Understanding challenging and complex behaviours

People develop behaviour skills over many years as they grow and mature into adulthood. A brain injury can affect parts of the brain involved with emotions, impulse control, self-awareness and ability to monitor and change behaviour.  Injury often means a person needs to relearn behaviour skills, which in some cases may be extremely difficult.

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 non-verbal communication
• when and what parts of a person’s body may be seen naked.

Behaviour that breaks these ‘rules’ can lead to social exclusion, restricted access to community services, family breakdown and even may even have criminal consequences.

A complex behaviour is one where the reasons behind the behaviour are difficult to see. A challenging behaviour is one that people find hard to accept.  These behaviours usually break unwritten social rules and are difficult to understand.

Examples of challenging and complex behaviours include:

• physical or verbal aggression
• self-injury
• property destruction
• disinhibited and impulsive behaviour
• hyper-sexuality
• impulsivity
• aggressive behaviour.

It is important to develop a good understanding of how brain injury affects behaviour to recognise the ‘message’ behind each behaviour and develop positive responses.

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
• be clear about which behaviours are acceptable or not
• have clear limits and rules – what is expected 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, such as talking it through, changing the topic or changing 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.

People can become critical, argumentative or angry as a result of brain injury. Their behaviour should not be taken personally, although this can be difficult when it is upsetting. Family and carers need to remind themselves that the brain injury has affected the person’s ability to manage their own behaviour. Family members can play a productive role in influencing behaviour by reacting positively and consistently.