Behaviours of Concern: Taking a Step Back
When a behaviour causes concern for family members, support workers, or clinicians, it can be tempting to focus immediately on stopping it. However, one of the most important questions Occupational Therapists can ask is:
"Is this behaviour actually harmful to the person, or is it simply different from what we would choose ourselves?"
This distinction is critical.
Many behaviours that attract attention are not necessarily dangerous, harmful, or reducing quality of life. Sometimes they are a form of communication, a sensory preference, a way of expressing identity, or simply a personal choice.
Looking beyond the behaviour
As humans, we naturally compare what we see to our own experiences and preferences.
When someone behaves differently from us, it can trigger an automatic reaction to correct, redirect, or prevent the behaviour. While often well intentioned, this response can sometimes overlook an important question:
What purpose is the behaviour serving for the person?
For example, someone may express a strong desire to shave their head.
A common response might be to discourage this, hide shaving equipment, or repeatedly tell them not to do it.
But before doing so, it is worth exploring the reasons behind the choice.
The person may:
Prefer the sensory experience of shorter hair
Find hair maintenance difficult
Enjoy the appearance
Want greater independence in self-care
Be expressing personal identity and autonomy
If the behaviour is not causing significant harm, the focus may be better placed on supporting the person to achieve their goal safely rather than preventing it altogether.
When restriction creates more problems
Attempts to stop behaviours without understanding their purpose can sometimes create additional challenges.
When people feel unheard or controlled, they may:
Become frustrated or distressed
Seek alternative ways to engage in the behaviour
Hide activities from supports
Experience reduced trust in those supporting them
Develop additional behaviours in response to restrictions
For example, a participant who is repeatedly told they cannot shave their head may begin attempting to do so privately, without support or safe equipment. This can increase risk and reduce opportunities for learning and collaboration.
Often, working with a behaviour rather than against it can lead to better outcomes for everyone involved.
A capacity building approach
Occupational Therapists aim to build skills, independence, and self-determination wherever possible.
Rather than focusing solely on stopping a behaviour, an OT may explore ways to support the person to communicate, plan, and engage safely.
Using the shaving example, supports may include:
Social stories and visual supports
A participant may struggle to explain exactly how they would like their hair cut.
An OT might develop:
A visual guide showing preferred hairstyles
A social story explaining the process
A laminated picture sequence for communicating preferences
Some participants may benefit from a simple diagram with hair illustrations that they can point to or pretend to shave, helping others understand the style they are aiming for. (See example below)
An visual created by a Fast Track Therapy OT to help a participant communicate what part of their body they would like to shave.
(Includes velcro images of “hair” that can be pulled off/placed on a photo of a man)
Equipment modifications
Safety can often be improved without removing choice.
Examples may include:
Electric shavers with safety guards
Adapted handles for improved grip
Mirrors and positioning supports
Step-by-step visual instructions
This allows the person to participate while reducing risk.
Building communication skills
Sometimes the issue is not the behaviour itself, but the way it is communicated.
An OT may work with the participant to:
Request support before shaving
Communicate preferences clearly
Discuss concerns with family or support workers
Plan grooming activities in advance
Positive reinforcement can then be used to encourage these communication skills.
For example, if a participant feels comfortable asking for assistance rather than shaving secretly due to fear of negative reactions, this can improve both safety and relationships with supports.
Person-centred practice means respecting differences
Supporting autonomy does not mean ignoring risks. It means carefully considering whether the risks are significant enough to justify restricting choice.
Many behaviours that initially appear concerning become more understandable when viewed through the lens of sensory preferences, communication, identity, emotional regulation, or personal choice.
When we take time to understand the purpose of a behaviour, we often discover opportunities to build skills rather than impose restrictions.