4: Find the Purpose

Goal: learn how to figure out the consequences or purposes of problem behavior in persons with dementia
Understand the common purposes of problem behavior
Practice determining the purpose of behaviors via scenarios

Common Purposes of Problem Behavior in Demented Elderly

Reducing stimulation

Does the behavior occur when there is lots of activity in the person’s environment (e.g., loud TV or music, people talking)?
Does the behavior stop when the patient is moved to a quiet environment?

*If you answer “yes” to both of these questions, chances are the purpose of the behavioral challenge is to reduce stimulation.

Increasing stimulation

Does the behavior occur when there is little going on in the person’s environment?
Would the behavior continue if no one was around?

*If you answer “yes” to both of these questions, chances are that the purpose of the behavior is to increase stimulation.

Escaping from an unpleasant situation

Does the behavior occur when you make a request (e.g., asking the patient to move to another location)?
Does the person look upset right before or during the behavior?

*If you answer “yes” to both of these questions, chances are that the purpose of the behavior is to escape an unpleasant situation.

Getting attention from others

Does the behavior occur when you stop paying attention to the patient?
Do you or other staff end up spending more time with the person when and/or after the behavior occurs?

*If you answer “yes” to both of these questions, chances are that the purpose of the behavior is to get attention from others.

RIEG Record Form

	Reducing stimulation	Increasing stimulation	Escaping from an unpleasant situation	Getting attention from others
Behavior 1
Behavior 2
Behavior 3
Behavior 4
Behavior 5

Exercise

Use the above form to record what is the purpose of each behavior
Click = to compare your choices to answers.

Yelling out loud “help, help” whenever the roommate plays music or turning TV on. = Increasing stimulation

Yelling out loud “help, help” after lunch when residents in a NF are back in their rooms for a nap/quiet time. = Reducing stimulation.

Running between room and nurse station multiples time during the day and knock things off the desk at nurse station each time. = Getting attention from others.

Hiding under the bed, every other day before shower time. = Escaping from an unpleasant situation.

Touching every staff when they walk by in a hall. = Getting attention from others.

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While the consequences or purposes of problem behavior in persons with dementia might seem endless, behavior scientists have narrowed these to just four: (1) Reduce stimulation; (2) increase stimulation; (3) escape from unpleasant situations; and (4) attention from others. Bear in mind that a specific behavior might serve more than one purpose; this is especially the case with persons in the later stages of dementia, as their repertoires become extremely limited and they try to make the best with what abilities they have left.

When determining whether the purpose of behavior is to reduce stimulation; increase stimulation; escape from an unpleasant situation; or get attention from others; the following questions will serve as a guide.

Reducing stimulation

(A) Does the behavior occur when there is lots of activity in the person’s environment (e.g, loud TV or music, people talking)?
(B) Does the behavior stop when the patient is moved to a quiet environment?

*If you answer “yes” to both of these questions, chances are the purpose of the behavioral challenge is to reduce stimulation.

Increasing stimulation

(A) Does the behavior occur when there is little going on in the person’s environment?
(B) Would the behavior continue if no one was around?

*If you answer “yes” to both of these questions, chances are that the purpose of the behavior is to increase stimulation.

Escaping from an unpleasant situation

(A) Does the behavior occur when you make a request (e.g., asking the patient to move to another location)?
(B) Does the person look upset right before or during the behavior?

*If you answer “yes” to both of these questions, chances are that the purpose of the behavior is to escape an unpleasant situation.

Getting attention from others

(A) Does the behavior occur when you stop paying attention to the patient?
(B) Do you or other staff end up spending more time with the person when and/or after the behavior occurs?

*If you answer “yes” to both of these questions, chances are that the purpose of the behavior is to get attention from others.

Of course the behavior can serve multiple functions in different situations. Yelling, for example, might attract the attention from others in one setting while getting people to back off with their requests in another. Technically speaking, although the topography of the behavior looks identical, it can serve different functions in different settings.