The ABC's of Managing Challenging Behavior in Alzheimer's Disease

Health Professional

In previous Shareposts I have talked about ways of approaching and dealing with the more difficult aspects of Alzheimer's disease such as wandering behavior, disinhibited or inappropriate sexual behavior. For a variety of reasons which often include fatigue and stress, caregivers are often unable to get a clear picture of their situation. Yet a little organization and planning can have a big influence over the way caregivers view and manage challenging behavior.

Alzheimer's disease causes damage to the brain. Damage occurs at different rates and in different areas of the brain. People with Alzheimer's may become aggressive, suspicious or disinhibited in a way they would never have done prior to its onset. The behavior must not be viewed as malicious, but as a result of brain damage over which they have no control.

One method of trying to work out why challenging behaviors are occurring and finding more effective ways of dealing with them, is to keep a diary. A good method of recording is an A B C diary. A = Antecedent, B = Behavior and C =Consequence.


An antecendant is anything that happens immediately before a challenging behavior occurs. It sets the stage for the behavior. For your diary, record the time, place, who is present and anything out of the ordinary (the weather temperature, building work, etc). Although you will have to manage the challenging behavior first, try not to leave it too long before you write your ABC diary.


This is the behavior you have targeted as the problem. It requires an accurate observation of what actually occurs, not how you interpret what has occurred or your emotional reaction to it. Something along the lines of 'spat on the carpet three times' is clear and measurable.


Consequences refer anything that happens directly after the behavior. This includes information about the person and those intervening to deal with the situation.

Using A B C to Improve and Change Behavior

An ABC diary will observe and track difficult behaviors. It is simple to use and can be a valuable nursing assessment tool that anyone can fill in. An ABC diary is also a record that can assist medical staff assess your relative's physical and psychological state should they become involved.

This is what you do:

  • Record antecedents, behaviors, and consequences each time a challenging behavior occurs. An easy method of writing up the information is to divide up a large piece of paper into 3 columns, headed A, B, C, then you just need to fill in the relevant column.
  • It is important to write the ABC diary as quickly as you can following an incident. It is amazing how people can forget the subtlety of detail after even a short time.
  • You will need to record the behavior several times before you see any patterns emerging between the antecedents and consequences. Sometimes this may take a week or more.

The aim of using the ABC diary is to identify any recurring problems that contribute to the behavior. Armed with the information you can then aim to change the antecedents and/or consequences you think are contributing to the behavior.

Suggested Links:

Coping with disinhibited and inappropriate sexual behavior

What is Sundowning?