Health · England
Finding out what makes distress worse
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Different things can make people feel distressed.
You can help people understand what matters to you.
Start with your experience
Tell people what feels difficult and what helps.
Use words, pictures, signs or your own way to communicate.
Check your health
Pain, illness or poor sleep can make things harder.
Ask for health advice if something changes.
Do not wait for a chart to be finished.
Notice what is happening
Noise, changes or difficult requests may upset you.
Something earlier in the day may matter too.
People can feel different on different days.
Before distress
What happened just before?
Where were you and what were you doing?
Was the help you needed available?
During distress
Write what people saw or heard.
Include what you said or showed.
People should not guess your reasons.
Afterwards
What did supporters do?
What changed?
Did it help you feel more comfortable?
Find changes that help
A record can suggest ideas.
It does not prove why something happened.
Nobody should deliberately upset you to test an idea.
Agree an early response
Your plan should say what helps when distress starts.
You may need space, fewer demands or a quieter place.
Call 999 if there is immediate serious danger.
Keep information private
Ask what people record about you and why.
Keep completed records safe.
Share information only with appropriate people.
Check the plan
Are you feeling better and doing things you enjoy?
Ask for a review if support is not helping.
Your wishes and choices matter.
What you can do next
You can use the worksheet with someone you trust.
Ask your health or support team for help understanding patterns.
Read about finding the reasons for distress Web pageThis link opens another website.
It may use harder words.
More useful links
- Challenging Behaviour Foundation: finding the reasons Web page
A quick read and detailed information about assessment and ABC records.
- Challenging Behaviour Foundation: communication Web pageFuller information
Ways to understand and support communication.
- National Autistic Society: sensory processing Web page
Sensory needs and reducing overload. Adapt support to the person.
- NHS England: appropriate medication Web page
Questions about medicine effects and review. Do not change prescribed medicines yourself.
These links open other websites.
They may use harder words.
Understanding triggers for distress
Notice possible triggers and patterns, check health, record observations respectfully and agree changes that help.
Children and adults · England · For individuals, families and supporters
Understand triggers and background factors
A trigger is something that may start or increase distress, such as noise, an unexpected change or a difficult request. Background factors can make distress more likely, including poor sleep, pain, hunger, worry or earlier upsetting events. Several factors may combine. What matters for one person may not matter for another, and the same situation can feel different on another day.
Check health and safety first
New or changing distress needs consideration of physical and mental health. Pain, constipation, infection, dental problems, seizures or medicine effects may be involved. Notice changes in eating, sleep, movement or toileting and contact the appropriate clinician. Do not wait to complete a chart before seeking needed healthcare. Call 999 for immediate serious danger or a medical emergency. Recording is never more important than helping the person.
Ask the person and notice when life goes well
Ask what feels difficult and what helps, using their preferred communication. Include people they choose and information about their usual comfort and communication. Look at similar times when distress does not happen: support, surroundings or choices may be different. Do not assume that quietness means comfort. A person may become still or withdrawn when distressed.
A: what happened before?
An ABC record describes events. A stands for antecedent: what happened just before the action. Note the place, activity, people present, words or requests, changes and access to help. Record relevant earlier factors, such as a poor night’s sleep, separately. Describe what you observed rather than writing a conclusion such as “wanted attention”. Keep the record short enough to use consistently.
B: describe what happened
B stands for behaviour: what you saw or heard. Write observable details, timing and duration where useful. For example, “covered ears and left the room when the hand dryer started” is more informative than “was difficult”. Include communication and possible signs of pain. Record the person’s explanation in their own words where possible. Clearly identify uncertainty instead of inventing a reason.
C: what happened afterwards?
C stands for consequence: what followed the action. It does not mean punishment. Describe how supporters responded, what changed and how the person responded afterwards. Include whether demands stopped, help arrived or the surroundings became quieter. Record whether the response appeared comforting, distressing or unclear. The purpose is to understand support needs, not to find fault with the person.
Look for patterns without assuming a cause
A professional functional assessment considers how different factors relate to the behaviour and what it may achieve for the person. The immediate trigger and the possible function are different questions. An ABC chart can suggest ideas but cannot prove them. One action may have more than one explanation. Do not deliberately provoke distress, withhold help or remove communication to test a theory. Seek specialist help if patterns remain unclear or there is risk of harm.
Agree practical changes with the person
Possible changes include treating pain, making communication clearer, adjusting noise or lighting, offering genuine choices and ensuring support arrives promptly. Prepare for changes and make room for meaningful activities. Teach useful skills when the person is comfortable. Do not stop harmless stimming simply because it looks different. Agree who will make each change and how you will know whether it helps the person.
Plan an early, calm response
Agree early signs and preferred support before a crisis. Fewer demands, short explanations, more space or a chosen quieter place may help. Avoid crowding, arguing or unexpected touch. Use an individual plan and trained support where needed. Punishment or unnecessary restrictions can add distress. After an incident, arrange healthcare if needed and invite the person’s account when they are ready, without forcing them to relive it.
Keep records private and review the support
Explain what is recorded and why, involve the person and follow consent and confidentiality requirements. Share only relevant information with appropriate people; keep completed records secure. Do not film distress simply to complete a chart. Ask the GP, community learning disability team or appropriate children’s service about further assessment. Review the person’s wellbeing, activities and choices as well as incidents. Change an unhelpful plan and check that agreed support was actually provided.
Words you could use
“Please listen to my experience, check health and possible triggers, and agree what support or surroundings need to change.”
More useful links
- Challenging Behaviour Foundation: finding the reasons Web page
A quick read and detailed information about assessment and ABC records.
- Challenging Behaviour Foundation: communication Web pageFuller information
Ways to understand and support communication.
- National Autistic Society: sensory processing Web page
Sensory needs and reducing overload. Adapt support to the person.
- NHS England: appropriate medication Web page
Questions about medicine effects and review. Do not change prescribed medicines yourself.
These links open other websites.
They may use harder words.
Where the information comes from
Links checked 9 November 2026.
These links open other websites.
They may use harder words.
- Challenging Behaviour Foundation: ABC records and background factors (PDF) PDF
Recording antecedents, observed behaviour, consequences and wider setting events.
- NICE NG11: assessment and support Web pageProfessional guidance
Health, sensory and communication factors, functional assessment and proportionate support.
- NICE QS101: personalised daily activities Web page
Meaningful activities and shared plans that improve quality of life.
- NHS England: clinical care and learning disability Web pageProfessional guidance
Recognising pain and health changes without attributing everything to a disability.
- Challenging Behaviour Foundation: communication Web pageFuller information
Accessible communication and understanding unmet needs.
- National Autistic Society: sensory processing Web page
Reducing sensory demands and allowing time and space during overload.
- National Autistic Society: stimming Web page
The benefits of harmless stimming and individual support if there is harm.
- NICE NG93: services and support Web page
Involving the person, coordinated assessment, support plans and family assistance.
- GOV.UK: making decisions in health and social care Web page
Involvement, decision-specific capacity, least restrictive support and confidentiality.
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