129 Case study challenging behavior 6 1.2 Describing change over time The second step is to zoom out, quantitatively exploring how these factors are ordered in time on the participant’s 560-day timeline. EMA research typically employs multiple daily self-ratings for 1–3 weeks, but individual accounts of challenging behaviors over longer timeframes are scarce. Some studies used not daily but weekly caretaker-reports of challenging behavioral incidents. These showed that, during a period of 41 weeks, staff of 33 inpatients with a mild intellectual disability reported in total 210 aggressive- and 104 self-injurious incidents (van den Bogaard et al., 2017; van den Bogaard et al., 2018). Interestingly, 4 of those 33 inpatients were responsible for over half of the 210 aggressive incidents, while a staggering 85% of the 104 self-injurious incidents were from only 2 clients. Few individuals thus account for many incidents, but little is known about the day-to-day temporal patterns of such chronic challenging behaviors over the course of weeks or months. When a person is tracked over longer periods of time, one can detected phases in which certain behaviors are relatively stable. A single-case study using EMA of a person with a major depressive disorder over almost eight months (239 days; Wichers et al., 2016) found two distinct phases. The first four months were characterized by consistent low self-reported depressive symptoms. On the 127th day this abruptly changed, marking the start of a four-month period characterized by consistently high depressive symptoms. From a complex systems perspective, these two stable phases (before and after day 127) are called attractors (Olthof et al., 2020a). That is, the dynamics of the person (i.e., person-environment system) are attracted towards a specific behavioral pattern that remains relatively stable over time (e.g., a depressive phase in this example). Importantly, stability does not speak to the desirableness of the patterns, but only to the consistency of change over time. For example, consistently never self-harming, consistently being aggressive once-per-week on Tuesdays, or consistently self-harming on weekends are all examples of stable patterns. Following complex systems theory, stable patterns of challenging behaviors can thus be understood as attractors (Hayes & Andrews, 2020; Olthof et al., 2023). Our second research question is how challenging behaviors are ordered on the participant’s 560-day timeline? This is done by identifying if there are different attractor states (e.g. timeperiods with relatively few vs. many challenging behaviors) and explicate ways in which these time-periods are (dis)similar from one another in terms of internal states (e.g., experienced emotions) and environmental influences (e.g., social interactions).
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