Daan Hulsmans

131 Case study challenging behavior 6 Figure 1 Conceptualization of two potential change-mechanisms according to complex systems theory Note. Possible attractors are visually conceptualized as a landscape with basins. In this example, the left basin reflects a desirable attractor (few self-injury) and right one an undesirable attractor (frequent self-injury). The ball reflects a person’s state at one point in time while arrows below the ball symbolize interactions between person and environment in daily life. The top panel (A) reflects a mechanism in which we can observe instability over time. During instability the attractor loses strength, visualized as the basin becoming more shallow. When this happens, interactions between person and environment, however casual or extraordinary, lead to a transition towards another attractor. The bottom panel’s mechanism (B) reflects a mechanism in which the attractor itself does not lose strength. Therefore this will not be marked by instability. Everyday events will not be enough to reach a transition. Instead it takes extraordinarily strong environment-person interaction to ‘force’ this change. 2. Methods 2.1 Case presentation The participant is a woman in her 30s, diagnosed with a mild intellectual disability and borderline personality disorder. For over a decade, she has lived in a 24-hour residential care facility specialized for people with a mild intellectual disability and severe behavioral problems. Her daily routine typically consists of working in the house (e.g., cooking, cleaning), she likes to take walks, and enjoys playing board games. For several days a week she goes to an activity center where she works creatively (e.g., draw paintings, make music), alone or together with others. This provides important structure in her daily routine. Staff is available 24−7 to support her. Even seemingly regular tasks, such as arriving in time for

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