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Interventions For Behavioral Problems After Brain Injury

Comments [12]

Carrie Beatty, CBIS, ResCare Premier

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Interventions For Behavioral Problems After Brain Injury


Behavior change is difficult for any individual to accomplish. The process, however, can be infinitely more difficult for those who suffer from a traumatic brain injury (TBI) due to physical, cognitive, and emotional impairments associated with an injury. Successful reintegration into the community and return to activities of choice is often dependent on the individual’s ability to modify maladaptive behaviors that may result from the injury. Behavioral challenges that frequently require intervention following brain injury include aggression, disinhibition, difficulty relating to others, and a host of other behaviors.

A total reversal of behavioral problems after a brain injury may not be possible. A more realistic goal is to modify behaviors. There are several interventions available to assist with the modification of those behaviors that negatively effect goal achievement, successful community reintegration, or quality of life for individuals with TBI. The intent of this article is to describe and provide examples of current options for therapeutic intervention and examine their effectiveness for individuals with TBI.

Proactive Measures

There are a number of steps that can be taken proactively to set the stage in developing effective plans for behavior change.

Developing Trusting Relationships

It is important to build a trusting relationship with an individual who has had a brain injury. Much of what occurs during rehabilitation is based on trust that the individuals providing services understand what is important to the person receiving services. There must be trust that the recommendations providers make and activities they encourage, are designed to help the individual achieve his/her goals.

Trust is developed through honest, caring, and consistent interactions. It is important to be realistic with the individual. You cannot promise to ‘make him/her better.’ We, as family members or professionals, do not have all the answers to the individual’s problems. We may be most helpful by providing a comfortable, nonjudgmental atmosphere in which the individual can discuss his/her concerns and preferences, even if the concerns and the accompanying behaviors do not appear to be logical. The knowledge gained from such discussions is invaluable when developing behavior plans or carrying out treatment.

The importance of relationships in behavior change goes beyond relationships between professionals and a person with brain injury. Following a brain injury, an individual may feel isolated and depressed (Denmark & Gemeinhardt, 2002). Success in coping with or adapting to changes after injury, as well as in modifying maladaptive behaviors, is highly dependent upon the feedback and support an individual receives from his/her social network. A supportive network may include professionals, family, old friends, new friends, and persons who have had similar experiences.

Understanding the Behavior

Developing adaptive behavior first requires recognizing what may be contributing to the problematic behavior. Triggers, antecedents, and precipitating factors are terms describing that which precedes the behavior. Triggers to acting-out behavior may be internal or external (Caraulia & Steiger, 1997). Examples of internal causes of behavioral problems can be fatigue, hunger, lowered self-esteem, etc. External triggers may include a frustrating task, interaction with certain individuals, change in structure/ routine, increased level of stimulation, etc. In addition to understanding what may trigger maladaptive behavior, it is important to understand what occurs following the behavior that may serve to reinforce and hence maintain the behavior. For example, if a given behavior consistently results in a rewarding experience such as increased attention, the frequency of the behavior will most likely increase. Modification of antecedents and consequences to change behavior is discussed in more detail under the heading Behavior Therapy.

Recognizing and Responding to Precursors

Individuals often provide non-verbal and verbal signs prior to displaying the behavior of concern. A person’s change in behavior can represent a negative internal state. There may be signs of anxiety such as pacing and fidgeting. The face may become flushed; he/she may have difficulty maintaining eye contact or may display decreased attention to a task. An individual may also exhibit verbal signs, such as muttering to him/herself or increasing the volume of speech. Clearly, it is important to be aware of sudden, often subtle, changes in behavior (both non-verbal and verbal) in order to effectively intervene. Intervening early in the sequence of behavioral escalation is one of the most effective strategies for behavior change.

General Guidelines

In order to select the most appropriate intervention for modifying behavior during rehabilitation, the following guidelines, outlined by White, Seckinger, Doyle, and Strauss (1997), need to be considered:

  • Include the individual with TBI when developing a strategy. If a plan is developed without client input, it is not likely to be effective.
  • Prioritize the functional needs of the individual. Consider his/her strengths and weaknesses.
  • Analyze the tasks required for goal achievement. Individuals have more success if they can incorporate what they have already learned and know.
  • Consider the learning style. Individuals can learn from written information, oral information, or a combination of both. Ensure the intervention is compatible with the learning style of the individual.
  • Consider the individual’s willingness to participate in the therapy or strategy.
  • Ensure that the strategy is practical. Time and funding constraints, family concerns, and environment limitations (i.e., in-patient vs. day-patient) should be considered.

Therapeutic Interventions

Several different approaches have been used to modify behavioral problems in individuals with TBI, some with more success than others. Most of the therapeutic intervention strategies were developed originally for individuals with learning disabilities, emotional dyscontrol, and psychiatric disorders. Studies have shown that with some adjustments or combination of approaches, these intervention strategies can benefit individuals with TBI (Alderman, 2003). However, most researchers agree that additional studies should be conducted to better measure the effectiveness of therapeutic interventions that have been adapted for use with persons with TBI (Denmark & Gemeinhardt, 2002; Kinney, 2001; Manchester & Wood, 2001; Schlund & Pace, 1999).


From ResCare Premier. Used with permission. Third-party use prohibited. www.rescarepremiertexas.com.

Comments [12]

My niece has a brain injury due to ATV accident . She has been stealing things from me and purposely stained every pair of my jeans with something and putting it on the right knee of every pair. She denied doing it and swears she is innocent. Shows no remorse. She says that I have Alzheimer's. Why would she do this to me. I was the only one that has been there for her.

Oct 16th, 2016 9:33am

Anyone have advice on behavioral changes after a brain injury ? Is there help, like, reallly ?

Oct 9th, 2016 4:43am

Hi my name is Thomas. On October 2014 I had a very traumatic head injury. I was punched by two men in the head numerous times and had my head slammed on the floor too many times until I blacked out briefly. Since the injuries I have developed strange habits that i have never had before and loss of memory too and I'm very angry too. Can anyone help me with either advice or medical recommendations? I'm desperate and I'm developing I believe very scary changes in my desires and my anger/ personality . My head hurts too usually and my hands now shake too? Anyone out there reply please

Oct 9th, 2016 4:40am

My son was in an accident over 20 years ago. He has a TBI. He has exhausted all resources for behavior help in our area. He desperately needs help. He was 17 at the time and will soon be 38. We desperately need advice and where to turn for help. Laura

Oct 7th, 2016 11:53am

Brain Injury Association of America might be a good place for you to start. They have a page with a map of resources: http://www.biausa.org/state-affiliates.htm

Sep 15th, 2016 3:26pm

Where and how do you get this therapy in each state, county, etc?

It is so difficult to find professionals who even get it, much less to provided the intensive therapy needed as well as encouragement to become your best possible self to positively impact others and yourself in your life time.  

Can someone be a specific "create a list" for us and clear steps to move to therapy or path to observable improvement.  I think all of us with TBI's get the impact and healing with each TBI is different or individualized.  Not to be sarcastic but that is a "no brainer".  We want real steps and a pathway to follow to be able to function and check off each area or aspect of our lives so we can be or become our "new optimal" best.

Sep 7th, 2016 4:01pm

My son has had several outburst of anger. If you try to talk to him it gets worse. He feels that he is right and you are always wrong. He has a lot if pain with injuries, but won't take medication.

Mar 28th, 2015 11:16am

Unfortunately, people do change after brain injury, but getting a person of 24 years old to accept how their life has changed is bigger and harder to do. In their mind they feel they are not different and should be able to do what they use to do.  The one who he seems to be mad at is his mom who never left his side and worked with him to get him to the point he is now where he is physically able to do every day functions, but gets upset if she tried to discipline him as told by many doctors

Mar 12th, 2015 4:15am

Unfortunately, this information is very dated and does not reflect current state of practice in the field - especially when working with individuals in the community.

Jan 19th, 2015 12:52pm

People chages after Brain Injury. You can not restore the previous condition. The important thing is to focus the patient in their new condition, accept it and learn to live with it.

Jan 4th, 2015 1:03pm

Great overview!

Dec 8th, 2014 9:34pm


Oct 18th, 2012 9:14am

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