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/care givers/staff or one which
creates feelings of discomfort, powerlessness,
frustration, fear of 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 and behaviour which may
be extremely challenging to one person may be acceptable
to someone else. People with 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 behaviour as following
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 neuropsycholoist
or psychiatrist to make an assessment.
Types of Challenging Behaviours
Some examples include:
- Withdrawal / avoidance
- Tactlessness
- Impatience
- Restlessness
- Self/centeredness
- Verbal aggression
- Physical aggression
Verbal aggression
- Increased libido
- Decreased libido
- Alcohol/drug abuse
Awareness of behaviour
It is not uncommon for people with
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 had 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 very according to the individuals
with a brain injury, the people around them and the
environment.
- Irritability
- Impulsivity (acting first & thinking
late)
- Paranoia
- Self harm
- Financial irresponsibility
Positive, non-aversive techniques
should always be used in the first instance. Negative
consequences are 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
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