NICE Guidelines on Challenging Behaviour: What Practitioners Need to Know

When I first read the NICE guidelines on challenging behaviour, I remember nodding along thinking, “Yes… yes… definitely yes… oh I wish every service actually did this.”
The guidelines don’t just set standards — they outline what safe, ethical, evidence-based practice should look like for people with learning disabilities and behaviour that challenges.

If you’re working in education, social care, or health, understanding NICE guidance isn’t optional. It’s the baseline for what good support should look like — and, honestly, it makes our work easier when everyone is on the same page.

Why NICE Guidance Matters (and Why It’s More Than a Tick-Box Exercise)

NICE guidelines provide a national, research-informed framework that tells services what works, what doesn’t, and what should never happen when supporting people whose behaviour communicates distress, unmet need, or environmental mismatch.

And, importantly, NICE makes one thing very clear:

Challenging behaviour is never “the person.” It is always a message about need, environment, or skill gaps.

This aligns perfectly with the PBS Competence Framework — values first, understanding behaviour second, and reactive strategies as a last resort.

The Foundations: What NICE Says About Understanding Behaviour

1. Behaviour always has a function

NICE emphasises that behaviour is usually linked to:

  • unmet physical or emotional needs
  • communication differences
  • environmental triggers
  • skill gaps
  • trauma and past experiences

This means assessment should never be superficial.
No assumptions. No “that’s just how they are.”
We look, we listen, we assess.

2. Assess before responding

NICE is very clear:
No intervention should be offered without a comprehensive, person-centred assessment.

This includes:

  • functional behaviour assessment
  • communication assessment
  • physical and mental health screening
  • sensory profiling where appropriate
  • social and environmental review

If you’ve used BST with staff (as I have), you’ll know that training people to observe before acting can be game-changing.

What NICE Says MUST Be in Every Support Plan

Support plans should be rooted in proactive, preventative strategies, not reactive ones.
NICE specifically highlights that plans must include:

1. Environmental adjustments

Small changes — a quieter space, predictable routines, choice-making, clearer transitions — often prevent escalation entirely.

2. Teaching new skills

This might include:

  • communication skills
  • coping and emotional regulation
  • independence skills
  • social interaction skills
  • sensory self-management

NICE repeatedly emphasises skill development as essential, not optional.

3. Positive reinforcement of desired behaviour

Not bribes.
Not “rewards for being good.”
Just reinforcement based on clear, functional understanding.

4. Collaborative planning

Plans must be developed with the person, not for them.
Families, carers, teachers, support staff — everyone needs a seat at the table.

(If you’ve ever seen a team suddenly realise they can do PBS collaboratively, that “eyes lighting up” moment is unforgettable.)

What NICE Says Should Be Avoided

here are a few things NICE is unambiguous about:

❌ No punishment-based approaches

NICE is extremely clear: punishment is harmful, unethical, and ineffective.

❌ No restrictive practices unless absolutely necessary

And even then:

  • only when all other options fail
  • only in the least restrictive form
  • only to prevent immediate harm
  • only for the shortest possible time
  • and always, always recorded and reviewed

NICE standards align strongly with the PBS value base here — dignity, safety, and human rights first.

❌ No pharmacological intervention without clear justification

Medication must never be used as a behavioural control tool.
If medication is considered, NICE requires:

  • physical and mental health assessment
  • clear documented rationale
  • ongoing monitoring
  • clear review dates
  • involvement of the person and family

What Practitioners Must Do (According to NICE)

NICE outlines several responsibilities for practitioners:

1. Follow a person-centred, trauma-informed approach

This includes understanding life history, preferences, communication, and emotional needs.

2. Use evidence-based assessment and intervention

This is where PBS comes in:

  • functional assessment
  • skill-teaching
  • environmental redesign
  • consistent reinforcement
  • data-informed decisions

3. Work collaboratively

No lone rangers.
Behaviour support without teamwork is behaviour support that will fail.

4. Monitor and review consistently

Plans should be living documents.
NICE makes clear that support plans must be:

  • reviewed regularly
  • evaluated through data
  • adjusted based on what is working or not

5. Build competence, not dependency

Practitioners are expected to coach staff and families — not just “deliver” strategies at them.

This is exactly where BST shines.
Instruction, modelling, practice, and feedback build long-term capacity across teams.

Where PBS Fits Into the NICE Framework

PBS isn’t just compatible with NICE — PBS is one of the recommended approaches within NICE guidance.
Both emphasise:

  • dignity
  • quality of life
  • understanding behaviour
  • collaboration
  • proactive support
  • human rights
  • reducing restrictive practices

And both acknowledge that real change happens at the level of:

  • systems
  • environments
  • relationships
  • skills
  • values

Common Misinterpretations of NICE Guidelines

Over the years, I’ve seen a few recurring misunderstandings:

❌ Misinterpretation 1: “We have a behaviour policy, so we’re compliant.”

Not even close.
Policies are paper.
Practice is lived experience.

❌ Misinterpretation 2: “Challenging behaviour training = crisis training.”

NICE is very clear: understanding behaviour means prevention first, not crisis management first.

❌ Misinterpretation 3: “PBS = de-escalation.”

PBS is not a reactive model; it’s an entire system of proactive support grounded in values and function.

What This Means for Your Practice

If you’re a practitioner supporting individuals with behaviour that challenges, the NICE guidelines ask you to:

  • Maintain a person-centred mindset
  • Prioritise understanding over control
  • Teach skills that build long-term independence
  • Create enabling environments
  • Collaborate respectfully and consistently
  • Use evidence-based methods such as PBS and BST
  • Monitor, reflect, and adjust
  • Minimise restrictive practices

It’s demanding work — but it’s meaningful work.
And when people feel understood, respected, and supported, behaviour often shifts in ways that still surprise me years into this career.

There’s a feeling I get when a team finally sees the link between unmet need and behaviour — a kind of softening, a realisation that this work is fundamentally about humanity, not “management.”
It’s subtle but unmistakable.
Someone’s posture changes, someone breathes out, someone nods slowly.

Those moments remind me that NICE guidance isn’t just policy — it’s a blueprint for dignity.
And when we follow it well, we don’t just reduce challenging behaviour…
We create environments where people can thrive.

References

National Institute for Health and Care Excellence. (2015).
Challenging behaviour and learning disabilities: Prevention and interventions for people with learning disabilities whose behaviour challenges (NICE Guideline NG11).
NICE. https://www.nice.org.uk/guidance/ng11

Beadle-Brown, J., Grey, B., & Ashton-Smith, J. (2020).
Implementing positive behavioural support: Changing social and organisational culture.
Journal of Applied Research in Intellectual Disabilities, 33(4), 584–595. https://doi.org/10.1111/jar.12702

Gore, N. J., McGill, P., Toogood, S., Allen, D., Hughes, J. C., Baker, P., Hastings, R. P., Noone, S. J., & Denne, L. D. (2019).
Positive Behavioural Support: A competence framework.
International Journal of Positive Behavioural Support, 9(1), 1–16.