Behaviours of Concern and Positive Behaviour Support

People may exhibit behaviours of concern for various reasons and it's important to understand that behaviour is complex and can be influenced by a combination of factors.

Here are some common reasons why individuals may engage in behaviours of concern:

• Communication difficulties - Individuals who struggle with verbal communication may use behaviours of concern to express themselves.  Comprehension difficulties can lead to misunderstandings. Underestimation of the individua's communication abilities can further compound the individual's frustration and social isolation. This could be due to developmental disorders like autism, cerebral palsy or in situations where language barriers exist. Behaviours such as aggression or self-harm can be manifestations of their inability to convey feelings of frustration, pain, or need for assistance.
• Unmet needs - Behaviours of concern often stem from basic unmet needs. For instance, a child might act out when hungry or tired, while an adult may exhibit challenging behaviours if they feel isolated or neglected. Sensory needs are also significant; some individuals might seek specific sensory input (like certain textures or movements) or may be overwhelmed by sensory overload, leading to distress and problematic behaviours.
• Lack of social skills - Difficulty in social interactions can lead to frustration and behaviours of concern. This is particularly true for those with social skill deficits, such as individuals on the autism spectrum. They might struggle with understanding social cues, leading to inappropriate responses or interactions that are perceived as problematic.
• Difficulties with emotional regulation skills - Individuals who have trouble managing their emotions, such as those with anxiety, depression, or certain neurodevelopmental disorders, might display behaviours of concern as a coping mechanism. Emotional dysregulation can result in outbursts, aggression, or withdrawal as a way of dealing with overwhelming feelings.
• Environmental factors - The surrounding environment plays a crucial role in behaviour. Chaotic, loud, or unpredictable settings can be overwhelming, especially for those with sensory sensitivities. Conversely, environments that are too unstimulating can also lead to behaviours of concern as individuals seek to create stimulation or excitement.
• Learning and cognitive challenges - People with neurodevelopmental disorders, learning disabilities, or cognitive impairments (e.g. Dementia or Acquired Brain Injury) may find it difficult to understand and navigate their environment. This can lead to frustration and behaviours of concern, as they might not fully grasp social norms or might find routine tasks challenging.
• Health related issues- Physical discomfort, illness, or mental health issues can manifest as behaviours of concern. For example, a person in pain might become irritable or aggressive, while someone with a mental health issue like depression might withdraw or exhibit self-injurious behaviour.
• Attention seeking- Some individuals might engage in behaviours of concern to attract attention. This can be due to feeling neglected or overlooked; in such cases, even negative attention can be perceived as better than no attention at all.
• Modelled behaviour - Behaviours can be learned through observation and imitation. If an individual is frequently exposed to certain behaviors, especially in family or close social circles, they might mimic these, even if they are problematic.
• Reinforcement - Behaviours that are reinforced, either positively or negatively, are likely to be repeated. For example, if a child throws a tantrum and is then given what they want, they learn that this behaviour is an effective way to get their needs met.
• Lifestyle factors - Lifestyle choices like lack of sleep, excessive screen time, poor diet, and a sedentary lifestyle can all contribute to behaviours of concern. Fatigue, low energy, and lack of physical activity can lead to irritability, lack of focus, and general disengagement.
• Social environment - Changes in family dynamics, routine, or social settings can trigger behaviours of concern. This includes situations like family disharmony, bullying, or trouble at school. These changes can create feelings of instability, stress, or insecurity, leading to challenging behaviours as a way to cope with the emotional turmoil.

At School / In Education

At school and in education generally, disruptive behaviours can interfere with learning and can often lead to academic underachievement. Behaviours of concern often prevent the child, and to a lesser extent those around them, from focusing in class and engaging with the learning.

If the behaviour leads to disciplinary actions such as suspensions or detention (often to protect the learning of others in the classroom) then the child’s learning is obviously adversely affected.

The stigmatisation that often follows such actions sometimes leads the child to be labeled by teachers and peers as ‘badly behaved’. This social conflict can cause the child to be rejected and excluded which can lead to lowered self-esteem and isolation.

The behaviour of concern itself and associated stigmatisation, detentions suspensions and/or school expulsion can all lead to long term problems. 

At Work

Similarly to school, behaviours of concern affect performance at work, workplace relationships and may even lead to disciplinary action.

If the behaviour of concern hinders or prevents the individual from doing their work well, or doing their work at all this is likely to limit career opportunities or even result in concerns being raised by colleagues.

In a team setting, the behaviour itself and / or lack of productivity could strain workplace relationships or even lead to conflicts with colleagues and supervisors.

Ultimately, the culmination of these factors could lead to disciplinary action or dismissal. None of this helps to address the behaviour of concern and its underlying cause.

At Home / With Family

Behaviours of concern can place significant stress on family relationships. For example, parents might find their relationship strained by behaviours of concern in a child or young person in their care. The potential breakdown of the family unit is a real concern.

Family members are often in the role of ‘caretaker’ and they may experience increased levels of personal stress, burnout or mental health issues of their own in the course of caring for and managing someone exhibiting behaviours of concern.

In severe cases, behaviours like aggression or self-harm can pose safety risks to the individual and family members.

With Friends

Behaviours of concern often lead to social isolation because they can disrupt the course of making and maintaining friendships. Peers may reject the individual if they find their behaviour offensive or unsafe. This has a significant emotional and well-being impact on the person.

Limited social interactions can then lead to limited opportunities for getting out into community or wider society, meeting new opportunities or forming healthy relationships.

In Wider Society

Aggression, violence, physical damage to property, substance abuse, sexualised and inappropriate behaviours can have consequences with the law. For adolescents and adults repeated behavioural issues may result in involvement with the juvenile justice system. 

On the flip side, some behaviours of concern may cause an individual to become vulnerable to new threats from society such as emotional manipulation or social fraud in person or online.

Hence, it is important to intervene early and provide appropriate support to address behaviours of concern effectively and mitigate potential negative consequences.  A commonly used approach for behaviour change intervention is called Positive Behaviour Support which can lead to better outcomes for the individual and others supporting them in the long term. 


PBS achieves this by identifying and understanding the root causes of the behaviour of concern. Based on this understanding PBS then uses a person-centred and strength-based approach to:

• Address the underlying causes of behaviours of concern
• Better meet the individual’s needs to foster well-being
• Reduce the likelihood of behaviours of concern
• Reduce and eliminate the need for restrictive practices
• Provide tailored supports to help the individual develop skills that maximises their participation, independence and development across multiple domains and
• Elevate the quality of life for both the individual and those that support them.

When it comes to the National Disability Insurance Scheme (NDIS), PBS is the approach that is used in supporting individuals who exhibit behaviours of concern.

These professionals may include: Behaviour Support Practitioners, Board Certified Behaviour Analysts, Educators and other professionals supporting individuals with emotional and behavioural difficulties in school, clinical, justice or other therapeutic settings.

In the context of NDIS, a NDIS Registered Behaviour Support Practitioner is able to assist.

The PBS professional will collaborate with the individual, family members, educators, medical professionals, allied health professionals and support staff in all aspects of the PBS process as a team.

What is the PBS process?

At Behaviour Help we have created ‘The Behaviour Help Cycle’ to explain the PBS process step by step.

The team led by the PBS professional uses a person-centered approach which involves the individual being at the center of the decision-making process. By having the individual at the forefront, it enables the team to seek out, understand and plan services based on the individual’s needs, preferences and goals. 

By using a person-centered team approach the following outcomes are achieved:

• Quality of Life: Improvement in various aspects of the individual’s well-being including physical health, mental well-being, social connections, economic security and overall satisfaction with life. 
• Choice & Control: Increase in the individual’s autonomy and freedom to make decisions about the various aspects of their life and circumstances.
• Meeting Needs: Individual needs such as food, shelter, safety, healthcare, education and social belonging being met.
• Rights & Respect: Being respected for their diversity, and better safeguarding of human rights such as freedom of expression, equality before the law and the right to live free from discrimination and violence.

Step 1 – Complete Assess Stage

The Assess Stage involves completing a Functional Behavioural Assessment (FBA). FBA is a systematic process of gathering information about the individual, recording behavioural data and analysing data to gain insight into the factors contributing to the behaviours of concern. 

Based on this analysis, reasons why the individual may be engaging in these behaviours (i.e., the “function/s” of the behaviour) are hypothesised. The collated information helps the team better understand the individual and the reasons for their behaviours of concern.

To complete the FBA the following are completed:

• Individual’s profile: Gather information about the individual to create a comprehensive picture of the individual, their context and systems of support.
• Behaviour data collection forms: Measurable details (e.g. frequency, intensity, duration) about the behaviours of concern are recorded by observing the individual in different settings. 
• Incident A-B-C: Incident details are recorded by reflecting on the antecedents (what preceded the behaviour), behaviours (describing the observable actions as they occurred) and the consequences (what happened after the behaviour).
• Hypothesis: By reflecting on both the qualitative and quantitative data the most likely purpose (i.e., function) that the behaviour of concern serves for the individual and what reinforces that behaviour to occur again can be determined. Some common functions of behaviours of concern include
• Communication: Behaviours of concern may occur as a way to communicate their needs, wants, or discomfort when they have difficulty expressing themselves verbally.
• Escape/Avoidance: Behaviours of concern may occur to escape or avoid certain situations, tasks, or demands that the individual finds overwhelming, unpleasant, or anxiety-provoking.
• Attention-Seeking: Behaviours of concern may occur to gain attention from others, whether it's positive or negative attention. This could be due to feeling neglected or seeking social interaction.
• Sensory Stimulation: Behaviours of concern may occur behaviours may provide sensory stimulation or relief from sensory overload. Individuals might engage in repetitive behaviours or self-stimulation to regulate their sensory experiences.
• Tangible/Access: Behaviours of concern may occur can occur when individuals want access to specific items, activities, or privileges that they desire but are not readily available to them.
• Self-Regulation: In some cases, behaviours of concern serve a self-regulatory function, helping individuals cope with stress, anxiety, or emotional dysregulation by providing a means of expressing and managing their emotions.

Information gleaned from the assess stage contributes to the next two stages: manage and prevent stages that together form an individualised positive behaviour support plan.

Step 2 – Complete Manage Stage

The Manage Stage in the positive behaviour support plan aims to provide a structured approach to behaviour management. This is achieved by helping the team better understand the individual’s emotional and behavioural needs, recognise the pattern in the individual’s stages of escalation and use stage specific behaviour management strategies to respond in ways that safely de-escalate the situation in the least disruptive manner.

To complete the manage stage the following are completed;

• Number of escalation stages: This helps those supporting the individual recognise the number of stages the individual typically exhibits as their emotional intensity rises (i.e., mild escalation, moderate escalation, extreme escalation and recovery stage).
• Escalation stages description: This assists those supporting the individual in recognising what nonverbal and/or verbal behaviours are exhibited in the different escalation stages and how long each escalation stage typically lasts.
• Stage-specific de-escalation: This provides stage specific de-escalation strategies to those supporting the individual to respond early in ways that can safely defuse, redirect and de-escalate the situation in the least disruptive manner. If authorised restrictive practices are to be used, then clear procedures for these practices are included.

Information gleaned from the assess and manage stage also contributes to the development of targeted interventions in the prevent stage.

Step 3 – Complete Prevent Stage

The Prevent Stage in the positive behaviour support plan aims to help the team develop consistent preventative strategies across settings that minimise or avoid triggers that prime or reinforce the behaviours of concern. 

As well as enable the team members to teach and reinforce the development of new skills and alternative behaviours that serve the same function as the behaviour of concern, to maximise the individual’s participation, quality of life, independence and development across multiple domains.

To complete the prevent stage the following are completed:

• Supportive environments: Equips those supporting the individual with strategies on how to tailor indoor and outdoor spaces to support diverse sensory, accessibility, physical and emotional regulation requirements.
• Supportive activities: Equips those supporting the individual with strategies on how to tailor activity scheduling, activity resources, activity design and activity engagement to meet the individual’s needs, abilities and preferences.
• Supportive interactions: Equips those supporting the individual with strategies to promote communication that is clear, fair, empathetic, collaborative and responsive to foster respectful relationships.
• Teaching skills - Equips those supporting the individual with person-centred SMART goals, associated teaching approaches and positive reinforcement methods to help the individual learn functionally equivalent replacement behaviours (FERBs) and new skills.  FERBs are contextually appropriate alternative behaviours that fulfill the same underlying need or function of the the behaviours of concern. By helping the individual develop FERBs it helps reduce the likelihood of behaviours of concern which allows for the fading out or eliminating the need for restrictive practices.  Teaching the individual new skills can build their independence, participation and wellbeing. These can include communication, social, adaptive, cognitive, sensory, physical, play, academic, self-regulation, employment and daily living skills.

Step 4 – Continuous Review Cycle

Ongoing monitoring is critical to ensuring the team has a shared understanding of the effectiveness of the PBS plan.  By reviewing the behaviour data collection forms, incident forms and tracking progress towards SMART goals adjustments can be made as needed.  Hence, by using a data driven approach measured steps towards reducing restrictive practices can take place.  

By continuing to complete the behaviour data collection forms and incident forms in the assess stage and tracking progress towards SMART goals in the prevent stage progress can be measured. Hence, by using data to inform a theoretically driven and ethically sound Positive Behaviour Support plan can be implemented and take measured steps toward reducing restrictive practices.