Use Antecedents and Consequences to Manage Dementia Behaviors

In my last post, I examined what the ABC approach is and how to evaluate the antecedents and consequences that may be influencing or causing unwanted behaviors in dementia. In this post, I will review how to use the ABCs to create a behavior log and manage problems in dementia.

Creating a behavior log

Behavior logs can help you to identify the antecedents and consequences of behaviors and, importantly, help you to track them to see if your interventions are successfully reducing unwanted behaviors and increasing desired ones. Behavior logs can also show you that sometimes your actions can accidentally make things worse!

Why would a behavior get worse? Well, if your loved one yells every time you try to give them a bath until you give up and skip the bath, they may “learn” that they can avoid things they don’t like by yelling. They may then start yelling when you ask them to do other things they don’t want to do, such as getting dressed or getting out of the car.

Using the example above, let’s complete a behavior log:

Antecedents (Include the date, time of day, place, person(s) present, and events)

• Sunday, 3 pm
• Me and my loved one
• Bath time

Behavior (specific, observable, measurable — frequency and/or duration)

• Yelling for 7 minutes

Consequence (How did things change?)

• Decided to skip the bath that day

Here’s another behavior log:

Antecedents

• Had trouble sleeping in the night, slept late, skipped breakfast, and had an early lunch.

Behavior

• At 2 pm began yelling and stomping feet for 15 minutes until I offered her a snack.

Consequence

• Made her a sandwich and then laid down with her on the bed and she took a nap.

Using the ABCs to change behaviors

Once you are able to identify antecedents, behaviors, and consequences, you can begin to try to change the behavior. For example, you want your loved one to decrease (or stop) yelling. Then you need to decide what you want your loved one to do instead, the desired behavior—in this case, take a bath.

The next step involves some creativity. To choose an intervention, you need to decide how you are going to change the environment to result in the desired behavior. There may be many things you can try to change, but it is important to only make one change at a time so that you know what worked and what didn’t. In order to help your loved one take a bath, you might start by having them sit on a stool by the tub and put their feet in the warm water. If this intervention works, they are no longer yelling, and now they’re happy to slip into the tub and wash up, that’s great; you can stop there! If it doesn’t, you need to reassess the intervention and try something new. For example, maybe next time you’ll try playing their favorite music in the bathroom.

Practice makes perfect; enlist family and friends to help

Using the ABCs of behavior change takes practice. You should start by keeping a log of your own that includes the antecedents, behaviors, and consequences, like the one above. Then you can pick an intervention and try to find something that works. Don’t get discouraged—the first intervention you try might not work. You also don’t need to try to figure out an intervention alone. This is a great time to involve your care team: family, friends, and professionals that can help you think of interventions you can try.

Let’s consider an example to illustrate how to use the ABCs:

• About an hour after the grandchildren come to visit, my wife becomes agitated. She used to love playing with them, but now she ends up yelling and saying nasty things. It upsets everyone and the visit often ends abruptly. I’m not sure what’s wrong or what to do.
  • Keeping a behavior log to identify the antecedents and consequences around the behavior can help you understand why your loved one is becoming upset. Perhaps the grandchildren are visiting right before dinner so it is being served later than usual. Changing the time of the visit may reduce or eliminate the problem. There could be many other reasons and a behavior log can provide clues for what to try next if the first intervention doesn’t work.

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© Andrew E. Budson, MD, 2022, all rights reserved.