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Introduction
The challenging behaviors I am currently experiencing in my practice comprise those displayed by people suffering from severe intellectual disability and Alzheimers disease. Persons with intellectual disability find it difficult to learn and manage the skills of everyday living. Intellectual disability can be classified as severe or profound when one has an IQ ranging from 20 to 35 (Matson, 2007: 1). People with profound intellectual disability are able to recognize people they are familiar with as well as maintain relationships with significant people in their lives. They tend to have speech problems; hence, they rely mostly on facial expressions, gestures as well as body language to express their needs and feelings. Persons with severe intellectual disability need assistance with their personal care and communication. They also need help in accessing community facilities as well as participating in various community activities (Roy, A., Roy, M. & Clarke, 2006: 107).
Alzheimers disease is a condition that gradually damages ones memory as well as the ability to think. Alzheimers disease is irreversible, and it eventually destroys a persons ability to do basic tasks. It is what commonly causes dementia among geriatrics. Alzheimers disease starts damaging the brain ten to twenty years before noticing any signs and symptoms; though what initiates the process is still unknown. The early stage of Alzheimers disease is characterized by memory problems (Green, 2005: 17). There are people with memory problems who suffer from Mild Cognitive Impairment (MCI). People with this condition tend to experience more memory problems than usual compared to their peers. However, the symptoms of MCI are not particularly severe compared to Alzheimers disease. Nonetheless, most people with MCI proceed to develop Alzheimers disease compared to people who do not suffer from MCI. As Alzheimers disease advances, there is continued loss of memory as well as deterioration of other cognitive abilities. Some common signs include inability to handle money and pay bills, changes in personality as well as taking a longer period to complete ones usual tasks (Hales, Yudofsky & Gabbard, 2008: 112). A person also tends to get lost and takes a long time to understand a question; hence repeating them. Most people are diagnosed with Alzheimers disease during this stage (Green, 2005: 17).
Case study
One of the cases that I am currently dealing is of a 45 year old man. He was recently diagnosed with profound intellectual disability as well as Alzheimers disease in its early stages. There are several signs and symptoms displayed by this patient that evidently depict early stage Alzheimers disease and severe intellectual disability. The patient has a scar on his stomach that he picks until it bleeds. He does this mostly when bored. The patient does not seem to be aware of the harm that he is inflicts, upon him. In numerous instances, he appears to have remarkably little comprehension of hazardous exposure. Sometimes, the patient would attempt to assault or assault people around him (First & Tasman, 2010:17).
Patients of Alzheimers disease are normally paranoid and delusional. When this overcomes a patient, they tend to display impulsive behavior; hence, the patients attempt to assault people around him. As memory loss progress in Alzheimers patients, they become confused and start experiencing challenges in identifying friends and family. This is one of the sign displayed by the patient in this case (First & Tasman, 2010: 18). At certain times, he will suddenly jump from his seat and look afraid and extremely confused. There are also certain times when this patient suddenly jumps from his seat then runs from one part of the house to another. When this normally happens, the patient seems to have little recognition of those around him as well as where he is.
Patients of Alzheimers disease experience hallucinations sometimes. This is also one of the common symptoms displayed by the patient in this case (First & Tasman, 2010: 18). The patient is unable to cross the road by himself and rarely travels using public means. Most of the time he waits for other staff members to prompt when to cross the road. Lack of road safety skill is a clear indication of profound intelligence disability. The patient is not able to carry out tasks that entail several steps and hence at a certain times requires the help of others to complete certain tasks. The patient lacks the ability to cope with new situations (Cohen, 1999: 43). When in an unfamiliar environment, he tends to grab, hold or lean on clients and staff. He may try to grab those next to him when traveling in a van. Sometimes, he tries to walk out of the gate at the house, especially during council cleanups. He looks quite agitated when he has to wait for a lengthy period, when he attends a dental or medical facility (First & Tasman, 2010: 19).
Challenging behaviors identified in the case study
The above patients behaviors can be considered challenging to himself and others for a number of reasons. Patients of both Alzheimers disease and severe intellectual disability display behaviors that are not similar to their personalities before developing these conditions. For instance, the patient above tends to be agitated as well as paranoid and suspicious on frequent occasions. Unfortunately, a person that has these conditions is unable to prevent or even control these behaviors (Emerson, 2001: 2). In turn, this compromises the physical safety the patient and the people around him. Challenging behavior also denies the patient, the chance to use facilities in their communities. Eventually such people become exceedingly dependent on their caregivers. The types of challenging behavior that directly affects the patient include; infliction of injury by biting, cutting or even burning oneself. When one lacks the ability to recognize a hazardous environment, they are constantly at risk of getting physically hurt (Emerson, 2000: 2).
Another challenging behavior commonly displayed by patients of these conditions is aggression. Such patients tend to assault others by kicking or hitting them. They sometimes spit on people and scream when displaying challenging behaviors. Aggressive behavior can lead to both the patient and the person being assaulted sustaining injuries. In numerous occasions, patients display challenging behavior, upon impulse. Challenging behaviors can sometimes be publicly inappropriate. An example of such behaviors is masturbating in public (Emerson, 2001: 11). Other challenging behaviors are directed at the destruction of property. Some patients of Alzheimers disease and profound intellectual disability tend to throw objects when feeling agitated, and this can be dangerous for the people around that patient. Other types of challenging behaviors include stealing as well as repeatedly rocking oneself when feeling afraid.
Alzheimers disease and severe intellectual disability are both conditions that affect the brain. Therefore, these conditions affect a persons thoughts, personality, emotions and ultimately, behavior (Janicki & Dalton, 1999: 11). They have effects on various parts of the brain, which takes place at different times and rates; hence, it is not easy to predict how a patient will behave at any given point in time. Challenging behaviors such as wandering and aggression, amongst others, result from brain damage and hence cannot be prevented nor controlled (Lueckenotte, 2009: 13). For instance, there are challenging behaviors displayed frequently by the forty five years old patient. Recently, he assaulted a client who was waiting to see a doctor like himself, at the clinic he normally goes to for check ups. He seemed particularly angry and was screaming at the top of his voice. He hit his victim with a bunch of keys that he was holding, and he had to be stopped by the staff at the clinic. His behavior was quite impulsive because a few seconds earlier, he seemed remarkably calm.
Factors affecting challenging behaviors
Challenging behaviors displayed by patients suffering from the conditions mentioned above are as a result of various factors. These factors could be biological, environmental, social or psychological. Sometimes, patients portray challenging behavior as a means of communicating their needs as well as feelings. The biological factors that lead to challenging behaviors include medication as well as pain, which could be both physical and emotional. Environmental factors that lead to such behaviors include noise or need to reach an object or activity. Psychological factors that affect the behavior of patients of severe intellectual disability and Alzheimers disease include feeling lonely, disempowered, excluded or devalued (Lueckenotte, 2009: 14). Challenging behaviors can also be displayed by such patients when they feel the need to live up to the negative expectations of others. This also happens when they think that they are being labeled. The social factors that lead to challenging behavior include feeling bored, need to be in control or seek social interaction (Soukup, 1996: 11). Such behavior is also displayed when others are insensitive to the patients needs or wishes. In certain cases, challenging behavior is displayed as a way of communicating needs and feelings to others (Lueckenotte, 2009: 13).
Conclusion
In most situations, patients acquire challenging behavior in order to cope with various challenges in their environment. People with developmental disabilities use challenging behavior as a means of expressing dissatisfaction of some sort. However, these patients can be taught new ways of coping with their challenges. Most importantly, caregivers can only manages challenging behavior by being compassionate as well as nonjudgmental. First, a caregiver should be quite observant in order to identify challenging behaviors. The behavior as well as its consequences should be noted down each time it occurs. Noting down these behaviors enable the caregiver to identify patterns that are visible in the behaviors and their consequences. One should establish how they react each time these behaviors occur. This way, it is easy to establish some of the factors that trigger or reinforce the challenging behavior. Finally, try to device a new way of dealing with the patients behavior. This is aimed at changing factors that lead to the occurrence of the behavior; hence, reducing occurrences of the challenging behavior. It is essential to remember that patients who have developmental disabilities lack the capacity to control or prevent their challenging behaviors.
References
Cohen, E. 1999, Alzheimers disease: Illinois: McGraw-Hill Professional.
Emerson, E. 2001, Challenging behavior: analysis and intervention in people with severe learning disabilities: Cambridge University.
First, M. & Tasman, A. 2010, Clinical Guide to the Diagnosis and Treatment of Mental Disorders: New Jersey: John Wiley and Sons.
Green, R. 2005, Diagnosis and management of Alzheimers disease and other dementias: New York: Professional Communications.
Hales, R., Yudofsky, S. & Gabbard, G. 2008, The American Psychiatric Publishing textbook of psychiatry: Virginia: American Psychiatric Pub.
Janicki, M. & Dalton, A. 1999, Dementia, aging, and intellectual disabilities: a handbook: New York: Psychology Press.
Lueckenotte, L. 2009, Alzheimers Days Gone by: for Those Caring for Their Loved Ones: Indiana: Author House.
Matson, J. 2007, Handbook of Assessment in Persons with Intellectual Disability: London: Academic Press.
Roy, A., Roy, M. & Clarke, D. 2006, The Psychiatric of intellectual disability: Oxon, Radcliffe Publishing.
Soukup, J. 1996, Alzheimers disease: a guide to diagnosis, treatment, and management: Connecticut: Greenwood Publishing Group.
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