Dementia Centred

Wendy Perry's picture

By Wendy Perry

May 20th, 2016

I see what you’re saying…

recognising distressed behaviour as communication

All of us have had those moments where we grit our teeth and say “I'm sure that will be fine” when in reality something is not and will not be fine. In those moments the lack of “fine-ness” is often communicated loud and clear through our body language and tone of voice.  I know what I am talking about with this, I have two teenagers who exercise their right to dissenting opinions through their body language on a regular basis.  

Of course we have long recognised the link between behaviour and communication.  Before we developed verbal skills we relied on body language and behaviour to make our needs and wishes known, and all of us still communicate in this way every day.  

According to a landmark study from 1967 by Albert Mehrabian and Susan Ferris, our verbalised words make up only about 7% of what we communicate;  the rest is non-verbal and through tone of our voice. For some people, a loss of verbal communication skills is a part of their dementia journey.  Luckily that is only a small part of their communication arsenal.

The challenge for those of us who support someone who struggles to express themselves verbally is to recognise the importance of behaviour as communication, and to support that means of communication throughout a person’s journey with dementia. There may be times when this becomes the most effective method of communication for that individual, but if we do not recognise it as such, then that pathway to communication becomes closed off.

Rather than talking about “challenging behaviour” as we have in the past, we now talk about stress and distress.  We know that people with dementia live with increased stress levels and this is frequently communicated through distressed behaviour. However, it is often easy to miss the small signs of distress that may be present; signs of anxiety, loneliness and boredom. It is essential that we develop our observational skills.  Learning to listen to people with our eyes is a vital skill for those of us in supportive roles.

Behaviour as a means of communication is much like verbalisation in communication.  If someone cannot hear what we are saying we say it louder. The same principle applies when someone is communicating through their behaviour.  If we miss the smaller signs of distress then the volume of the distressed behaviour may be turned up and up until someone recognises that there is a problem for that person who is communicating their distress. The louder the distressed behaviour becomes, the more difficult it may be to figure out what the distressed behaviour is trying to communicate.  Though a certain amount of information can be gathered by observing the behaviour of a stranger, it is difficult to interpret needs that are deeper and that are more personal to identity unless we know that person.  So first we seek to understand the story of the person we are supporting.  

At DSDC we teach carers about how to move away from needing to manage behaviour by making it stop, to seeing it as the communication of an unmet need. By responding to a need as one human being to another, rather than by looking at the behaviour as a medicalised symptom, we can provide responses and interventions that are dignified, and which promote the value of all people regardless of their cognitive status.  This is so important, because distressed behaviour is not a symptom of dementia, it is a symptom of trying to communicate.

The training course Understanding distressed behaviour includes an interactive workshop where you can practice identifying triggers for distress and developing effective interventions.


DSDC has developed the Best Practice in Dementia Care programme to help you achieve national and regional care standards. The programme not only meets these standards but is accredited by the Royal College of Nursing and City & Guilds


Mehrabian, A. and Ferris, S. (1967) Inference of attitudes from nonverbal communicatoin in two channels. Journal of consulting psychology 31(3), 248-252.

Categories: behaviour