Transcript: The dimensional model of challenging behaviour
This is a demonstration of the dimensional model of challenging behaviour. It’s a model that helps us understand why often people behave in ways that we struggle to understand; and gives us a way of thinking about the occurrence of challenging behaviour and how that relates to events and circumstances that the person experiences as well as what’s going on inside them.
So it’s a simple thing, pen and paper job, and I’m going to talk through it now.
So on your piece of paper, the first thing you do is to draw a line across the middle and that line represents you, the inside of you. It represents your moods, your emotions, your psychological state, your physical state, the degree of health or otherwise that you’re experiencing.
And what you do is you put a mark at this far end here, which indicates that that is you at your best. The inside of you is absolutely tip-top. So it could be a tick or it could be a smiley face or whatever works best for you. And so you put that at that end and then at this end you put the equivalent bad sign, a cross or a frowny face.
So that scale from one end to the other is the continuum, the range of your internal world.
And so you can imagine circumstances in which you feel fabulous, you just feel brilliant, everything that’s going on inside you is tip-top, you are on top form health-wise and you’re in a good mood, all of your good hormones are buzzing around and you just feel superb. And some of us experience that sometimes, some of us never experience it. But you know it exists at one end of the continuum.
And obviously the other end down here is the circumstances in which you just feel awful, the inside of you is just going terribly wrong. So your mood is low, your health is poor, your self-esteem, all of those kind of things that come from within you are just in a bad way.
And so all of us spend our entire life somewhere along this thing and we move.
So there are mornings we wake up and we are kind of up here and we just know it’s one of those good days when you get up and things are fantastic in terms of how you feel inside. And there are other mornings where you wake up and grrr.
So for all of us there is that range and within any one day within any one hour we will change in terms of where we are along this line and if we can imagine waking up in the morning and things are really good but actually we begin to deteriorate. Getting tired is one of the things that ends up meaning that you move down this way. But through the day things change.
Actually there comes a point somewhere on this line where your general ways of normally behaving disappear and you start to express distress. You start to be grumpy. You might start swearing, shouting, throwing things, slamming doors.
And so there is a point on this line where that happens and so on this model what we would do is actually make a mark which shows where that point is, as our internal world that deteriorates from superb to frankly awful. There’s a point where our behaviour changes.
Having done that we then turn to the middle of the page and we draw a line from the top to the bottom, and this represents the external world that we’re experiencing. And at the top we’re going to say that that’s where things are just fantastic.
We’re with people we like, the way things are happening around us is exactly how we would want things to be, the weather is warm, or if you don’t like warm weather the weather is like you would really enjoy it to be, and the way that people talk to us works. All of those things, that’s kind of up here. So you would put a tick again or a smiley face to represent that at the top of here.
And then unsurprisingly the bottom here is the opposite of that. So everything is going terribly wrong in terms of what’s happening around you. The things just don’t work for you and so you put a cross or a frowny face again down here. And similarly as we’ve explored before and as we move because we’re going to do that, our circumstances will change in terms of how congenial they are to us.
There will be a point and it’s round here probably, which draw a little mark on the line there, to represent the moment the circumstances in which our environment, what’s going on around us, and tip us over the edge into behaving poorly, behaving in ways that actually aren’t helpful for us and are distressing for other people.
So we’ve got a line across here with a mark and a line down here with a mark and actually what you can then see is if you shade out all this side of the mark on this line then that is circumstances in which you are going to display challenging behaviour. And similarly you can shade out all of this under here to represent the environmental conditions in which you’re going to behave badly and we’re going to call this the zone of challenging behaviour.
So all this shaded area here and here are the circumstances, both represented by your internal world and also by what’s happening outside you, within which challenging behaviour happens. We can just kind of scoop this bit here.
This is true for all of us and you can see that there are circumstances where, either things change inside us which move us from being perfectly alright and behaving in a way that helps us and that helps other people, to an internal state that pushes you over into challenging behaviour and similarly in terms of what’s going on here.
There would be circumstances that you could describe that you could think of right now where actually you’ve been tipped over by somebody being unpleasant to you and you’ve moved from being able to behave in a way that is helpful to actually tipping over into the zone of challenging behaviour. Or where you’ve got so tired or unwell that actually you just behaved in that way.
And this is true equally for people that we support and it goes some way to explaining a number of things about challenging behaviours that are important. So for example one of the things that quite often happens is that someone displays some challenging behaviour but in circumstances that we find difficult to understand.
So let’s imagine that we’re in a supermarket and so that has a set of circumstances which would be represented by this outside world line here. And so normally there’s a supermarket so it comes up here somewhere and so this is not therefore in the zone of challenging behaviour and so we would expect that the person would do shopping and kind of do the paying and all of that kind of stuff.
And we can draw a line that is up here which is normally what the environment of being in the supermarket does in terms of our behaviour. But you can see that if there’s something about the internal world that pushes us in this direction then we’re going to end up falling into the zone of challenging behaviour despite the fact that we’re in the supermarket when normally challenging behaviour doesn’t happen.
Similarly there can be sort of internal states where normally that would mean that there would be no challenging behaviour so we could describe kind of somewhere along this line a state of being in a good mood and that might be kind of over this side somewhere and we could draw a line up here that represents what that good mood means to us.
But you can see that normally if we’re in a good mood and our environment is working for us as well there will be no challenging behaviour but as the environment deteriorates despite the fact that you’re in a good mood you drop into the zone of challenging behaviour.
And so this helps us to understand that for all of us, it’s true for you and it’s true for me for sure, but it’s also true for the people that we support, it’s a correlation between the two, it’s an interplay between people’s internal state and what’s going on around them, that means that that affects the chances of challenging behaviour occurring.
And so quite often we hear things like but he was in such a good mood it came from out of the blue. Well in those circumstances something is changing in the environment. And similarly you know he always liked to go to the supermarket and I don’t understand why the challenging behaviour happened.
Well actually what that means is something has changed in the way that’s working but particularly inside the person so despite the fact they’re in a place they like something has changed here which means that they’ve fallen into the zone of challenging behaviour.
And of course they’re all related – as your environment changes actually that then has a knock-on effect in terms of your internal state so as you become frustrated for example by people not responding to you in the way that you are hoping then that actually has an effect that pulls you and your internal state in this direction so you end up kind of moving further and further down here.
And most of us, all of us, when we’re in this bottom corner here, what we’ll do without planning it, without thinking it through, what we’ll do is do something that will move us out of the zone of challenging behaviour.
It could be that we leave, it could be that we ignore what’s going on, it could be that we take some time out to recover our kind of equilibrium and our good mood, it could be that we take some days off in order to get back on kind of in that direction, it could be that we agree with our colleagues that they’re going to talk to me in a different way and that’s going to change about it, it could be that you hit someone so that they go away.
So all of us will do things here and for the people that we’re supporting this is not a kind of deliberate thought through act it’s just a reaction to the circumstances that they find themselves in that will move them back up towards here.
For most of us it looks kind of like that and it’s kind of fairly evenly sort of spread in terms of the amount of time we might spend up here, we’re all different but these are kind of approximately the same in terms of how much time we’re likely to spend in these places.
But of course for people that we’re supporting actually the whole thing is shifted in this direction because at a personal level people with a learning disability are more likely to suffer ill health that’s going to move them in this direction.
They’re less likely to experience happiness and satisfaction that’s going to move them in this direction. They’re more likely to experience internal difficulties because of the way that their brain works that’s going to move them in this direction.
Similarly the experience of people with a learning disability is that they’re not treated well by other people that’s going to move them in this direction in terms of the impact that their environment has on them.
And the experience of people that we’re supporting is not good so actually the whole thing for people that we work with is even more down here than it is for everybody else and you can represent that with a dotted line that shifts the whole set of quadrants in this direction.
One of the other advantages of the dimensional model is that it demonstrates what an intervention plan is designed to do. So an intervention plan has proactive and reactive strategies.
Your proactive strategies are designed to move people’s personal experiences – how well they are, how good they feel – along this line in this direction. The more that the proactive strategies do that, the further they are from falling into the zone of challenging behaviour.
They’re also designed and particularly designed to change the experience that people have – how the environment works for them and the way that people interact with them and the extent to which things make sense – that’s going to move where people commonly experience themselves up in this direction along the environment dimension.
And so your practice strategies have the combined effect of moving the person from routinely down in this bottom corner up here more towards that direction, taking them further away from where they’re likely to display challenging behaviour.
That’s how proactive strategies work.
Reactive strategies are designed to enable people to move rapidly from here out. And it doesn’t matter in many ways how, but that’s their job. To find ways to rescue people out of this zone of challenging behaviour as quickly as possible, and safely, so that they can get to here and then the proactive strategies can kick back in.
So that’s the dimensional model. It illustrates better ways of understanding challenging behaviour and the rationale for why we need an intervention plan with proactive strategies and reactive strategies.