Synapse - reconnecting lives

Challenging and complex behaviours are common following a brain injury if there is damage to parts of the brain that control our impulses and regulate our emotions.

Behaviour that is considered acceptable is set by thousands of unwritten rules. Some examples include:

• how close to stand to other people
• when it is okay to interrupt another person
• when and how to show emotions
• how to interpret and respond to nonverbal communication
• when and what parts of a person's body may be seen naked.

Behaviour that breaks these "rules" can lead to social exclusion, restriction of access to community services, family breakdown and even prison.

What are complex & challenging behaviours?

A challenging behaviour is one that we find hard to accept; it literally challenges our ability to understand why it is happening - usually because it is breaking those unwritten social rules.

A complex behaviour is one which makes it difficult to initially see the reasons for the behaviour. We will use these terms as interchangeably as they are usually strongly linked together in the context of a brain injury.

Examples of challenging & complex behaviours include:

• Physical or verbal aggression
• Self-injury
• Property destruction
• Disinhibited and impulsive behaviour
• Hypersexuality
• Impulsivity
• Aggressive behaviour.

Why not just say 'bad behaviour'?

The problem is that when we use negative and judgmental words our actions tend to follow suit, and the behaviour will only deteriorate in response. Using terms like challenging behaviour makes us more objective in our thoughts and actions.

If we take Sarah as an example, her behaviour changed dramatically after a brain injury. If her family sees Sarah as bitchy, temperamental and willfully disruptive, these negative perceptions will seriously affect any efforts to understand the reasons behind the behaviour, and disrupt any plans made to encourage more appropriate behaviour. 

 What causes challenging behaviours?

A brain injury can affect those parts of our brains involved with our emotions, our ability to control impulses, and our self-awareness and ability to monitor and change our behaviour. As we grow and mature toward adulthood, we learn these skills over many years. A brain injury often means a person needs to relearn many of these skills, and in some cases may be unable to do so if their self-awareness is affected severely. 

What can I do about challenging behaviours?

Get a good understanding of how brain injury affects behaviour, then you can understand the "message" behind each behaviour and develop positive responses. When you understand why a behaviour is occurring, you can respond positively, instead of just reacting negatively. 

Read about all the various strategies available you can use when responding to challenging behaviours. 

Ask for support from others such as family members, therapists, psychiatrists, psychologists and your nearest Brain Injury Association.

Here are some basic tips that can help to reduce the chances of challenging behaviours, or develop positive responses to them:

• Provide as much structure and routine as possible
• Communication should be clear, direct and frequent
• Talk about issues, including the behaviour and what to do about it
• Don't be vague - explain which behaviours you like and don't like
• Have clear limits and rules - what you expect and what is appropriate
• Give the person feedback and information about their behaviour
• Be consistent in how you manage behaviour
• Be positive - notice and encourage appropriate behaviour frequently
• Take into account changes in thinking, understanding or memory
• Use strategies that defuse behaviour and help a person calm down - talk it through, change the topic, change the task
• Use redirection, distraction, and diversion to shift behaviour
• Use humour to defuse things and reduce tension and stress
• Get support for yourself and for the person with the brain injury.

Don't take challenging behaviours personally

Usually the behaviour is not deliberately targeting you so try to not take it personally if the person is critical, argumentative or angry although this is usually difficult if the behaviour has upset you. Remind yourself that the brain injury has affected the person's ability to manage their own behaviour, and focus on positive responses to the behaviour - this reduces the powerlessness many feel when just reacting to challenging behaviours instead of responding. 

Stress management for carers & family members

It is normal to feel upset and angry - where possible stay calm while responding to (or ignoring) the behaviour but talk later with other family members, your support group or your Brain Injury Association for support. 

Get support from people around you - talk about ways to manage behaviour and cope better - talk to friends, family, or talk to a counselor or brain injury specialist. Discuss ideas to make things work better.

Take time for regular breaks. You need time out for relaxation, rest and restoring your energy. Keep in touch with your friends and keep up with your own hobbies and interests as much as you can.

Find out about more about brain injury so you can understand any difficulties that the person may have.

Is there a 'cure' for behaviour problems?

There are no easy solutions or fixes for challenging behaviours as they are caused by many complex factors (including the brain injury) which may not change. However, the good news is that even when a person has very limited self-awareness, family members can often influence behaviours by responding consistently and positively with positive behaviour support.

Click here to view the Spanish version of this fact sheet.