Challenging & complex behaviours: giving feedback
Clear direct feedback is a key part
of a positive response to challenging behaviours after a brain
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
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
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
Feedback should be simple &
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
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
Make sure the feedback
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.
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.
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
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,
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
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
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
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.