Problematic Behaviors

The Formation of Problematic Behaviors
-Pay attention to the feeling of an individual-
Previous Executive Director of Awaji Kodomoen Takahiko Iwasaki (Executive Director of Himejima Kodomoen)
Table of Contents ŸIntroduction
ŸThe situation of individuals with problematic behaviors
@@@(1) Starting with understanding
@@@(2) Aggressive behavior and self-injury
@@@(3) Avoiding offering inappropriate support
@@@(4) Expressing frustration and anger
@@@(5) The necessity and difficulty of cooperation
@@@(6) The importance of proper support in crisis situations


@There are people who havenft been able to receive gClients-driven welfare servicesh, as I mentioned in the beginning of an article published in gSupport Research Communicationh Vol. 18. Those clients are people with severe problematic behaviors.

They cannot sit still, jump as hard as they can, and go into the street without thinking. They repeatedly hit their own head and cheeks while working, bite their own arms or fingers, and swing their body roughly. They cannot stop their actions even if staff suggest to them in a friendly manner, gWhy donft you take a rest?h They may respond aggressively to staff for no apparent reason. When they see another child crying, they often run over to them and push them over. They may rush through meals and throw up, knock plates over, drink too much water and become severely ill. Their daily living rhythms may result in abnormal sleeping-waking patterns.

@There are many people with these kinds of severe problematic behaviors across the country. Some of these individuals may not be able to continue living in their local community, and may have no choice other than to live in residential facilities or mental hospitals. If appropriate support systems are not created in local communities to promote the importance of understanding from the individualfs perspective, the numbers of people who cannot continue living in their local communities will gradually increase. It is important to urgently deal with these problems at the local community level.

@Why do some people show such problematic behaviors? It is often the result of an individualfs independence being undermined.

@I have worked with children with intellectual disabilities and their families at the daycare center for 26 years. I have supported and consulted with them continuously from infancy to adulthood. As my experiences grew, it became clearer how challenging problematic behaviors actually develop.
@Problematic behaviors are not necessarily an innate part of the individual. The development of any of these problems depend on the type of relationships the individual has with those around them and the degree to which they offer support and understanding. Understanding how many of these problems develop, I feel greatly motivated to seek better support for both the individuals and their families throughout their lives. My principal objective is to respect the individualfs experiences and needs and to develop a greater understanding of their point of view.
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ŸThe situation of individuals with problematic behaviors

i1jStarting with understanding
@People with problematic behaviors often seem to act out in what appears to us as very extreme ways, resulting in them being seen as gquite differenth. They are not as different as we might think and are capable of relating with those around them. Individuals with intellectual disabilities have their own needs, feelings and views. When a person is feeling happy (fully understood, satisfied, and comfortable), they donft normally hurt themselves physically or emotionally or hurt others. It is important to recognize that when individuals are demonstrating severe problematic behaviors they are most likely experiencing a difficult situation.

@However, when a child is increasingly acting out, it is difficult to have such an empathetic understanding of their situation, and what they may be feeling because we do not understand their experience. For example, we may think it is simply an individual with intellectual disabilities who naturally act this way, etc. without acknowledging either the complicated circumstances that led to the behavior or the role of others in instigating the behavior. Understanding what is happening can be extremely difficult.
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i2jAggressive behavior and self-injury
@When an individual is in a difficult situation, they may find it challenging to express their unhappiness or stress in words, which may lead to them acting out as a means of expressing themselves. For example, it is thought that aggressive behavior such as biting, head-butting, hitting, and pinching, are ways an individual may express their anger or frustration. When you experience such aggressive behavior from an individual, if you can remember gThey are hurting me because they feel hurt tooh, then you can better understand the meaning behind their behavior. If the individualfs feelings of pain or frustration increase whether physically or emotionally, they may act out even more.

@Similarly, some individuals turn unexpressed feelings of anger and frustration inward in the form of self-injury. If the individualfs anger and frustration grows, incidents of self-harm may also increase. Some people may think, gSelf-injury is better than attacking other people.h, gThey may feel good when they hurt themselves.h or gThey donft have sensations of pain.h However, these views are not accurate.

¦It is difficult for parents and those working with the child to simply accept these aggressive behaviors or incidents of self-injury. However, it is important to understand the meaning behind these behaviors. We need to consider the cause and provide appropriate support so that the individual can feel gThey (the supporters and parents) understood me.h or gItfs so nice to be understood.h We try to understand the individual from these perspectives and support them to feel safe and secure in relationships with others when they face difficulties in daily life. It is a lengthy process, but we have clearly seen positive results, including a decrease in problematic behaviors and an increased ability to express their needs and feelings through facial expression, gestures, and words.
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i3jAvoiding offering inappropriate support
@When children experience problematic behaviors, it is important to remember that they have had to endure many difficult situations and are often coerced into doing things against their will. What is difficult for the individual? What choices has the individual been able to make for themselves? If you are able to pay attention to the relationships between the individual and people around them, the answers become clearer.

@For example, teachers at school or staff at the center may make the individual study, work or give them additional assignments and structure with the idea these things will help them overcome their disabilities and encourage them to be more independent. However, forcing the individual to do these things may create too much stress for them. Even when we address them directly, they may avoid making eye contact with us, lower their eyes, freeze their face, or have difficulty starting to work on their own. These behaviors may express their confusion or anxiety. When they start to work, they may move slowly, not be able to pay attention to the task, pause often, not look at their hands, or bite their fingers, and forcefully rock themselves. These behaviors may be symptoms of excessive stress. If a member of the staff has strong expectations or demands, such as gI want them to do X.h or gI donft want them to do Y.h, they may find it difficult to remember the individualfs feelings and wishes. This may be especially true when the individual has difficulty expressing their genuine feelings or wishes to the staff or any person who speaks in such an assertive or aggressive manner.

@If staff downplay or ignore the individualfs wishes and keep forcing them to do the assignment, the individual, sensing the stafffs strong desire, may feel intimidated. They may try to finish the tasks they dislike quickly in order to escape from the painful feelings they are experiencing. This kind of gforceful obedienceh is not appropriate or helpful. If the individual continues to experience such stressful interactions with staff, problematic behaviors may appear. These can include a decrease in the individualfs ability to be flexible as they rely on doing the same activities each day for their emotional security and stability. Even if staff eventually tell them they do not have to do the assignment, the individual may have difficulty ignoring the stafffs initial, and somewhat forceful, request making it difficult to stop doing the task they dislike.

@Some individuals show strong attitudes or resistance: flopping down, not moving, or being aggressive, etc. If staff donft recognize that these problematic behaviors may be a result of the individual being forced to do something they may not want to and continue to force them to do the task, the individual may develop a sense of distrust and wariness of other people that continues to be reinforced by the stafffs behaviors. The results of this negative reinforcement may display themselves in various ways in the individual. They may feel physical tension, may express extreme emotions, and may not want to be touched by others.

@There can potentially be serious negative results if the staff person fails to see the situation clearly and simply believes that the individual has started to understand the instructions and can do it by themselves, rather than understanding the stressful situation the individual is experiencing. Eventually, the individualfs stress will increase, leading to the appearance of severe problematic behaviors. It is important for everyone in contact with individuals with problematic behaviors to understand this.

¦It is important for people working with these individuals to be able to read theirr feelings through facial expressions, attitudes and behaviors. People must accept these expressions as their maximum expressions even though they may appear to be weak expressions, and support them to feel comfortable and secure in their environment. People involved need to objectively understand whether the individual fully wants to participate or not, or if they are experiencing excessive stress. If the staff are able to objectively able to understand the situation and patiently support the individual and their wishes or feelings, they will develop increased confidence and be able to express themselves more clearly. They may even feel comfortable enough to say, gNoh.
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i4jExpressing frustration and anger
@When people who work or live with individuals with problematic behaviors can look at the whole life of the individual, they can start to see the origin and pattern of his/her problematic behaviors. It is important to think not only of what has happened at each place, whether school/center, home/group home, or specialized institution, but also to look at the differences of behaviors among each place, in order to determine its meanings and relationships. For example, in the case that the individual has excessive stress or appears to be isolating or feeling down, some of these behaviors may only appear after he/she goes home, even if the individual displays no problems at school or the center. It may be the other way around too. There are various ways an individual may respond depending on his/her personal ego-strength, communication skills, and the depth of his/her relationships with others. Responses may include, aggressive behaviors, being demanding of others, being grumpy, and hyperactivity.

@There are people who respond by biting, hitting, or grabbing the person to whom they want to be understood or comforted by. It may be because the individual cannot communicate verbally well: gX was hard for meh. There are also people who obsessively focus on one activity or their favorite items. It is often difficult to understand how they could be so focused on one thing. For example: they want to ride a train endlessly, they want to buy large amounts of their favorite juice, but donft drink and spill them, or they continue to watch a specific scene in a video over and over again. They cannot be satisfied unless they get their way. It may be a result of the negative experiences they have had with staff or others close to them. If they have often felt they are forced into doing things, they may feel more frustrated and behave even more aggressively.

@Parents (especially, mothers) who experience such frustration and anger directed at them, have a hard time handling it, in part because they donft understand the background of their childfs behaviors. The individualfs demands may escalate more, because his/her parents may not be able to understand the stress the individual is or has been experiencing. Therefore, parents are often exhausted, and have difficulty seeing how best to handle the situation. Consequently, parents may feel hopeless about the situation changing or becoming easier. Their anxiety, and that of their child, may increase, resulting in a loss of confidence as they wonder if they can continue on like this.h

¦The individual may become sad if those around him/her assume these behaviors are feature of intellectual disabilities, and are not able to understand the different stresses or situations that cause or contribute to his/her problematic behaviors. We have to remember the consequences of any individual being forced to do something they do not want to.
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i5jThe necessity and difficulty of cooperation
@There are parents who are worried about their childfs condition, so they want to consult with the staff at the school or center. However, the staff donft always understand the seriousness or significance of the situation. Quite often the staff may not see the childfs severe problematic behaviors, or understand its significance in the family, even when they do see the same behaviors at the school or center. Instead, a member of the staff may say, gThere must be some other problems at home.h or instructs the parents, gPlease let your child do X at home.h It is not unusual the staff recommends, gIf you have such a hard time, why donft you put your child in a special residential facility?h Parents are up against the wall.

¦In that case, teachers at the school or staff at the center need to sincerely listen to the parentsf and discuss their childfs situation. It is important to consider why the childfs behaviors may differ depending on the place, and what the meaning of these differing behaviors may indicate. It is also important not to force an individual to do something they do not want to, and to remember to respect his/her real feelings and wants. If teachers/staff and parents can openly discuss and support the individual by respecting his/her feelings and wants, his/her behaviors will deescalate.

@However, different principles of guidance and support exist among institutions, schools and specialized institutions. Consequently, it may be difficult to closely cooperate. Parents may feel that there are some problems at school or the center, while the staff may feel that there are some problems at home. Both sides tend to lay the blame on each other. Additionally, parents may find themselves in a difficult position, because the deeply rooted misconception exists that parents are not professionals and only specialists can understand the situation. Therefore, teachers and staff need to support the individual together with his/her family while listening to and respecting what the parents are experiencing. If it is difficult to work together, intermediation of a third party may be necessary.
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i6jThe importance of proper support in crisis situations
@When problematic behaviors become severe, it may become difficult to deal with the individual at home. The individual may not want to go to a temporary stay residential program in order for his/her parents to have a short break and /or for their escalating behaviors to be addressed. It also may be difficult for him/her to feel comfortable at an unfamiliar place with staff he/she does not know. With such resistance to a temporary residential program, there may be the possibility that his/her problematic behaviors increase: becoming violent, insomnia, anorexia, etc. If the individual goes back home with additional problematic behaviors, his/her family may hesitate to use a temporary residential program again. As a result, his/her family may endure problems until they reach a crisis point, because they donft want to send their child to the program again.

¦When such difficult situations or emergencies occur at home, it cannot often be solved by just the family. First, it is important to find a temporary residential program where the staff give thoughtful consideration to the individualfs anxiety and resistance and support him/her individually. It should also be a place that his/her family feels confident with. Simultaneously, the other organizations or programs the individual is involved with should discuss his/her escalating problematic behaviors in order to determine the causes of such behavior. They will then need to work together in order to develop a plan to address and deescalate the behavior.
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@It is important to have a support system in the community. It is also clear how important it is for any person working with the individual to understand his/her feelings and needs, and consider, gWhat does he/she want?h and gWhat does he/she think?h The two important conditions that allow people with problematic behaviors to have a positive feeling are to feel they are understood, and to live in their local community. When people with problematic behaviors have difficulties, it is important that they have a reliable person whom they can trust. It is also important that people working with these individuals respect their independence, help them to accomplish their goals, and support them to live in a positive way. In order to do this, it is important to consistently provide and maintain these supports from infancy through adulthood.

@Currently, many support systems for people with problematic behaviors are lacking. There is a possibility that new government institutional reforms may exacerbate the situation. However, we have to continue creating better systems to support the independence of people with disabilities in the future. We need to remember that the issues of individuals with problematic behaviors effect a larger number of people than people may think. We believe that problematic behaviors are not necessarily an innate part of the individual and many of these problems develop depending on the type of relationship the individual has with those around him/her. Also the understanding of and support for people with problematic behaviors are very important social welfare topics that address the quality of support and the need to respect these individualsf humanity, independence and needs.
Support Research Communication Vol. 24, Nov. 2005
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