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Challenging & complex behaviours: giving feedback

Information Services
 
 

Behaviour

Challenging & complex behaviours: giving feedback

Clear direct feedback is a key part of a positive response to challenging behaviours after a brain injury.

After a brain injury, some people will have difficulty with self-awareness, communication, mood, social skills and behaviour. They may also not realize when their behaviour is inappropriate, so providing immediate, direct and clear feedback is very important.

 

Behaviours can include something the person does (e.g. shouting, interrupting, touching, hitting, pinching, slamming doors, crying, uses angry tone of voice, masturbates in public)or something the person says (e.g. uses swear words, threatens to hit, talks about sexual/personal information, tells jokes with a sexual theme).

 

Feedback should be clear

Unspoken social behaviour rules that you take for granted should be very clear. Examples include:

  • "It's not okay to touch women on the breast"
  • "Hands off"
  • "I would rather you didn't talk about . . ."
  • "You are staring at that woman . . . she might feel uncomfortable."

 

Feedback should be simple & immediate

Don't assume a person will pick up subtle cues about their behaviour. Information that is too vague or general will leave the person unclear or uncertain about what it is you do and don't like. For example, "I don't like it when you shout loudly at me" is much clearer than "I don't like it when you are rude."

 

Give feedback in a calm manner

Try to control your own emotions. Angry or critical behaviour from you or others is likely to trigger more anger or aggression. Try to be calm and uncritical when you are giving feedback. Feedback should be matter-of-fact and firm, without strong emotional reactions such as anger, impatience, shock, disapproval or fear.

 

Make sure the feedback is understood

If there is difficulty with comprehension or understanding of information, feedback may need to be simpler. You might need to use pictures, diagrams or other communication aids. Check whether they understand what you are saying. Tell the person which behaviours are acceptable or expected.

 

Repeat information

If the person has any difficulties with memory and learning, you may need to repeat the information at regular intervals, or try other memory strategies such as writing things down, using signs, checklists or prompts. If a person does not remember or learn what is expected of them immediately or quickly, you may need to build in regular reminders, possibly each time you see them.

 

Talk about the behaviour

Try to talk about the behaviour, rather than the person when you are giving feedback. It is important that the person feels like you support them, but not the behaviour. For example, "I understand why you are frustrated, but I don't want to you shout at me." or "Let's talk about what we can do about your frustration".

 

Give ideas about alternative behaviours

Provide clear alternatives or choices about the behaviour you want them to stop. For example "You sound angry, do you want to talk about this later?" or "Could you wait until I have finished, please?"

It is important for the person to know what they should do, not just what they are not to do e.g. ask the person to say please, or speak politely, or wait until you are finished talking.

It's important to understand why the behaviour is happening too. If behaviour is occurring because a person feels overwhelmed by a noisy environment, it is probably best to simply escape that environment than stay there and try to manage the consequences.

 

Give direction about their behaviour

Redirect the person to other activities or topics that are appropriate or acceptable. Sometimes a person may need direction regarding alternative topics of conversation or other behaviours that are acceptable. For example, jokes with a sexual content might not be acceptable, but other jokes might be; touching on the breast or bottom may be off limits, but touching on the hand may be an acceptable alternative.

 

Responses to behaviour must be consistent

Consistency is important, especially with setting limits and giving feedback. Make sure the person with a brain injury gets the same message from everyone about what behaviour is acceptable or unacceptable. It is important to be consistent in giving feedback when a number of people are involved - workers, friends, family. This means you have to:

  • identify behaviours that are inappropriate and appropriate
  • decide on management strategies,
  • use the strategies the same way in each situation where they are needed.

 

Encourage appropriate behaviours

Notice examples of behaviour you would like to see more of, and mention it to the person and family. For example, "I've noticed how calm you have been today." and "You really seem to be listening to other people's points of view." and "Thanks for waiting until I finished what I was saying."

Positive feedback and encouragement is an important part of learning and maintaining appropriate behaviour. Experiment with genuine ways to give encouragement. Examples include:

  • "I like to see how you are helping others"
  • "Great job!" 
  • "I admire you for . . ."
  • "You seem to be very happy today"
  • "I like the way you did that"
  • "You are doing so well with. . ."
  • "Thank you for your help"
  • "You put a lot of effort into that task"
  • "You got that finished quickly."

References and further information

This is an excerpt from an ABIOS (Acquired Brain Injury Outreach Service) fact sheet. Visit www.health.qld.gov.au/abios/ for the full fact sheet. ABIOS is a specialist community-based rehabilitation service to enhance the service system for people with Acquired Brain Injury (ABI) and their families.

 

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