Individuals with intellectual disabilities and/or developmental disabilities (I/DD) are initially identiﬁed based on cognitive functioning and/or deﬁcits in adaptive functioning. However, this population frequently also presents a range of inappropriate and maladaptive behaviors. Common maladaptive behaviors exhibited by individuals with I/DD include physical aggression, verbal aggression, self-injurious behavior, elopement, socially unacceptable behavior, and disruptive behavior. It is estimated that approximately 30 percent of adults with I/DD exhibit challenging behavior, though some estimates of speciﬁc behavior, such as aggression, are as high as 45 percent.¹ Many of these behaviors become barriers to an individual’s access to opportunities such as employment, and to their full inclusion in their communities.
The underlying causes of maladaptive behavior exhibited by an individual with I/DD are generally diﬃcult to pinpoint, as challenging behavior can be caused or exacerbated by a combination of factors, including medical conditions (e.g. constipation, an earache), environmental factors (e.g., boredom, social isolation), and/or a mental health condition. Individuals with I/DD, who often have impaired expressive language skills, frequently use behavior to communicate a need or want. It is widely accepted that if an individual exhibiting a challenging behavior continues to engage in the behavior of concern, then they are getting a need met through the behavior; in other words, the behavior is functional for the person.
According to Positive Behavior Supports Guidelines published by NASDDDS² , “it must be understood that all human behavior is purposeful and goal-oriented, although the purposes or goals of each behavior may not be readily perceived”.³ Individuals with I/DD use behavior to access things or activities they want, to gain attention from their loved ones and/or caregivers, to stop engaging in a task or activity that has become boring or uncomfortable, and/or to avoid a situation or activity that they do not like or that causes them anxiety or discomfort. Therefore, it is not enough to simply “get rid of” a behavior. It is also important to teach an individual a new behavior, one that is more appropriate and also helps them get their needs/wants fulﬁlled. It is not ethical to remove a behavior that is functioning for an individual without teaching them a replacement, or alternative, behavior that functions in the same manner.
Oftentimes, individuals with I/DD have exhibited and practiced maladaptive behavior for lengthy amounts of time across environments, and as noted above, the behavior works for them. Perhaps the behavior is not dangerous, but is instead socially unacceptable, annoying, and/or irritable to those around the person. Less intense behaviors can also be barriers to the individual accessing their community, making friends, and/or getting a job. In order for behavior change to be meaningful and eﬀective, thereby allowing the individual more opportunities for full participation in their community and/or preventing the need for a more restrictive environment (e.g., psychiatric hospital), behavior intervention and support should be proactive, timely, and comprehensive. Many times, behavior intervention is reactive—services are sought only after an individual’s behavior has become dangerous to themselves or others—and there have likely been numerous opportunities to intervene prior the behavior reaching this level. Those who support individuals with I/DD, including family caregivers as well as paid staﬀ, have opportunities each day to positively and proactively support behavior management. Oftentimes, however, these staﬀ and caregivers are not equipped with the most eﬀective strategies or they have not had enough practice using the strategies that are most eﬀective with the individuals they support.