Have you completed the first three modules in this series about learning disabilities?
Part one: Learning disabilities in context
Part two: Communication and consultation skills
Part three: Learning disabilities and physical health.

CPD activity

Before you start reading this article, think about:

• What do I want to learn?
• What will I gain from this learning?
• What will my employer gain?
• What difference will it make to people who use my services?

The term ‘behaviour that challenges’ refers to difficult or problem behaviours including:

• Aggression – hitting, kicking and biting
• Destruction – throwing objects and ripping clothes
• Self-injury – skin picking, eye poking and head banging
• Tantrums.

Behaviour that challenges is more common in people with a learning disability than in the general population, although actual prevalence figures vary.

There is no simple explanation of causes of behaviour that challenges. Similar behaviour can be seen in the general population, although normal developmental communication and social skills can help individuals to manage their needs more appropriately. Most toddlers are able to develop the skills and communication process to move on but many children with a learning disability do not develop such skills to anything like the same extent and although they have much the same needs as their peers, they have less competent ways of getting them met.

Pharmacy professionals have a role in supporting families, carers and support workers to identify factors that can lead to behaviour that challenges. Factors can include:

• Living environment – this may be noisy and crowded, which can be extremely upsetting for a person with autism
• Boredom – not being engaged in meaningful activity
• Underlying or co-existing mental health problems
• Poorly controlled epilepsy
• Physical discomfort or pain including infections or dehydration
• Inability to express emotions such as misery or anxiety
• Poor vision which may lead to eye poking as a method of generating visual stimulation
• Transitions or moving from one living environment to another.

Behaviour that challenges may offer a person a way to control or influence an environment in which they don’t feel comfortable or secure. The healthcare environment can be stressful for people with a learning disability and this can be a trigger for behaviour that challenges. All healthcare professionals have a legal requirement to think about environmental and other adaptations that they can make to help a person with a learning disability feel more in control in an unfamiliar environment.

As well as being more likely to suffer from behaviour that challenges, people with a learning disability are potentially more likely to suffer from mental health problems. It is important to highlight that behaviour that challenges is not a diagnosis, nor is it a mental illness.