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Hilma 2nd Apr 2020 Nurse
Hi All! Does anyone have suggestions for the resident in the activity group, who is the loudest, answers all the Q's. Doesn't give others the opportunity to engage? What do you do!?
Cindie 3rd Apr 2020 Music Therapist
Hilma, I have a list of strategies for you at the bottom of this post.
Any idea why they do this? Dementia, don't understand / remember social norms, unaware of behavior, impulse control, faster / higher cognitive functioning than the others, not challenged enough, being knowledgeable has something to do with their identity, used to being or wants to be a leader, attention seeking or needs acknowledgement or human connection, wants to matter to someone / be important in some way, other?

All behaviors have a reason. Looking at behaviors as an opportunity to uncover & meet needs provides more benefits for patients and staff alike rather than trying to extinguish problematic behaviors. Consider with the treatment team how this behavior might be related to other behaviors, the patient's current and past experiences, their environment, their impairments, and needs.

Some strategies:
1. "Let's hear from someone who hasn't given an answer yet." -- When I try this and it isn't working, I might say it again while gesturing toward a section of participants who haven't answered.
2. "I want to give everyone time to think about this, so I'm going to ask you (plural you) to wait before answering." (be sure to make eye contact with the person, but not only them)
3. "Fred, I think you know the answer to this. I'd like to see if someone else knows it, so I'd like you to wait before answering."
4. "Fred, you're a fast thinker! (you could make a comment or ask a question related to their career or hobby like, That must have come in handy when you worked as a ....) Not everyone thinks as fast as you do. Would you wait to answer so some of the others have time to think through the question?" -- Give 'Fred' a way to be part of the solution.
5. Speak with 'Fred' privately.
6. Find something else for 'Fred' to do that uses a skill or interest he has. Maybe he can ask some of the questions.
7. "Fred, this doesn't seem like much of a challenge for you. So, ...." Give him a challenge - to wait, to write down the answer w/his non-dominant hand instead of verbal answer, answer in Morse code or another language, ... be creative.
8. Seat him in a different spot. In the back, front (he might feel like he has more access to you yet the others might not hear his answers), to the side?
9. If other things aren't working, I might combine #1 and #8 and just nod (or quietly thank) at 'Fred' or ignore him (depending on the reason for the behavior) while making eye contact with others and continue to look to them for answers.
Susan 3rd Apr 2020 Activity Director
I have had residents like this
First of all I start the activity by saying that everyone gets a turn
When this person answers the question before person who’s turn it is I thank them and say it’s somebody else’s turn now so let them answer
Positive re-enforcement is always best
You also may want to have a private conversation with this person because you don’t want rewarding them for behavior you don’t like
Explain to them that everyone needs to get a turn
We know you like to give answers
How about if I give you a piece paper and you could write the answers down
Also when it is their turn maybe you can give them a harder question to challenge them
Let me know how these work and if you need any more strategies
Susan 3rd Apr 2020 Activity Director
Wow Cindie thank you for this information
I am sure it will be very helpful
You must be a great therapist thanks again
Hilma 5th Apr 2020 Nurse
You're right Susan! Wow indeed Cindy. You are very knowledgeable. I can't exactly pinpoint the reason why this female resident is the way she is, except I notice she always seems to be looking for praise ( " I spoke to the boss about getting all the new furniture.. She listens to me! One of her diagnosis is somataform. But I can't help but think ALOT her problem is she wants people to notice her, whether by yelling out in grp activities or saying, 'oh the pain in my back!'.. Then will engage in sitacise 10mins later.
I also wonder if CBD/ mindfulness therapy could help.
Susan 6th Apr 2020 Activity Director
Hi Hilma
You must be a great nurse as evidenced by your concern
However sometimes no matter what it try You could not solve the problem fully
All you can do is try your best
From what I know about somataform disorder it is not an easy diagnosis to make and there may be psychological implications to it
I assume you talked to her family about her condition
We had a resident who had problem behaviors
No matter what we tried we were not successful fully
We tried to accommodate her as best we could
I do not have CBD oil will help
Will your facility even allowed to be used??
Good luck and let us know what happens
Hilma 6th Apr 2020 Nurse
Oops! I meant CBT. Cognitive behaviour therapy.
Cindie 9th Apr 2020 Music Therapist
Hilma, you mention she has a diagnosis of somataform disorder and ask if CBT will help. Yes, Cognitive Behavioral Therapy can help with this. However, somataform disorder isn't about attention seeking. The person suffers from very real physical symptoms. It's just that even though a physical cause may be present, the level of distress is excessive and disproportionate. It is accompanied by persistent thoughts or anxiety about their health, which could cause the person to talk about it but that wouldn't have anything to do with some of the comments you related. You have described some of the symptoms of histrionic personality disorder but would need to have her evaluated to see if that or any other diagnosable mental health issue is involved.

The attention seeking behavior could have a wide variety of causes. It could be relatively recent behavior, perhaps related to being in care such as reduced autonomy / insecurity / powerlessness or feeling abandoned. The behavior could be lifelong and related to childhood experiences. Or something else. If you can figure out the reason for the behavior that will help you figure out how to meet her needs and reduce the behavior.

You could try:
Ignore inappropriate behaviors without ignoring her: Continue with the group activity without acknowledging inappropriate behavior. Do give her the same opportunities to participate as others. Thank her for appropriate responses. Schedule time each day, or shift, for someone to spend a few minutes focused on her. Try to make it the same person, roughly the same time (or associated with a specific daily activity) each day so she can trust she will get attention. There may be people she especially wants approval from. Consider adding Noncontingent Reinforcement. This has been proven to be an effective intervention for attention-seeking behaviors like screaming. This procedure involves providing reinforcement, such as attention from staff via verbal praise or high fives on a fixed schedule (every 15 minutes, every hour) --or-- at random, completely independent of the behavior. For example, staff would provide social praise every hour.

Include your plan of action in the nursing plan and get care staff on board.
Adrian 21st Apr 2020 Activity Director
Have him are her help you run the class or activity read the questions with you taking turns not answering unless the others just cant figure the answer out.
Susan 21st Apr 2020 Activity Director
Thank you for your suggestion Adrian
Hilma 24th Apr 2020 Nurse
Thanks All very much!
Jean 25th Apr 2020 Activities Coordinator
I was a trainer and the principle is the same 'there is one in every class' , the best way to deal with it is to give them a job or responsibility. Perhaps she can read out the questions or answers at the end, is she able to keep a simple pre printed score sheet?
Susan 27th Apr 2020 Activity Director
Thanks for your input Jean
Gigi 14th May 2020 Director of Recreation Therapy
I have been in your shoes.
I think someone already touched on this but I take the "we go around the table clockwise so each person can answer" approach. I used to play the 'make small words out of a big word' and I had "Al" who walked into a room and just blurted out all the words. They were to write down all the words they could think of for 10 minutes.
I actually ended up asking him to assist another resident that usually struggled with this game. It gave him "purpose".
Susan 14th May 2020 Activity Director
Thank you for this information Gigi
I think it will be helpful

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