Positive Approaches Journal, Volume 14, Issue 1
Escudé | 26-30
Volume 14 ► Issue 1 ► June 2025
Understanding Behavior as Communication When Supporting People with IDD
Craig Escudé, MD, FAAFP, FAADM, FAAIDD
Supporting people with intellectual and developmental disabilities (IDD) comes with the responsibility of understanding their unique ways of communicating. For many people with IDD, especially those who are unable to use words to communicate, behavior often becomes their primary form of expression. A sudden outburst, withdrawal, repetitive movement, or even a smile or gesture can carry important messages about their physical health, emotional state, environment, or unmet needs.
Rather than viewing challenging behaviors as problems to be fixed or controlled, it’s essential to ask, “What is this person trying to tell me?” Behavior is communication, and often, it's the most accessible way for someone to express pain, frustration, fear, discomfort, confusion, or joy. Misinterpreting or ignoring these signals can lead to missed opportunities for support and connection.
As supporters, our role is to become skilled observers and compassionate interpreters. This means taking the time to understand each person’s baseline behavior, recognizing changes that might indicate distress, and being attuned to triggers or environmental factors that influence behavior. Responding with empathy and curiosity, not judgment, builds trust and promotes safety and dignity.
Ultimately, when we listen closely to what people are telling us through their actions, we strengthen relationships and improve outcomes. In doing so, we honor each person’s voice, whether spoken or unspoken, and affirm their right to be heard and understood.
The Purpose Behind Behavior
Every behavior has a purpose. Understanding that purpose helps us provide better support. Here are some common reasons a person might exhibit certain behaviors:
- Seeking Access – A person may be trying to get something they want, like a favorite item or activity.
- Gaining Attention – Sometimes, behaviors are used to connect with others. This isn’t necessarily negative; it simply means the person has learned that a particular action gets them noticed.
- Escaping a Situation – If someone repeatedly "acts out" in a specific environment (such as when they are doing something they do not enjoy), they may have learned that this behavior results in being removed from the situation.
- Avoiding Discomfort – Some behaviors help a person avoid situations they find distressing.
- Sensory or Internal Needs – Certain behaviors may be responses to internal sensations, such as self-soothing or reacting to overstimulation.
Considering Medical or Physical Discomfort
A person’s behavior is a sign of an underlying medical issue. Since some people cannot tell us when they are in pain or discomfort, their behavior can provide important clues. For example:
- A person who becomes aggressive at mealtimes might be experiencing nausea due to a medication side effect.
- Someone who screams when approaching the bathroom may anticipate pain with urination due to a bladder infection.
- A person who spits out food might be hungry but struggling with pain from a dental issue.
By paying close attention to patterns in behavior, we can identify potential health concerns and ensure those we support receive the care they need.
Connecting Behavior and Mental Health
Keep in mind that mental health conditions can result in challenging behaviors as well. “Acting out” may be a way of communicating emotional distress.
- Anxiety may appear as repetitive movements or pacing.
- Depression may appear as irritability or increased aggression, as well as withdrawal.
- Past trauma can lead to heightened fear responses, avoidance behaviors, or outbursts when triggered.
- Psychotic disorders may appear as confusion, paranoia, or agitation.
Recognizing Triggers
Observing when and where behaviors occur can help us understand what might be causing them. Consider these questions:
- Does the behavior only happen at certain times of the day?
- Does it only occur in specific environments or around certain people?
- Could the setting be a factor—such as loud noises or bright lights—cause distress?
By identifying triggers, we can adjust environments or approaches to better support the person’s comfort and well-being.
How Supporters Can Help
- Recognize behavior as a form of communication – Instead of viewing behaviors as "bad," ask, “What is this person trying to tell me?”
- Look for changes in behavior – A sudden increase in aggression, withdrawal, or self-injury may indicate discomfort.
- Create a calm, predictable environment – Structure and reassurance can help ease anxiety and emotional distress.
- Advocate for appropriate mental health care – People with IDD deserve access to proper psychiatric support, therapy, and medication if needed.
- Encourage alternative communication methods – Some individuals may express emotions through art, movement, or assistive technology rather than words.
Responding with Compassion
When supporting someone with intellectual disabilities, it’s essential to remember that behavior is often an attempt to communicate, not just something they "do." Instead of reacting negatively, we should ask ourselves: “What is this person trying to tell me?”
By approaching behaviors with curiosity, empathy, and patience, we can build stronger, more trusting relationships and help the individuals we support feel heard, valued, and respected.
Biographies
Dr. Craig Escudé is a board-certified Fellow of the American Academy of Family Physicians, the American Academy of Developmental Medicine, The American Association on Intellectual and Developmental Disabilities, and President of IntellectAbility. He has more than 20 years of clinical experience providing medical care for people with IDD and complex medical and mental health conditions, serving as medical director of Hudspeth Regional Center in Mississippi for most of that time. While there, he founded DETECT, the Developmental Evaluation, Training, and Educational Consultative Team of Mississippi. He is the author of “Clinical Pearls in IDD Healthcare” and developer of the “Curriculum in IDD Healthcare,” an eLearning course used to train clinicians on the fundamentals of healthcare for people with IDD, and the host of the IDD Health Matters Podcast.
Contact Information
Craig Escude, MD, FAAFP, FAADM, FAAIDD
IntellectAbility, President