When a person with a disability becomes distressed or displays behaviour that challenges, what is the first thing we try to do? Do we try to understand what is happening, or do we immediately try to stop the behaviour?
There is a question that deserves much more attention: when we shout at a disabled person because we want them to change their behaviour, are we actually helping them regulate, or could we sometimes be adding to the very situation we are trying to resolve?
This is not an argument that staff should allow unsafe behaviour to continue. Nor is it an argument that boundaries should not exist. People sometimes need clear instructions, firm boundaries and immediate intervention when there is a risk of harm.
The question is what happens when raising our voice becomes the primary response to behaviour that challenges.
What Does the Research Say?
UK guidance from the National Institute for Health and Care Excellence, NICE, takes a fundamentally different approach from simply trying to make a person stop behaving in a particular way.
NICE recommends developing an understanding of the function of behaviour. In other words, instead of asking only, "How do we stop this behaviour?", professionals are encouraged to ask, "Why is this behaviour happening, and what is the person trying to communicate or achieve?"
NICE states that behaviour that challenges often indicates an unmet need. It also says that personal and environmental factors can contribute to the development and maintenance of behaviour, including communication difficulties, sensory needs, changes in routine, physical health and recent life events.
Perhaps most importantly, NICE recognises that the responses of staff and carers can themselves play a role in maintaining behaviour.
That should make all of us stop and think.
What Happens When Someone Is Already Distressed?
Imagine a person who is already overwhelmed. Perhaps something has changed in their routine. Perhaps the environment is noisy. Perhaps they cannot explain that they are frightened, confused, uncomfortable or in pain.
Their behaviour begins to escalate.
A member of staff tells them firmly to stop.
The person does not stop.
The staff member raises their voice.
The person's distress increases.
The staff member becomes louder because they believe the person is refusing to listen.
The person becomes even more distressed.
Eventually, what started as a relatively small incident can become a major confrontation.
At that point, it is tempting to conclude that the person's behaviour was the problem. But another question needs to be asked: did the response to the behaviour become part of the escalation?
This is precisely why NICE recommends looking at the interaction between the person's behaviour, environmental triggers and the responses of staff, carers and other people around them.
Is Shouting the Same as Setting a Boundary?
It is important not to confuse these two things.
A calm and clear instruction can be appropriate. A person may need to be told that something is unsafe or that a particular behaviour cannot continue. Protecting the person and everyone around them remains important.
But shouting is not automatically the same thing as effective communication.
If someone has difficulty processing language, communicating their needs or regulating their emotions, increasing the volume and emotional intensity of an interaction may not teach them what to do differently.
It may simply communicate that the situation has become more frightening or unpredictable.
That leads to an uncomfortable question:
Are we teaching an alternative behaviour, or are we simply trying to suppress the behaviour we do not like?
Behaviour as Communication
One of the most important ideas behind modern positive behaviour support is that behaviour should be understood within its context.
NICE recommends considering communication abilities, sensory needs, physical and mental health, relationships, recent life events, changes to routine and the physical environment when assessing behaviour that challenges. It also recommends identifying the situations that predict when behaviour is more or less likely to occur.
This changes the question completely.
Instead of saying, "How do we make them behave?", we might ask:
"What happened immediately before this behaviour?"
"What is the person communicating?"
"What happened afterwards?"
"Did our response reduce the person's distress or increase it?"
Those questions turn an argument about behaviour into an investigation of behaviour.
Could the Environment Be Part of the Problem?
NICE specifically identifies environmental factors as potentially relevant, including noise, sensory stimulation, changes in staffing, changes in routine and the quality of communication and relationships within a person's environment.
This is particularly interesting because it means that behaviour cannot always be understood by looking solely at the individual.
Sometimes the environment around the person may need to change.
Sometimes communication needs to change.
Sometimes expectations need to change.
Sometimes staff responses need to change.
And sometimes the person may need help developing another way of communicating the same need.
What About Positive Behaviour Support?
Positive Behaviour Support, often referred to as PBS, takes this person-centred approach. Rather than simply attempting to suppress behaviour, it aims to understand why behaviour occurs, improve quality of life, modify environmental factors and help the person develop alternative skills.
Research has examined whether PBS delivered by staff can influence challenging behaviour and quality of life. A multicentre study published in the Journal of Applied Research in Intellectual Disabilities found improvements in several areas, including self-determination and personal development, while reductions in irritability were particularly evident among participants with higher levels of irritability or lower levels of intellectual disability.
Earlier UK research also examined staff training in positive behaviour support through a cluster randomised controlled trial, reflecting the idea that changing how staff understand and respond to behaviour is itself an important part of intervention.
Another randomised controlled study of setting-wide positive behaviour support reported a substantial reduction in challenging behaviour alongside improvements in the quality of social care.
But What About the Person Doing the Shouting?
There is another side of this conversation that should not be ignored.
Supporting someone whose behaviour is escalating can be extremely difficult. Staff can become frightened, frustrated, overwhelmed or exhausted. NICE therefore recommends that organisations provide staff with personal and emotional support and help them recognise and manage their own stress.
This is important because staff are human beings too.
If a member of staff is already stressed, and the person they are supporting becomes increasingly distressed, the emotional state of one person can influence the other.
Could this create a feedback loop?
Person becomes distressed ? staff become stressed ? staff response becomes more intense ? person becomes more distressed ? staff become even more stressed.
If that cycle exists, perhaps the solution is not simply to tell the person with the disability to behave differently.
Perhaps the whole interaction needs to change.
Are We Measuring the Right Thing?
Another important question concerns how services measure success.
If the only measurement is whether a particular behaviour stopped, then shouting, punishment or other reactive approaches might appear successful in the very short term if the person becomes quiet.
But what if the person has not actually learned anything?
What if they have simply become frightened, withdrawn or exhausted?
What if the same behaviour returns tomorrow because the underlying problem has never been addressed?
This is why NICE recommends objective measurement, functional assessment and ongoing review of behaviour support plans rather than relying solely on whether an incident appears to have stopped.
A more meaningful measure might therefore be:
Has the person's quality of life improved?
Can they communicate their needs more effectively?
Are incidents becoming less frequent or less severe?
Are staff better able to recognise early signs of distress?
Does the person have more control over what happens to them?
The Bigger Question
Perhaps the most uncomfortable question is not whether disabled people need to change their behaviour.
Perhaps it is whether the people around them sometimes need to change theirs.
If behaviour is affected by the environment, communication, sensory experiences, relationships and the responses of other people, then changing the environment and the response may sometimes be more effective than repeatedly demanding that the individual change.
That does not remove responsibility. It does not mean unsafe behaviour should be ignored. It does not mean staff should never be firm.
It means that firmness, safety and compassion do not have to be opposites.
So, Does Shouting "Fix" Behaviour?
Perhaps the answer is more complicated than simply saying yes or no.
There may be situations in which a raised voice is used to obtain immediate attention during an emergency. But that is very different from using shouting as a routine method of changing behaviour.
The evidence and professional guidance point towards understanding triggers, identifying unmet needs, adapting environments, improving communication, teaching alternative skills and supporting staff to respond effectively.
So perhaps the question we should be asking is not:
"How do we make this person stop?"
Perhaps we should ask:
"What is this behaviour telling us?"
And then perhaps ask an even more uncomfortable question:
"Could our response be helping the person regulate — or could we unknowingly be making regulation harder?"
A Final Thought
Behaviour is visible. Distress is not always visible. A person may not be able to tell us that they are frightened, overwhelmed, confused, in pain or struggling with a change in their environment.
What we see may therefore be the final part of a much longer process that began before the behaviour became obvious.
Perhaps the real challenge for disability services is not simply learning how to stop behaviour.
Perhaps it is learning how to listen to behaviour before it reaches the point where somebody feels they have to shout.
And perhaps the most important question of all is this:
If we want people with disabilities to learn better ways of regulating their emotions and communicating their needs, shouldn't we make sure that the environment around them is also helping them to do that?
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