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

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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:

  1. Behaviour resulting directly from damage to a particular area of the brain e.g. those responsible for impulse control such as shopping continuously
  2. Behaviours learned or adopted following the injury as a form of adjustment to the environment and its demands
  3. 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.

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Types of Challenging Behaviour

Some examples include:

  • Withdrawal / avoidance
  • Tactlessness
  • Impatience
  • Restlessness
  • Self/centeredness
  • Verbal aggression
  • Physical aggression
    Verbal aggression
  • Increased libido
  • Decreased libido
  • Alcohol/drug abuse

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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.

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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

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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
While all care has been taken to ensure the accuracy of this factsheet the information is intended to be a guide only and proper medical and professional advise should be sought. Elements Support Services are not responsible for any damages or injuries that arise as a result of the information in this factsheet.