145 Case study challenging behavior 6 two subthemes: positive events and negative events (see themes positivity and emotional tensions in Figure 3), as they reflected impactful events that were extraordinary across the 560-day timeline. Table 2 Summary of what happens the week prior to and during transitions in terms of instability and extraordinary events. Transitionpoint Direction of change Extraordinary event in the week prior to transition Instability the week before or during change Potential mechanism Day 57 Undesirable Fear for an escapee (negative) Yes Event- and instability-induced Day 92 Desirable None Yes Instability-induced Day 147 Desirable None No Unknown Day 221 Undesirable First Covid lockdown (negative) No Event-induced Day 286 Desirable None No Unknown Day 413 Desirable Finishes tattoo (positive) Yes Event- and instability-induced Day 446 Undesirable None Yes Instability-induced Day 467 Desirable Starts relationship (positive) Yes Event- and instability-induced Day 484 Undesirable Ends relationship (negative) then release of own CD (positive) Yes Event- and instability-induced Day 500 Desirable Traumatic experience (negative) No Event-induced Note. Desirable change is towards an attractor with less frequent challenging behavior than before, and undesirable is the opposite. Extraordinary event is based on negative and positive event subthemes from thematic analysis. Instability is when the dynamic complexity value of one or both challenging behaviors were significantly high, based on a z-test with α = 0.05. The last column shows whether our findings indicate what was a likely change-inducing mechanism. Table 2 summarizes what happens one week before each of the 10 transition-points. There were four transitions towards an attractor with more frequent challenging behavior than before. These undesirable transitions were all either instability-induced, environment-induced or a combination of both (Table 2). Day 221, for example, was likely an event-induced change, given that there was no instability, but the first Covid-19 lockdown likely led to this undesirable change. Social contact with friends and family – as well as support from staff – were drastically reduced while in lockdown, disrupting her everyday routine increasing her need for aggression and self-injury as an outlet. There were also six desirable changes. One such example was that the week before she finished her tattoo (extraordinary event on day 413) was instable,
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