Today I want to talk about a very important distinction when it comes to responding to a “difficult dementia behavior". This can be the difference between your loved one continuing to engage in the behavior even more often or getting them to greatly reduce their behavior.
If you would rather watch a video on this topic, click here.
I was reviewing a book recently. I read it before, but I wanted a refresher and this just popped out to me. I can’t believe I haven't shared this before. It’s wonderful and I’ll link the book here if you want to check it out yourself.
I’m going to share the difference between ignoring a behavior and acknowledging a behavior and how ignoring a behavior will likely make it worse. Then, I’ll share the 3 steps you can take to make sure you aren’t contributing and reinforcing a difficult behavior. You’ll want to stay tuned to the end so you can learn how to apply these 3 steps to your situation!
First, let’s talk about ignoring a behavior. Many times when someone is doing a behavior that we find frustrating, bothersome, or annoying we may get to the point where we are so tired of it that we start to ignore it all together. While you might think ignoring a behavior is a great thing to do, in many cases it can make it worse.
Let’s say your loved one asks the same question over and over and over again. You’ve already answered the question 50 times today, your loved one forgets, you don’t want to keep answering it so you start ignoring the question. If your loved one continues to ask and ask and ask, perhaps even becoming more upset when they ask, chances are high that after another 50 times of them asking while you are ignoring them, you break down and answer it. Perhaps with more frustration and irritation than before, but you gave the answer. What you just did is REINFORCED THE BEHAVIOR. The person has just figured out that if they keep asking they’ll get the answer so even if you don’t answer after 20-30-40 times, after 50, you might. SO they keep asking.
Or let’s take this to the situation of a person with dementia living in a community living facility. They are in their room and pressing the call button. After the first several times of the staff checking on the person to realize they don’t really need anything, the staff stop checking after the call button is pressed. So the person with dementia continues to press it over and over and over again 5 mins, 10 mins, 15 mins, until finally....guess what? A staff member stops by the room. And bam, the behavior, repeatedly pressing the call button until someone arrives no matter how long, is reinforced.
SO ignoring the “problem” behavior isn’t really the answer. What can you do?
Here are 3 steps that Dr. Camp outlines in his book, "Hiding the Stranger in the Mirror".
Step 1: DO NOT REINFORCE THE BEHAVIOR.
For example, if someone keeps asking the same question about when it’s time to eat, you can respond with “What time do you think?” If they answer correctly, you can say, “That’s right. Now I need to finish up the project I’m working on" and then walk away.
Careblazer, feel free to adjust the response. I’m just laying the framework, you make the adjustment based on your situation.
Let’s say they don’t know the answer or give you the wrong answer. For example, your loved one keeps asking when it’s time to eat. When they ask you the question, you respond "what time do you think" and they say "I don’t know" or give you a time that’s way off. You can say, "Actually, we are eating at 5 o’clock. I'll be sure to come and get you when it's time to eat. Now I need to get back to work” and walk away.
This isn’t ignoring their behavior. But it’s also not reinforcing it by staying and engaging in a conversation about this same question. It’s a simple acknowledgment.
Step 2: PROVIDE REINFORCEMENT FOR WHEN THE BEHAVIOR IS NOT TAKING PLACE
All too often people with dementia are getting reinforced for their behavior accidentally, as I mentioned earlier. In Step 2, you want to find ways to reinforce when they are NOT doing the behavior. This allows them to learn that they can get attention, support, and answers to their common questions when they aren’t actually asking the question.
For example, sticking with the example of your loved one constantly asking when dinner is, you can find time during the day when they AREN’T asking about dinner and provide reassurance that dinner is happening at 5pm. You can notice when they aren’t asking the question and say, we are having chicken for dinner tonight at 5pm, I’ll be sure to come get you at that time.
Step 3: PROVIDE A MEANINGFUL ACTIVITY
This is a good step to use for so many reasons and in many different situations. As I mentioned before in THIS instagram post, someone with dementia who is engaged in a meaningful, enjoyable activity, can’t also be engaged in distressing behavior. And if you need a refresher on the various different types of meaningful activities that you can choose from, you’ll want to watch THIS video. When someone is engaged in doing something they actually enjoy doing, they aren’t thinking about and engaging in the behavior that you find frustrating so this is a worthwhile step to take some time thinking about.
Careblazer, that’s all I have for you today. I hope this helps you if you find that your loved one continues to ask the same question over and over again. There is certainly a fine balance between acknowledging the behavior and reinforcement the behavior.
You’ve got this, I believe in you!