Effective management of challenging behaviors in cognitively impaired residents requires attention to the following: (a) their cognitive deficits and the manner in which these compromise everyday functioning, (b) environmental factors that trigger and maintain challenging behaviors, and (c) staff attitudes, perceptions, and expectations. Failure to attend to any of the above can jeopardize the management program.
Many challenging behaviors arise as a consequence of specific cognitive deficits are not intentional. Labeling, however, affects how staff interact with residents ad determines their emotional response to the challenging behaviors.
Having cognitive deficits does not mean that residents have lost all capacity for change. While these deficits contribute significantly to the emergence of challenging behaviors, they are not sole determinants. Important environmental event trigger and maintain all behavior. Changing these environmental events results in changes in behavior.
When confronted with challenging behaviors, caretaker must adopt a scientific attitude. Challenging behaviors must be defined in specific and objective terms and be subjected to a functional, or ABC, analysis in order to determine the environmental variables that control them. Being scientific does not mean being uncaring or unsympathetic.
An individualized management plan is developed which is based on the results of the ABC analysis and knowledge of cognitive deficits. Challenging behaviors require ongoing monitoring in order to determine the effectiveness of the program. Necessary adjustments are made as indicated.
Caretaker's perceptions of the challenging behaviors need to be examined, as these will affect their levels of stress. Challenging behaviors must be viewed as problems that require a solution. It is helpful to break down stressful interactions with a particular resident into a series of steps, for which coping self-statements are developed.
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