlling the computer. He was diagnosed with a psychotic illness and treatment with antipsychotic  medication was started. He made a slow recovery but 6 months later was able to return to school.  
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