Coping with Behaviours
COPING WITH BEHAVIOURS
Managing the challenging behaviours that can arise after a brain
injury can be very stressful for families or partners. Nathan's
family is one that demonstrates the patience, consistency and
willingness to develop strategies that can manage Nathan's
This was not one of Nathan's better days. He was more irritable
than usual this morning and his parents exchanged their usual
glances of frustrated affection when he was not looking. He
constantly interrupted his parents in mid sentence. He sulked when
he was told to wait. He threw his spoon to the floor before they
even finished their sentence.
At four years of age Nathan had a well developed wail he unleashed
every time he failed to get his way. It echoed around the room when
he was not allowed to steal his sister's toast. He resented being
told he must stop calling her a fat head. In his frustration he
tried to hit her and screamed when he was restrained.
Minutes later all this was forgotten as he happily played a game
on the computer. Every time his parents told him to get dressed he
said okay then ignored them. There was some more yelling as the
computer was shut down then he was taken through every step of
getting dressed which he resisted as much as he can. More than
usual, Nathan was unable to focus on getting ready to school and
was distracted by a bird outside, his sister's singing and the
CONSISTENCY AND PATIENCE
Through all of this Nathan's parents demonstrated the hallmarks of
good parents worldwide- patience, firmness, consistency,
understanding and affection. While they did not understand the
physiology of Nathan's brain, they did know that at five years of
age he was only beginning to learn a range of cognitive abilities.
Considering the needs of those around him.
Compromising with others. Restraining his impulses. Prioritising
and sequencing a range of tasks. Controlling his emotions.
The frontal lobe
The vast majority of these cognitive processes took place in
Nathan's frontal lobe, which would not fully mature until his mid
twenties. Until then his parents knew that he would gradually
acquire these skills if they continued to patiently model good
behaviour, provide feedback on his behaviour, and provide
consistent boundaries with affection.
Ironically it is in his mid twenties that Nathan damages the
frontal lobe of his brain. A particularly hard tackle in football
leaves him unconscious for three hours in the local hospital. The
scans do not reveal any brain trauma so Nathan's family feel he has
survived yet another accident of his sport oriented life.
Resentment within families
In the following months his family gradually realise that Nathan
has changed. The only way they can describe it is that in many ways
Nathan is five years old again. He can not take into account other
people's needs and interrupts his parents in mid sentence
constantly. He sulks or yells when his demands are not met
instantly. His moods vary wildly, particularly when he is fired for
inappropriate behaviour in the workplace.
Nathan has trouble with his household chores and financial
management. Initially his family try to help out but he is easily
distracted and inclined to outbursts when asked come back to the
task at hand.
Resentment builds up in the family and comes to a head when his
sister refuses to see him after he threatened to hit her. Their
local GP recommends a neuropsychological assessment which indicates
that Nathan has acquired a mild brain injury. She explains to the
family how the trauma to Nathan's frontal lobe has led to his
The need for understanding
As the family comes to understand Nathan's brain injury more
fully, they realise that he does not control over much of his
behaviour - much as he didn't as a child when his frontal lobe was
not fully developed. With this understanding they begin to exercise
the patience, firmness, consistency and affection that will slowly
help Nathan relearn some if his lost abilities - emotional control,
seeing others' points of views, curbing his anger and social
skills. While he may never fully regain lost abilities it is the
support of his loved ones that will provide the best environment to
recover as much as possible.