Individuals living with brain injury present with various levels of behavioural disturbance termed ‘challenging behaviour’. This refers to behaviours that cause distress including physical and verbal aggression, inappropriate social and sexual acts and difficulties with initiation and motivation (Kelly, 2006). This may manifest as staying in bed for long periods, watching TV for hours, swearing and so on.
In the client’s home where the environment is less structured, these ‘challenging behaviours can endure or worsen overtime (Johnson, 996). This can result in exclusion from services, cause significant distress for those providing support and reduce the likelihood of successful social and community re-integration (Kelly, 2008).
Research suggests that the following can aid family members in dealing with these behaviours:
- Modelling (demonstrating the desirable behaviour first so it can be copied by your loved one with brain injury);
- Consistent prompting (giving or encouraging desired behaviour through cuing);
- Giving verbal feedback in the moment;
- Reinforcement of the desirable behaviour through praise;
- Changing your expectations of your loved one with brain injury;
- Knowledge of the condition
- Modifying the environment
(Barman 2016; Kelly 2008)
Case study – Paul’s Punching People (The Message behind Behaviour, 2020)
Anger and aggression are common challenging behaviours following brain injury. Paul often screamed and punched his family. They became frustrated by the behaviour and ignored it, assuming Paul was in a bad mood as it wasn’t consistent. With time the behaviour became more frequent and difficult to manage. The family began to suffer from burnout & mental health difficulties.
Using ABC charts
When exploring Pauls behaviour more closely using ABC charts, they noticed that Paul usually punched and screamed when he was being talked over or being moved without prior warning. Paul struggled with information processing and so spoke slowly requiring extra time to comprehend and express himself.
Unmet need: Paul wanted to express himself and have agency over his movements. He resented having the opportunity to communicate taken away from him, it made him feel dehumanised.
Expression of mood: Punching and screaming is Paul’s way of expressing his frustration and distain.
This simple example highlights how behaviours often communicate a message. Paul required more time to communicate because of the brain injury and preferred to be alerted prior to being moved. His family mistakenly assumed they were helping Paul by predicting his needs, trying to reduce his need to communicate as it appeared difficult.
It also highlighted the burnout commonly experienced by family members (Chan, 2009). Without support in place, capacity for familial coping reduces overtime, particularly with challenging behaviour (Hall 1994; Media maker n.d).
The following can be helpful for families:
- Psychological support such as local GP, Headway, Brain injury groups, MIND, Samaritans, IAPT, Respite services
- Carer’s assessments via social services.
- Consult a professional e.g., Local psychologist
References
Kelly, G., Todd, J., Simpson, G., Kremer, P., & Martin, C. (2006). The Overt Behaviour Scale (OBS): A tool for measuring challenging behaviours following ABI in community settings. Brain injury, 20(3), 307-319.
Johnson, R., & Balleny, H. (1996). Behaviour problems after brain injury: incidence and need for treatment. Clinical Rehabilitation, 10(2), 173-180.
Kelly, G., & Parry, A. (2008). Managing challenging behaviour of people with acquired brain injury in community settings: The first 7 years of a specialist clinical service. Brain Impairment, 9(3), 293-304.
Barman, A., Chatterjee, A., & Bhide, R. (2016). Cognitive impairment and rehabilitation strategies after traumatic brain injury. Indian journal of psychological medicine, 38(3), 172-181.
.“The Message behind Behaviour.” Synapse – Australia Brain Injury Organisation, 9 Mar. 2020, synapse.org.au/fact-sheet/the-message-behind-behaviour/.
MEDIAmaker. (n.d.). Family reaction to a brain injury. Retrieved from https://www.headway.org.uk/about-brain-injury/individuals/caring/family-reaction-to-a-brain-injury/
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