Date Posted: 27.03.2012

What is a challenging behaviour?
We all exhibit behaviour all the time. Behaviour which may be extremely challenging to one person may be acceptable to someone else. One definition
of challenging behaviour can be defined as: “abnormal behaviour of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to the use of ordinary community facilities.”
(Adapted from Emerson & Bromley, 1995)
People with a brain injury can sometimes behave in ways that stretch the limits of acceptability in family and work relationships, and society in general. Following a brain injury, people can ‘break the rules’ on:
• 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 other people’s body language
• Sexuality and intimacy
• When to speak and how to get a point across.

Why does challenging behaviour happen after a brain injury?
Behaviour always serves a purpose. With behaviour which is challenging, it is important that we try and understand the purpose that it serves for the
person. Whilst it may be impossible to understand the cause of any one particular behaviour, it can be
helpful to consider behaviours as falling into one of three categories:
• Behaviour resulting directly from damage to a particular area of the brain, for example, when someone’s impulse control is affected and they start 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 professional, such as a neuropsychologist to make an assessment.

Types of Challenging Behaviours
Some examples include:
• withdrawal/avoidance
• self-centeredness
• physical aggression
• sexual inappropriateness
• alcohol / drug abuse
• extreme impatience
• impulsivity (acting first, and thinking later)
• tactlessness
• verbal aggression
• extreme irritability
• restlessness
• paranoia
• financial irresponsibility
• self harm

Awareness of Behaviour
It is quite common for people with a brain injury to experience a lack of insight into the nature and effects of their injury, including challenging
behaviours. As a person gradually begins to become more aware of the changes due to their injury, they may become anxious or even depressed.
Strategies for dealing with challenging behaviours
There are many different approaches and strategies to encourage someone to change their behaviour. The suitability and effectiveness of each
option will vary according to the person with the brain injury, the people around them and the environment.
A strategy will work best when a full assessment has been made of the behaviour and the person which takes into account their circumstances and
culture. You may need professional help from a psychologist to provide this type of assessment. By putting the emphasis on the behaviour, rather
than on the person these strategies try to minimise the potential for any harm resulting from behaviour. They also recognise that the behaviour
itself may be serving a useful purpose for that person.

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 for you to focus on a person’s behaviour rather than their 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 person and onto the behaviour.

Some approaches you can use include:
• Modifying the environment or routine, for example turning off a noisy television.
• Giving the person feedback about the behaviour.                                                                                                                                                                             Changing the demands you place upon the person.  

Changing how you, or other people around the person, react to the behaviour. If the challenging behaviour continues, you can seek professional help for the person through your GP. They may be able to make further suggestions such as a referral to a psychologist or reviewing any medication the person is taking. Brain injury organisations, including Headway, also provide specialist psychological services.
Remember that dealing with challenging behaviour can be a very difficult experience for anyone, and it is important to seek support for yourself when you
need it. A brain injury organisation may be able to help. Headway provides education, groups and counselling for family members.
 

Source : www.headway.ie