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Rip it up
Destructive behaviour is distressing, expensive and hard to manage, yet often a feature of caring for someone with profound learning disability . What can we do to reduce it?
Charlie is tall, blond and handsome and has a cheeky personality. He also has autism, is non-verbal and due to cerebral palsy is dependent on others for many of his daily needs. He has made significant steps to be more independent; his wheelchair is self-propelled and he can help with personal care, with eating and drinking and with other activities.
Of all of Charlie’s foibles and quirks, the one that his carers struggle most with is his habit of ripping things up. He can reduce a duvet set to ribbons in five minutes flat, which coincidentally is the time it takes for the team to be alerted to his being awake in the morning. He has curtains on Velcro, but these are also regularly in tatters and as for pyjamas, well, let’s just say sleeping au naturel seems to be the preferred option for Charlie.
The manager of his care home estimated that she has replaced about 11 duvet sets, 20 plus towels and three sets of curtains in the three weeks since Charlie moved in. Charlie is challenging, engaging and charmingly costing her the earth.
Hey, look at me!
So why does he engage in such destructive behaviour? Well, some of the care team feel that it is his way of getting staff attention (it works!) and speeding up the response of carers. He wakes up, nobody is about to help him, so he does something that will guarantee a swift response.
If this is indeed the motivation, staff need to look at the circumstances this behaviour occurs in to confirm their hypothesis. For example, does Charlie ever engage in the ripping behaviour when he is in company and engaged in other activities, with full staff attention? What is going on when the behaviour happens? Following the theme, what happens when he rips things up? What is his reward?
Feedback from touch
Another school of thought is that he is engaging in self-stimulatory behaviour. The act of tearing things gives him pleasurable sensory feedback. The resistance of the fabric, the physical effort needed to tear it, the sound of the tearing might all be highly stimulating. In examining this theory, staff need to consider again the circumstances in which the behaviour occurs and whether the consequence of the behaviour is likely to have an impact on its frequency.
What can we do?
There are obviously many other possible reasons that need to be explored, but I suppose the point is that buying strong sheets or removing the opportunity to engage in ripping by taking away the materials altogether is not providing a solution. Somewhere in Charlie’s world there has to be understanding and acceptance of what he is communicating and when we reach that acceptance and understanding, we need to use strategies to remove the negative impact of his behaviour.
We can work on more acceptable ways to communicate ‘hey guys, I’m awake! I need to get up now!”
We can find a heap of things that we need shredding, like waste paper or old rags.
We can engage the help of occupational therapists and psychologists to help unravel the mysteries of sensory seeking behaviour.
The outcome for Charlie depends on our being open-minded and seeing past the problem towards the best solution for everyone.
More on sensory seeking in this blog post.