Acknowledging a behavior to reduce it (three-step approach)

Step 1: Pause and Reframe Your Perspective. Before you respond to any challenging behavior, take a slow breath and remind yourself: 'This is not about me. They are trying to communicate something.' This mental shift prevents you from reacting with frustration or correction, which would only reinforce the behavior. For example, if your loved one is pacing and asking the same question, instead of thinking 'They're doing this to annoy me,' reframe it as 'They feel anxious or lost right now.' This sets the stage for a helpful response.

Step 2: Provide Positive Attention When They Are NOT Engaging in the Behavior. This is the most counterintuitive but powerful step. Instead of waiting for the behavior to happen and then reacting, you proactively give them attention and reassurance when they are calm. For instance, if your husband constantly asks when dinner is, walk past him at a quiet time and say, 'Hey, we're having chicken tonight at five o'clock. I'll come get you then.' You are answering the question before he asks it, meeting his need for reassurance without reinforcing the repetitive asking. This works because you are giving recognition and attention for the calm moment, not for the behavior.

Step 3: Offer a Meaningful Activity That Fills the Need. Once you've provided that proactive reassurance, engage them in a simple, enjoyable activity that addresses the underlying need. If they were asking about time, maybe they are bored or hungry. Offer a snack, a short walk, or a simple task like folding napkins. The activity should be something they can do with you (not for them) and should be broken into single steps. For example, say, 'Let's put on our shoes first, then we'll get a drink of water before our walk.' This gives them a sense of purpose and reduces the anxiety that drives the behavior.

Step 4: Use 'Cognitive Ramps' to Set Them Up for Success. Create visual or verbal cues that help them complete tasks without frustration. If they resist bathing, lay out a towel, soap, and a washcloth in plain sight. If they forget steps in dressing, put clothes in the order they go on. This reduces the fear of forgetting and the resulting refusal. As one expert notes, 'The longer a person stays involved in doing things themselves, the better.'

Step 5: Check for Sensory or Physical Discomfort. Many challenging behaviors stem from pain, hunger, thirst, or sensory overload. Before assuming the behavior is 'just dementia,' check if they need to use the bathroom, if the room is too bright or noisy, or if they are too hot or cold. Adjust the environment first. This step alone can eliminate many behaviors.

Step 6: Simplify Choices to Reduce Overwhelm. Too many options can trigger anxiety and refusal. Instead of asking 'What do you want to wear?', offer two choices: 'Do you want the blue shirt or the red one?' This reduces decision fatigue and makes them feel in control without being overwhelmed.

Step 7: Use Distraction with Fun. If they are anxious about a task (like brushing teeth), sing a silly song or have a little dance party in the middle. This shifts their focus from fear to fun, making the task easier. As one caregiver expert says, 'It helps get their mind off anxiety and helps them have fun while doing what they need to do.'

Step 8: Reflect on Your Own Triggers. After the situation is calm, take a moment to journal what happened. Ask: What was the need? What did I do that worked? What could I do differently next time? This builds your awareness and helps you plan for future challenges.