Introduction

The following modules are designed to teach you about nonpharmacological, restraint-free approaches to managing challenging behaviors in persons with dementia. It is our aim that by the end of this course, you will see challenging behavior differently. As individuals become more impaired by the dementing process, they lose their ability to communicate. Because individuals can’t tell you what’s bothering them, their challenging behavior might be the only way they can communicate to you that something is wrong. Taking away their ability to communicate by using powerful medications to sedate them simply masks their problems and may not reduce suffering. If an individual were in, say, significant pain, prescribing a benzodiazepine or atypical antipsychotic medication might suppress their challenging behavior but will have little or no impact on their experience of pain.

In this context, those powerful medications are a form of chemical restraint because they suppress a patient’s ability to communicate in the only way possible: Through their behavior.

This program will walk you through the steps of first, describing the challenging behavior in specific and simple language. When scientists describe the behavior of organisms, for instance, they don’t talk about intentions, but rather they describe the organism’s behavior clearly and in measurable terms. In the spirit of this, we would like you to adopt this strategy in how you communicate with other professionals.

We will talk about things to look for in ruling out medical conditions that might be contributing to behavioral challenges, like infections or adverse reactions to medication changes. Following a discussion on medical rule-outs, we will then discuss the behavioral or non-pharmacological approach to managing behavioral challenges. Ultimately, we would like to teach you to have a better understanding of the underlying principles that guide behavioral interventions. Techniques themselves are meaningless if you don’t understand the reason for using them and in what contexts.