Synapse - reconnecting lives

Parents generally want the best for their children. Despite obstacles presented by a brain injury, parents can still bring out their strengths, help them to ride out the difficulties, and enable them to develop to their full potential.

 
Bringing out the best in a young person means:

• Enabling each child to express fully his/her own talents and abilities
• Learning to build caring and satisfying relationships with other people
• Acquiring the skills to be as independent as possible, and take on responsible roles in life.

Two qualities are of particular importance in this process, self-esteem and resilience - the ability to handle life's 'knocks' and challenges. The support, love and respect of family members and, especially during adolescence, of peers and friends, are the foundation for building resilience and self-esteem. A brain injury can make it more difficult, but there are lots of positive things you can do to help your child build his/her skills, self-esteem and resilience.

Bringing out the best in your child also involves enabling and encouraging them to be involved in the normal run of community activities - doing the things that friends and peers are doing. Swimming at the local pool, joining the scouts, getting a pizza with friends, all help to build self-esteem and confidence and focus on the person rather than the problem.

Encouraging appropriate behaviour

The best basis for helping your child is a loving, caring relationship - not always easy in the face of very difficult behaviour. Try to see your child as separate from the difficult behaviour-'I love you, but I don't like what you're doing'. This can help you to work together on the problem, without a negative focus on the child.

Parents in general do lots of things to bring out the best in their child, and all these things can benefit young people with a brain injury:
Set specific rules and structures for particular situations, and rehearse these each time a similar situation is coming up.

Praise or reward behaviours you want to encourage but don't reward behaviours you don't want to see-ignore them or, if necessary, offer comment or an agreed punishment quietly, without drawing extra attention to the behaviour.

Help your child to learn from experience by talking over what he or she did right or wrong, and how there might be other ways of responding.
Show your child, by your actions, how to handle difficulties and get along with others.

Behave in the ways you want your child to behave-for example, be caring, empathetic and respectful of others.

Most importantly, young people with a brain injurymay need very concrete, detailed and explicit instructions and rules about what to do in particular situations (for example, who they should or should not hug), and parents may need to set very firm limits and keep a check on them.

Understanding challenging behaviour

In trying to understand challenging behaviour:

• Try to put yourself in your child's shoes, to see the issue from his or her perspective
• See behaviour as a form of communication and try to understand the message
• Be aware of your own responses as sometimes kids 'push our buttons', know how to make us react, and we respond automatically.

Young people with a brain injury  can take responsibility for their behaviour, given the right supports. They can learn appropriate ways of behaving, but - like everyone - they'll learn best when the goal is something they want to achieve for themselves. It's important to respect young people's own choices and priorities.

Managing agitation, frustration & anger

It's not uncommon for young people with a brain injury to behave in ways that are challenging or sometimes aggressive. They may have difficulty coping with small upsets and not even know why they are angry. Everybody feels angry, irritated or annoyed at times, but we all need ways of dealing with these feelings in ways that are appropriate, socially acceptable, and constructive. Physical violence, verbal abuse, avoiding someone, or just 'sitting on' the emotion are all unhelpful.

Very young children often hit out when they are angry, but over time they learn to use words (even if these aren't very polite). Saying 'I hate you' rather than delivering a punch shows that a child has learned the first step in anger management-a shift from a physical to a verbal way of expressing anger. This shift deserves praise and recognition. Later on, a child may learn how to feel angry less often, as they learn to negotiate and see another person's point of view.

Young people with a brain injury may have difficulty developing these more mature ways of managing anger. Cognitive problems can make it difficult to see things from another point of view.

Other people's reactions vary. Some might try to ignore the problem, or blame somebody, or demand that the young person change, or they might just become upset. In the long term, though, these responses generally don't deal with the situation very effectively.

Conflicts may be frequent and intense, and discipline that works with other children might not be effective. Parents may find it hard to apply discipline at all.

These situations can be very distressing for parents and families. They can also be distressing to the young person-nobody likes to feel that their behaviour is out of control. The first aim, then, is to find ways for you and your child to regain a sense of control over your lives.

Some helpful strategies

Young people with a brain injury can usually learn to avoid having their anger boil over into physical aggression. The following suggestions may help to manage challenging behaviour.

It doesn't help to confront the person or respond angrily. Ignore the behaviour, or simply say quietly that it's not appropriate now, and reward and praise other behaviours that are positive and appropriate. You can also set limits on what is acceptable behaviour-shouting may be OK, but no threatening gestures. Think about what you're willing to do to enforce these limits.

Make sure the standards you set are acceptable (and applied) in all situations in which your child must function. The whole family may have to make some adjustments - for example, brothers and sisters may need to accept the same rules.

Give praise when your child stays within the limits of acceptable behaviour or does something that avoids confrontations - for example, learning to walk away.

If temper or aggression is a significant problem, talk to a specialist (a neuropsychologist, or a psychologist who has expertise in working with young people, and preferably one with experience of brain injury). Don't wait too long before doing this-it's best to tackle problems before they become entrenched, for the sake of both the young person and the family.

A specialist may suggest a fairly structured 'behaviour management' approach. This involves working with you and your child to analyze what is happening, why it is a problem, and to reach agreement on how everyone involved will behave in the future - essentially a system for rewarding behaviours you want to encourage and ignoring those you want to discourage. The same strategies need to be used at home, at school, in day programs and so on - everywhere the young person is involved.

Anger can be a result of being misunderstood, and a longer term goal is to help the young person to develop socially appropriate ways to express feelings and opinions in words - to use language more effectively. A speech pathologist can help in this area.