Challenging & complex behaviours: an introduction
Challenging and complex behaviours are common
following a brain injury if there is damage to parts of the brain
that control our impulses and regulate our emotions.
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 nonverbal communication
- when and what parts of a person's body may be seen naked.
Behaviour that breaks these "rules" can lead to social
exclusion, restriction of access to community services, family
breakdown and even prison.
What are complex & challenging
A challenging behaviour is one that we find hard to accept; it
literally challenges our ability to understand why it is happening
- usually because it is breaking those unwritten social rules.
A complex behaviour is one which makes it difficult to initially
see the reasons for the behaviour. We will use these terms as
interchangeably as they are usually strongly linked together in the
context of a brain injury.
Examples of challenging & complex behaviours include:
- Physical or verbal aggression
- Property destruction
- Disinhibited and impulsive behaviour
- Aggressive behaviour.
Why not just say 'bad
The problem is that when we use negative and judgmental words
our actions tend to follow suit, and the behaviour will only
deteriorate in response. Using terms like challenging behaviour
makes us more objective in our thoughts and actions.
If we take Sarah as an example, her behaviour changed
dramatically after a brain injury. If her family sees Sarah as
bitchy, temperamental and willfully disruptive, these negative
perceptions will seriously affect any efforts to understand the
reasons behind the behaviour, and disrupt any plans made
to encourage more appropriate behaviour.
What causes challenging
A brain injury can affect those parts of our brains involved
with our emotions, our ability to control impulses, and our
self-awareness and ability to monitor and change our behaviour. As
we grow and mature toward adulthood, we learn these skills over
many years. A brain injury often means a person needs to relearn
many of these skills, and in some cases may be unable to do so if
their self-awareness is affected severely.
What can I do about challenging
Get a good understanding of how brain injury affects behaviour,
then you can understand the "message" behind each behaviour
and develop positive responses. When you understand why
a behaviour is occurring, you can respond positively, instead of
just reacting negatively.
Read about all the various strategies available you can use when
responding to challenging behaviours.
Ask for support from others such as family members, therapists,
psychiatrists, psychologists and your nearest Brain Injury
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
- Don't be vague - explain which behaviours you like and don't
- Have clear limits and rules - what you expect and what is
- Give the person feedback and information about their
- Be consistent in how you manage behaviour
- Be positive - notice and encourage appropriate behaviour
- Take into account changes in thinking, understanding or
- Use strategies that defuse behaviour and help a person calm
down - talk it through, change the topic, change the task
- Use redirection, distraction, and diversion to shift
- Use humour to defuse things and reduce tension and stress
- Get support for yourself and for the person with the brain
Don't take challenging behaviours
Usually the behaviour is not deliberately targeting you so
try to not take it personally if the person is critical,
argumentative or angry although this is usually difficult if the
behaviour has upset you. Remind yourself that the brain injury has
affected the person's ability to manage their own behaviour, and
focus on positive responses to the behaviour - this reduces the
powerlessness many feel when just reacting to challenging
behaviours instead of responding.
Stress management for carers &
It is normal to feel upset and angry - where possible stay calm
while responding to (or ignoring) the behaviour but talk later with
other family members, your support group or your Brain Injury
Association for support.
Get support from people around you - talk about ways to manage
behaviour and cope better - talk to friends, family, or talk to a
counselor or brain injury specialist. Discuss ideas to make things
Take time for regular breaks. You need time out for relaxation,
rest and restoring your energy. Keep in touch with your friends and
keep up with your own hobbies and interests as much as you can.
Find out about more about brain injury so you can understand any
difficulties that the person may have.
Is there a 'cure' for behaviour
There are no easy solutions or fixes for challenging behaviours
as they are caused by many complex factors (including the brain
injury) which may not change. However, the good news is that even
when a person has very limited self-awareness, family members can
often influence behaviours by responding consistently and
positively with positive behaviour support.