Concerning Behaviours

Traditional approaches to care often reflect the idea that caregivers must do something to someone to solve the problem of concerning behaviours.

Children who experience developmental challenges have been given consequences for their actions – natural or adult imposed. Similarly, people who experience cognitive decline are often communicated with through the techniques of gentle persuasion.

Both those with developmental challenges and those with cognitive decline lack the skills necessary to process information effectively. Therefore, both need a different approach to care – one that supports them in processing information and allows them the freedom to find ways on their own to adapt to new challenges they face.

When people, young or old, are unable to make good decisions and solve problems effectively, they are also unable to meet the expectations they have of themselves and others around them. As a result, they can become frustrated, fearful and anxious eventually exploding in anger.

Not everyone, child or adult, becomes angry when faced with difficulties. Some people choose to withdraw when they are struggling with problems or frustrations. These people are lucky because caregivers tend to respond to their less severe behaviours in ways that are more supportive, empathic, and nurturing.

The lack of global skills – flexibility, adaptability, frustration tolerance, emotion regulation and problem-solving skills – is something these two groups of people share in common.

External link opens in new tab or windowRoss W. Greene’s Collaborative & Proactive Solutions (CPS) approach is currently being adapted to people who experience cognitive decline. Preliminary results are promising in reducing anxiety and increasing thoughtful consideration of the stressors a person is experiencing in the moment.

Home and community offer many opportunities to engage people who experience cognitive decline in a variety of different activities and experiences. When someone has the freedom to explore, adapt and solve the problems within these environments, they are also more likely to recall memories from their past.

Ross W. Greene uses the Assessment of Lagging Skills & Unsolved Problems (ALSUP) he has developed to identify the global skills (or lagging skills) and unmet expectations (also called unsolved problems) that are the source of concerning behaviours. It can be found External link opens in new tab or windowhere and also on the website of the non-profit Dr. Greene founded, Lives in the Balance, at External link opens in new tab or 

Numerous published studies have documented the effectiveness of CPS, and it has been validated as an evidence-based intervention. To use this model effectively, you’ll need an open mind, time to practice new communication strategies and patience. Greene describes his approach as similar to putting on a new pair of lenses (or eyeglasses). When you’ve been thinking and caring for someone in a certain way for a long time, changing lenses and practices can take some doing.

Simile is currently working with subject matter experts to incorporate the Collaborative & Proactive Solutions approach into the Relationship Enhancement Training Program. We look forward to offering you a new perspective on care soon that includes insights, strategies and specialized communication skills to work collaboratively with someone who experiences cognitive decline in Ottawa, Canada.


The Explosive Child, Ross W. Greene, PhD., 2021

* From External link opens in new tab or windowUlysses - Lord Alfred Tennyson (1809-1892)

© Simile – Training in Supportive Care, 2023