Quality statement 7: Assessing possible triggers for behaviour that challenges

Quality statement

People with autism who develop behaviour that challenges are assessed for possible triggers, including physical health conditions, mental health problems and environmental factors.

Rationale

People with autism can sometimes present with behaviour that is challenging to manage. The causes of behaviour that challenges for a person with autism can be multifactorial, and can involve physical health conditions, mental health problems and environmental factors (that is, relating to the person's social or physical environment). An assessment should take all these factors into account, and also consider the risk of harm to the person and others, before appropriate interventions are agreed for the behaviour and any identified physical health conditions or mental health problems.

Quality measures

Structure

Evidence of local arrangements to ensure that people with autism who develop behaviour that challenges are assessed for possible triggers, including physical health conditions, mental health problems and environmental factors.

Data source: Local data collection.

Process

The proportion of people with autism who develop behaviour that challenges who are assessed for possible triggers, including physical health conditions, mental health problems and environmental factors.

Numerator – The number of people in the denominator who are assessed for possible triggers, including physical health conditions, mental health problems and environmental factors

Denominator – The number of people with autism who develop behaviour that challenges.

Data source: Local data collection. Included in NICE clinical audit tool: Autism in adults: challenging behaviour audit standards 1 and 2.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that there is staffing capacity and capability so that people with autism who develop behaviour that challenges are assessed for possible triggers, including physical health conditions, mental health problems and environmental factors.

Health and social care practitioners ensure that people with autism who develop behaviour that challenges are assessed for possible triggers, including physical health conditions, mental health problems and environmental factors.

Commissioners work with provider services to ensure that there is sufficient staffing capacity and capability so that people with autism who develop behaviour that challenges are assessed for possible triggers, including physical health conditions, mental health problems and environmental factors.

What the quality statement means for service users and carers

People with autism who behave in a way that other people find difficult (for example, becoming very upset or aggressive) have an assessment that looks for possible reasons why they are behaving in this way. These might include other physical health conditions and/or mental health problems, or any changes to their environment (for example, at home, school or work).

Source guidance

  • Autism: the management and support of children and young people on the autism spectrum (NICE clinical guideline 170), recommendation 1.4.1 (key priority for implementation), 1.4.2 and 1.4.3

  • Autism: recognition, referral, diagnosis and management of adults on the autism spectrum (NICE clinical guideline 142), recommendations 1.2.20 and 1.5.1

Definitions of terms used in this quality statement

Behaviour that challenges

This is defined as culturally abnormal behaviour(s) of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit use of, or result in the person being denied access to, ordinary community facilities.

[Taken from the Challenging Behaviour Foundation: Emerson, E (2001) Challenging Behaviour: Analysis and intervention in people with learning disabilities. Cambridge: Cambridge University Press]

Assessment for possible triggers

Children and young people

Assess factors that may increase the risk of behaviour that challenges in routine assessment and care planning in children and young people with autism. If a child or young person's behaviour becomes challenging, reassess factors identified in the care plan and assess for any new factors that could provoke the behaviour, including:

  • impairments in communication that may result in difficulty understanding situations or in expressing needs and wishes

  • coexisting physical disorders, such as pain or gastrointestinal disorders

  • coexisting mental health problems, such as anxiety or depression, and other neurodevelopmental conditions such as ADHD (attention deficit hyperactivity disorder)

  • the physical environment, such as lighting and noise levels

  • the social environment, including home, school and leisure activities

  • changes to routines or personal circumstances

  • developmental changes, including puberty

  • exploitation or abuse by others

  • inadvertent reinforcement of behaviour that challenges

  • the absence of predictability and structure.

[Adapted from Autism: the management and support of children and young people on the autism spectrum (NICE clinical guideline 170), recommendations 1.4.1–3]

Adults

Before starting other interventions for behaviour that challenges, assess for any factors that may trigger or maintain the behaviour, including:

  • physical disorders

  • the social environment (including relationships with family members, partners, carers and friends)

  • the physical environment, including sensory factors

  • coexisting mental disorders (including depression, anxiety disorders and psychosis)

  • communication problems

  • changes to routines or personal circumstances.

[Adapted from Autism: recognition, referral, diagnosis and management of adults on the autism spectrum (NICE clinical guideline 142) recommendation 1.2.20]