Question
How can we apply the "ABC Method" to challenging behavior exhibited in patients with dementia?
Answer
When examining challenging incidents, we are going to follow the “ABC” method.
Antecedent (A)
The antecedent, as I mentioned before, is what happened right before the behavior. When you take the opportunity to look closely at an incident, most of the time you can find the antecedent. For example if there was a loud bang, the intercom went off, or the person was participating in range of motion with a therapist just prior to incident, those could be the “antecedents”. Whatever happened just prior to the event is what we need to be clear on.
Behavior (B)
- What was the behavior?
- Objective, concrete descriptions.
Often we use the word “combative” when describing the behavior. What does combative mean? What exactly happened? We really need to be very specific. “The client hit the staff member during a shower or peri-care”, or “the individual kicked or pinched the staff while getting dressed”. Be as specific as possible when describing what happened.
- Identify the frequency, scope, and duration.
It gives us a lot more ability to be more accurate if we can measure exactly what happened.
- Identify any warning signs.
Was there a warning sign? If we were to interview that staff member that got hit or bit, we ask questions such as: “Did you notice the patient becoming more restlessness?”, “Were they making less eye contact with you?”, or “Did they tell you to stop?”. Did they have less vocalization when they usually are more verbal? Generally there are warning signs before the behavior comes out.
Consequence (C)
- What were the consequences of the behavior?
- Did they become very angry after they hit the individual?
- Did the client calm down very quickly or were they upset for some time?
- Was anyone injured?
- Were there any safety considerations?
These are some of the common things we ask.
Dealing with Challenging Behaviors:
When dealing with challenging behaviors, we always want to observe, assess and record the client’s behavioral patterns in these stressful situations. Some of the things that you can do to track are create a tracking log. Your facility or organization may already have a tracking log available. With the tracking log, some of the critical pieces that need to be present there are: what time did the incident happen, what is the observed activity or behavior, what was the trigger, what actually started it, what was the intervention that actually stopped it, and what time elapsed before stopping that behavior. When the behavior actually escalates into a challenging incident, it is really important that we find the best way to calm the client. By keeping a record like this, we can find out what works. None of us are involved with an individual 24 hours a day so this gives a way to keep track and communicate with each other more effectively.
When dealing with a challenging behavior, we want to give the client as much control as possible. We want to make sure that we are not making too many demands on them. We want to focus on: did they react differently in the situation in the past, is this a new reaction, or were there major changes to the client’s surroundings or routine recently. Structure, order and consistency are very important for these clients.
