Behavioural Changes

A person with a brain injury may experience changes in behavior, including self-control, self-awareness and response to social situations.  The following are common behavioral problems for a person with a brain injury, what you may see and suggested ways to help.

PROBLEM & SIGNS

 

WHAT TO DO

Problem: Difficulty with self-control

 

Signs:

  • Acts or speaks without all the information or without considering the consequences Impulsiveness or poor judgment
  • Lack of inhibition Inappropriate comments to or about others
  • Gets stuck on one idea or activity (perseveration)

 

What to do:

  • Limit the person’s choice of options.
  • Suggest alternatives for behavior.
  • Explain the reasons for tasks.
  • Be fair in your expectations.
  • Respond immediately to inappropriate ideas but
  • maintain the original focus of the discussion. Encourage the person to slow down and think
  • through tasks or responses.
  • Provide supportive verbal and non-verbal feedback for reassurance.
  • If undesired behavior occurs, calmly and confidently discuss the consequences in private. Praise and reward desired behavior.

Problem: Impaired self- awareness

 

Signs:

  • Lack of awareness of deficits and limitations (this is not typically intentional, but rather a common phenomenon following traumatic brain injury in particular)
  • Overestimates abilities; underestimates problems
  • Inaccurate self- image/self-perception

 

What to do:

  • Anticipate lack of insight.
  • Prompt accurate self-statements.
  • Use feedback generously and supportively.
  • Give realistic feedback as you observe behavior

Problem: Difficulty participating in or being part of social situations

 

Signs:

  • Acts or speaks without all the information or without considering the consequences
  • Difficulty taking turns
  • Impulsiveness
  • Socially inappropriate behavior or comments
  • Not always sensitive to social boundaries
  • Acting out of place in unfamiliar social or public settings

 

What to do — before the event

  • Provide clear expectations for desirable behavior in social settings or in special circumstances such as job interviews, attending a funeral, or going to church.
  • Plan and rehearse social interactions so that they will be familiar, predictable and consistent.
  • Establish verbal and non-verbal cues to signal the person to “stop and think.”

 

What to do —during the event

  • Treat the person appropriately, according to
  • age.
  • Encourage the person to slow down and think through responses.
  • Prompt the person to consider consequences of
  • behavior.
  • Provide positive feedback for appropriate behavior.
  • Encourage a break in activity when frustration or fatigue are evident.
  • Respond immediately to inappropriate ideas but
  • maintain the original focus of the discussion.
  • If undesired behavior occurs, calmly and confidently address the behavior in private. Be
  • objective and explain that the behavior, not the person, is inappropriate
  • Reassure and be fair in your expectations.

 

What to do — after the event

  • Review the behavior, the effectiveness of verbal and nonverbal uses, and the overall success of the outing.
  • Praise appropriate behavior and responses to cues and redirection.