Behavior Management

Behavior management refers to a class of therapeutic techniques for altering behavior by changing one or more aspects of an individual's environment. The aspects that are changed are those believed to contribute most significantly to the occurrence or maintenance of behaviors that are problematic for the individual himself/herself or for other individuals in the environment. Environmental changes are also made for the purpose of increasing positive behaviors that are considered desirable or adaptive. Behavior management techniques have been used most often with older adults to decrease problem behaviors that result from dementing illnesses, such as Alzheimer's disease (AD). Behavior problems associated with dementia are very common and place a great deal of stress and burden on the people who care for these elders. Behavior problems associated with dementia include disruptive vocalization (e.g., repetitive questions, cursing, chronic screaming), physical aggression (e.g., hitting, pinching, biting), and motor restlessness (e.g., wandering, inappropriate disrobing). Techniques that focus on environmental change are used with older adults who have dementia because their cognitive limitations (e.g., problems with memory and abstract reasoning) often prohibit the use of other therapeutic techniques, such as cognitive-behavioral or insight-oriented therapy, that rely on more complex cognitive abilities for success.

Behavior management techniques are derived from Albert Bandura's social learning theory, which asserts that observable behaviors emerge from an interaction between the person and environmental events. Antecedent events precede a behavior in time and can elicit the behavior or decrease the probability that a behavior will occur. For example, approaching a dementia patient from behind (antecedent) can startle the patient and elicit physical aggression (problematic behavior). Conversely, if a patient appears anxious, using calming speech and soothing touch (antecedent) can prevent physical aggression (problematic behavior) from occurring. Environmental events that follow a behavior in time (i.e., consequent events) can similarly increase or decrease the probability that the behavior will continue once it occurs or that it will reoccur in the future. For example, if the therapeutic goal is to increase an isolated nursing home resident's social interactions with other residents, staff provision of positive attention (consequent) when the resident interacts socially can serve to reinforce or increase the probability of the resident's interaction (desirable behavior). Conversely, if a resident becomes agitated during a social situation, relocating the resident to his/her bedroom (consequent) can serve to suppress the agitation, or decrease the probability that it will reoccur during similar social situations (desirable behavior).

Thus, behavior management techniques can be classified into two categories: (1) antecedent strategies, which are used before a behavior occurs in an effort to prevent or elicit a behavior, and (2) consequent strategies, which are used after a behavior occurs in an effort to prevent the continuation and recurrence of a behavior or to reinforce a behavior. Although both can be effective, antecedent techniques are used more often than consequent strategies with older adults because they are easier to apply, require less caregiver time, and are generally considered less manipulative, and therefore more acceptable, by caregivers and professionals.