Meaning of Challenging Behaviour
Challenging behaviour refers to actions of such intensity, frequency or duration that they pose a serious risk to the physical safety of the individual or others. According to the Challenging Behaviour Foundation (CBF), it can also describe behaviours shown by autistic people or people with learning disabilities as a way of expressing themselves or attempting to have their needs met.
In the UK, the term emphasises that the challenge is not just the person, but also how services and environments respond (or fail to respond) to those behaviours. For example, the term was coined to emphasise that such behaviour poses a challenge to services. The notion that behaviour is a form of communication is now widely supported: behaviour often serves to express an unmet need, distress, pain, or desire to influence the environment.
The focus tends to be on people with learning disabilities, autism spectrum conditions, and/or other complex support needs (such as sensory impairments, communication difficulties, epilepsy, children or adults with brain injury, dementia, or mental health issues) because they are more likely to show behaviours that challenge.
Read more about the impact of challenging behaviours on others.
What Causes Challenging Behaviour
Before exploring the causes, we need to assess the behaviour’s function – in other words, the purpose it serves. There is rarely a single cause. Instead, challenging behaviour is usually the result of a complex interplay of multiple factors. The possible factors include:
- Medication side effects or physical health conditions.
- Pain, illness, or discomfort (e.g., untreated toothache, infection, constipation).
- Sensory overload or deprivation – too much noise, light, or physical contact.
- Changes in routine or environmental stressors (e.g., new staff, hospital admission).
- Unmet emotional needs – loneliness, fear, lack of control or autonomy.
🧠 “All behaviour happens for a reason. Identifying what triggers and maintains it helps services respond more effectively.” – Published text of National Institute for Health & Care Excellence (NICE) guideline NG11: Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges.
Challenging Behaviour in Health and Social Care
In health and social care, challenging behaviour refers to actions by a person that may put their own safety or others’ safety at risk, or make it difficult for carers and professionals to provide adequate support.
In home-based care, or supported living environments, behaviours that challenge might include:
- Physical aggression
- Verbal aggression
- Self-injurious behaviour
- Aggressive behaviour
- Non-compliance or withdrawal
- Sexually inappropriate behaviour or running away (absconding)
Such behaviours can be distressing for especially for children with severe learning disabilities and support teams, and can disrupt continuity of care, increase risk, or strain service resources.
Challenging behaviour impacts the sector and has broad implications:
- Service quality – It can disrupt care routines, increase incidents, and lead to restrictive practices if not well managed.
- Staff well-being – Support workers and care teams may experience stress, burnout, or injury.
- Individual outcomes – People with challenging behaviour are more likely to experience placement breakdowns, hospital admissions, or social exclusion.
- Financial cost – High support needs can significantly increase service expenditure for local authorities and the NHS.
Ethically, carers and professionals are expected to adopt a human-rights-based, trauma-informed, and person-centred approach.
Challenging Behaviour Types and Examples
Challenging behaviour includes a wide range of actions that may put the person exhibiting it and those around them at risk. This consists of the risk of physical injury or possible exclusion from various spheres of life, such as school, the workplace, or relationships.
Behavioural challenges can be better understood by dividing them into three main types: verbal, non-verbal, and physical.
Verbal Challenging Behaviour
Verbal challenging behaviours are language considered unacceptable and offensive in most areas of society. This may include:
- Swear words
- Threats
- Name-calling
- Other inappropriate phrases
Furthermore, people with a learning disability might repeat certain words, shout, or scream while in distress.tress.
Non-Verbal Challenging Behaviour
Non-verbal challenging behaviour involves various non-verbal actions that are frowned upon within society and deemed inappropriate or offensive. For example, the individual may engage in the following forms of behaviour:
- Deliberately being silent
- Clenching fists
- Directly pointing at someone’s face
- Deliberately standing in someone’s personal space
- Intimidating facial expressions
Physical Challenging Behaviour
Physical challenging behaviour covers outbursts of physical aggression in autistic people and other learning disabilities. It can be self-harm, directly aggressive, or non-person-directed.
Physical challenging behaviour may involve:
- Chewing or eating inedible objects
- Inappropriate sexualised gestures
- Hitting, kicking, biting, spitting, and more
- Damage to property
- Eye poking
- Stealing
- Grabbing and holding
Functions of Challenging Behaviour
In behavioural science, particularly within Positive Behaviour Support (PBS), the function of behaviour is what the person gains from or avoids through the behaviour.
This perspective encourages care teams to ask:
“What is this person trying to tell me through their behaviour?”
Rather than focusing on stopping the behaviour, teams focus on understanding and meeting the need driving it. Below are the four main functions of challenging behaviour.
Social Attention
The person engages in the behaviour to gain attention or interaction from others, even negative attention.
- Example: A person shouts or hits when staff speak to someone else, because this guarantees a reaction.
- Support strategy: Provide positive attention for appropriate communication (e.g., using words, symbols, or gestures to request interaction), and avoid reinforcing shouting by responding calmly when it occurs.
Access to Tangible Items or Activities
The behaviour helps the person obtain something they want, like a preferred object, food, or activity.
- Example: A young person may throw objects when denied a favourite snack or tablet.
- Support strategy: Teach functional communication, such as requesting the item using a picture, word, or sign, and use clear boundaries around access.
Escape/Avoidance
The behaviour helps the person get away from something unpleasant, such as a demand, a noisy place, a painful sensation, or a social situation.
- Example: An autistic person may become aggressive when asked to complete a task that feels overwhelming or confusing.
- Support strategy: Break tasks into smaller steps, offer choices, and identify what triggers distress. This reduces the person’s need to use behaviour to escape.
Sensory Stimulation (Automatic Reinforcement)
The behaviour itself feels good or relieves discomfort, regardless of other people’s reactions.
- Example: Hand-flapping, rocking, or head-banging may provide sensory feedback or release tension.
- Support strategy: Offer alternative sensory input (weighted blankets, sensory toys, movement breaks) and check for underlying pain or discomfort.
When staff misinterpret behaviour, for example, seeing it as “bad” or “attention-seeking” — they may respond in ways that escalate the problem. By identifying function:
- Care teams can replace the behaviour with positive communication skills.
- Services can better adapt the environment to meet needs.
- Support plans shift from reactive to proactive.
This understanding forms the foundation of Positive Behavioural Support (PBS), now standard in UK social care practice.
What Is the Cycle of Challenging Behaviour?
The cycle of challenging behaviour describes how behaviour that challenges develops, escalates, peaks, and de-escalates. It shows that challenging behaviour is usually predictable and can often be prevented if early signs are recognised.
Trigger
The challenging behaviour cycle is initiated by a particular experience or event that arouses discomfort or anger in the person, i.e. a trigger.
Some triggers may be sudden and come as a single word, action, or specific noise. Others are slow-burning and can disturb a person’s peace over a more extended period, such as lack of sleep, lack of attention, or over-instruction.
Triggers can be:
- Changes in routine
- Overstimulation (noise, light, crowds)
- Physical pain or illness
- Unmet communication or emotional needs
Escalation
Without appropriate intervention immediately after the trigger, the person’s behaviour will enter the second stage. In this phase, the signs that the person is becoming distressed or agitated are visible and lead to escalation.
In this stage, an Autistic person, or a person with/or without a learning disability, may show obvious signs of irritation and hostility, such as clenching their fists, muttering, and grumbling. As a person’s agitation increases, they may leave their seat, start arguing, or refuse to respond to others.
Behaviour may include:
- Increased fidgeting or pacing
- Raised voice, muttering, or verbal outbursts
- Tensing, clenching fists, or sudden gestures
Crisis
When the person reaches the crisis stage of challenging behaviour, they enter a fight-or-flight state. In this phase, behaviour reaches its highest intensity and may pose a risk to the person or others.
Examples include:
- Physical aggression (hitting, kicking, biting)
- Severe self-injury (head banging, scratching)
- Destruction of property
Read more about how PBS helps in crisis situations and what strategies can be used for reaching positive outcomes.
Recovery/De-escalation Phase
In the final stage of the challenging behaviour cycle, the situation has de-escalated, and the person slowly begins to calm down and regain self-control.
Behaviour may still show signs of distress:
- Withdrawal
- Low mood or tearfulness
- Quiet restlessness
As people return from a crisis state to normal functioning, they may feel remorse for their actions, cry, or fall asleep.
ABC Charts for Challenging Behaviour
An ABC chart (Antecedent-Behaviour-Consequence) is a practical tool used in health and social care to understand challenging behaviour. It helps staff and support teams identify triggers, behaviours, and outcomes, which is essential for creating effective Positive Behavioural Support (PBS) plans.
This model educates family members, teachers, and carers to identify the causes of challenging behaviour, create approaches to prevent or reduce it, and encourage positive behaviour instead.
The ABC approach breaks down challenging behaviour into three main elements: antecedents, behaviour, and consequences.
Antecedents (A)
Antecedents are any actions that occur immediately before the behaviour that challenges. The meaning behind it: What happens before the behaviour. What provokes the behaviour, what are the triggers, environmental factors, or interactions?
Common examples of antecedents include:
- Specific tasks or demands
- Topics of conversation
- Exposure to sensory input
Behaviour (B)
Behaviour is the behaviour itself —the observable action: aggression, self-injury, shouting, withdrawal, etc.
Children, young people, and adults with learning disabilities may behave in a challenging way because they struggle to communicate their needs or emotions conventionally. These behaviours may involve verbal outbursts, physical aggression, or non-person-directed behaviour.
Consequences (C)
Consequences mean: What happens after the behaviour—how staff, peers, or the environment respond, which can reinforce or reduce the behaviour. This category includes carers who give attention, remove specific demands or activities, or grant access to desired objects in response to challenging behaviour. While antecedents turn on challenging behaviours, consequences aim to turn them off.
Preventing and Managing Challenging Behaviour
Preventing and managing challenging behaviour is a cornerstone of high-quality, person-centred care in UK health and social care services. The approach focuses on understanding the reasons behind a child’s challenging behaviour, reducing triggers, and promoting positive alternatives, rather than simply reacting when incidents occur.
Besides identifying and understanding the root causes of the behaviour, teams need to be focused on proactive strategies to prevent it. Core proactive strategies include communication-focused support, environmental adaptations, building relationship and trust, and early intervention (recognising the escalation cycle), crisis management, and post-crisis support. This humanised approach seeks to reduce challenging behaviour by improving the person’s quality of life rather than trying to “fix” them.
Read more on what our Restrictive Practice Lead, George Rickard, has to say on building better care through using least-restrictive practices.
Implementing Positive Behaviour Support (PBS) in Challenging Behaviour Management
PBS is the gold-standard framework recommended across UK health and social care. It is endorsed by NICE, Skills for Care, and the CBF.
PBS focuses on:
- Understanding the function of the behaviour.
- Preventing behaviour through proactive environmental and communication strategies.
- Teaching new, alternative skills (e.g., asking for help, requesting breaks).
- Ensuring the person’s quality of life improves, not just the behaviour, reduces.
- Reducing the use of restraints or medication.
In health and social care teams, PBS plans are usually developed by multidisciplinary professionals, including speech and language therapists, occupational therapists, and behavioural practitioners, alongside families and frontline staff.
How Can Leaf Complex Care Support You?
At Leaf Complex Care, our mission is to provide specialist support for children, young people, and adults with neurodevelopmental differences when they need it the most.
Meet Mitch
After facing challenges with his mobility and behaviour, Mitch now lives in a home that reflects his needs, choices, and aspirations. With compassionate, person-centred support, his daily life is filled with purpose, from bowling and park walks to visiting museums and enjoying the calm of his routine.
Through Positive Behaviour Support, a holistic care plan, and a focus on positive risk-taking, Mitch has grown more independent, confident, and settled. Today, he lives a life in which his voice truly guides his care, surrounded by a team that believes in his potential.
💚 What does it mean for Mitch to live a life of his choosing?
Watch here.
We provide tailored support for people with multiple needs in complex situations across the UK, and you can find our offices in Bristol, Slough, Somerset and the Midlands.
