Challenging Behavior in Context: A Case Study on How People, Space, and Activities Interact

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Aim: We aim to gain insight into the interaction between challenging behavior as shown by individuals with an intellectual impairment, and space, and to explore the possibilities of using routinely collected data to this end.
Background: Research on challenging behavior shown by intellectually impaired individuals links their behavior to context, which includes space. Unfortunately, research about this link is hard to conduct, since these individuals may have difficulties expressing themselves verbally and react extremely to sensory stimuli.
Method: We conducted a single-case study, focusing on a Dutch very-intensive care facility. We analyzed data routinely collected by the healthcare organization in search of time-space configurations that provide insights into the resident–space interaction. As sensitizing concepts, we used three different contexts the residents interact with—space, people, and activities.
Findings: The study exemplified reported interactions that were direct, for example, between the residents and the spatial context, and indirect, for example, through other contexts (people and activities). Space impacts on residents’ senses intensely and acts as a lightning rod for their perceived stress. People also influence residents substantially. Caregivers may both have positive or adverse effects, for example, absenteeism or schedule change. Co-residents may trigger challenging behavior directly by a mere presence or transfer of their stress. Transitions between activities cause unpredictability and are triggers for residents, which interact with space.
Conclusions: Living environments providing choice in nearness to the caregiver and distance to co-residents “high in tension,” lowering thresholds for transitions, and facilitating predictability would be beneficial for intellectually impaired individuals showing challenging behavior.
Original languageEnglish
Pages (from-to)296–312
JournalHealth Environments Research & Design Journal
Issue number4
Publication statusPublished - 11 Jun 2023


  • architecture
  • autism
  • challenging behavior
  • context
  • intellectual impairment
  • interaction


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