A significant number of people with dementia show challenging behaviours; one of the most challenging is vocally disruptive behaviour (VDB). VDB may be difficult to manage in all settings but particularly in rest homes and private dementia care hospitals. In a 2011 study direct observation of VDB was used to analyse the incidence, content of and response to VDB in two private New Zealand residential dementia care hospitals. Examples of VDB from both hospitals are discussed to illustrate the nature of VDB, both purposive and non-purposive. The relationship of the antecedents and consequences to the VDB are highlighted. Possible interventions to reduce VDB are reviewed. This challenging behaviour is highly variable and case specific. Caregivers would benefit from specific training to equip themselves with a range of interventions to allow for the individual needs of residents and the changing nature of the behaviour. More studies that use direct observation and participatory action research would enhance the current understanding of VDB and how to effectively manage it.