n) Challenging behaviour and ABI

Summary

 

 

 

 

 

 

Challenging Behaviour following an Acquired Brain Injury

What is a challenging behaviour?

Challenging behaviour can be defined as:

"Any behaviour, or lack of behaviour of such intensity, frequency and/or duration that has the potential to cause distress or harm to clients/carers/staff or one which creates feelings of discomfort, powerlessness, frustration, fear or anxiety. It is also behaviour, which delays or limits access to ordinary community facilities and is outside socially acceptable norms."

What makes a particular behaviour challenging is subjective. Behaviour which may be extremely challenging to one person may be acceptable to someone else. People with a brain injury can sometimes behave in ways that stretch the limits of acceptability in family and work relationships and society in general. Following a brain injury, people can 'break the rules' associated with:

• How close to stand to other people
• When it is appropriate to interrupt another person who is speaking
• When and how to show emotions
• How to interpret and respond to non-verbal communication
• Appropriate behaviour in relation to exposure of body parts
• When to speak and how to get a point across.

Why does challenging behaviour arise following ABI?

It may be impossible to understand the cause of any particular behaviour; however, it can be helpful
to consider behaviours as falling into one of three categories:

• Behaviour resulting directly from damage to a particular area of the brain e.g. those responsible for impulse control such as shopping continuously.
• Behaviours learned or adopted following the injury as a form of adjustment to the environment and its demands.
• Behaviour exhibited prior to the injury and not related to it but to other individual factors.

Understanding which categories any particular behaviour falls into may need the help of a rehabilitation professional, such as a neuropsychologist or psychiatrist to make an assessment.

Types of Challenging Behaviours

Some examples include:

• withdrawal/avoidance
• tactlessness
• self-centeredness
• verbal aggression
• physical aggression
• decreased libido
• increased libido
• irritability
• alcohol / drug abuse
• restlessness
• impatience
• paranoia
• impulsivity (acting first & thinking later)
• financial irresponsibility
• self harm

Awareness of behaviour

It is not uncommon for people with a brain injury to experience a lack of insight into the nature and effects of their injury, including challenging behaviours. As the individual gradually begins to become more aware of the changes due to their injury, depression and anxiety may set in. This can be very frustrating for those around them.

How to respond to challenging behaviour

How you and others respond to the person with the brain injury can play an important role in the rehabilitation process along with the quality of life of family and friends. It is important when challenged by a person whose behaviour has changed as a result of an ABI to keep the emphasis on behaviour rather than personality. This helps to:

• Maintain a greater sense that change is possible
• Specify what is happening in clear and concrete terms
• Direct any disapproval away from the individual and onto the behaviour.

Strategies for dealing with challenging behaviours

There are many different approaches and strategies to encourage individuals to change their behaviour. The suitability and effectiveness of each option will vary according to the person with the brain injury, the people around them and the environment.

Positive, non-aversive techniques should always be used in the first instance. Discipline should only be used when all positive strategies have failed as it is the least effective method of behavioural change.

Some of the most commonly used and successful approaches are outlined as follows:

 

• Modifying the environment or routine e.g. decreasing background noise.
• Giving the person feedback about the behaviour.
• Motivating the person to change e.g. a reward system.
• Changing expectations and demands placed upon the person.
• Teaching the person new skills and behaviours.
• Changing how people around the person react.
• Make use of psychological support.
• Evaluate medication.
• Consult a professional.

It is important not to lose sight of the person's rights. Despite the best intentions the person with the brain injury may not want to change their behaviour. In this case it is up to the individual whether to modify their actions or not and they cannot be restrained or forced to change.