Behavior Challenges after Acquired Brain Injury

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How does TBI affect behavior?

Inspirestock Inc./Alamy

How does brain injury affect behavior?

A brain injury can wreck havoc on a child or adolescent’s emotions, behavior and essentially their overall quality of life. Brain injury can cause behavioral, emotional and psychosocial changes and problems, issues that were not once there. A student can lack the cognitive skills to realize that behaviors are inappropriate. Sometimes the root of the behavioral issue deals with the student not having the social skills or ability to control their emotions.  

What is behavior?

Behavior is ultimately social in nature. Behavior is the external expression of our emotions, our feelings. It, like our executive functions, is what the world sees. It dictates how we appear to others. Our emotions reflect our behavior. Our emotions are a complex interaction of behavior, biology and cognition.

What can behavioral issues look like in the classroom environment?

  • increased aggression or poor anger control (verbal or physical outbursts)
  • emotional lability (instability, mood-swings, crying over a wrong answer or becoming angry because the wrong answer was given)
  • self-induced isolation (anti-social, loss of self-esteem)
  • egocentricity (insensitive, focuses all classroom conversations/activities on him/herself)
  • hyperactivity (always needs to be doing something and can’t sit still or stay in one place)
  • impulsivity (blurts out inappropriate comments during quiet time)
  • social disinhibition (unrestrained, sensation-seeking, risk taking behavior)
  • poor judgment (lacks self-awareness, does not make thoughtful decisions)
  • interaction difficulties (immature or childish behaviors).

The complex brain/behavior relationship:

While the primary reason behind behavioral issues is the brain injury itself, behavioral issues can be influenced by other issues as well. These factors include: age at the time of the injury, severity of injury, length of coma; pre-injury intelligence and personality traits, types of post-injury environments, personal motivation and family supports.

The concept of behavioral issues after brain injury is not easily understood. A student does not have to have physical impairments in order to have behavioral issues.  It is important to understand that the behavioral issues experienced after injury are rooted in the interaction between three variables:

1. the direct damage sustained to the brain;
2. the reactionary disturbances/behavior response of the student to the injury and
3. the state of the brain prior to injury (the student’s pre-existing abilities).

How these three variables interact and influences behavior is described next.

  • Damage to the brain

The underlying principle that drives behavioral issues/disturbances is the state of the brain after injury. The behavioral issues a student displays correspond directly with the part of the brain that was injured as well as the specific brain function that was damaged. This damage can directly influence behavioral control and emotional responses because the student’s brain is no longer working like it used to (the wiring in the brain, the neurotransmitters, no longer function as they once did).

  • Behavioral responses

The behavioral issues a student experiences after brain injury vary from one student to the next.  However, one thing is certain; the injury has disrupted the brain. It is only reasonable that the injury can result in reactionary disturbances/behavioral issues. A brain injury impacts how a student behaves in the classroom in relationship to environmental influences. A trigger in the environment can cause a spontaneous or unrestrained emotional response. These reactions can be intentional or unintentional behaviors.  Unintentional behaviors are spontaneous behaviors caused by the brain injury. These spontaneous, reactionary disturbances can negatively impact a student’s education goals and how the student is perceived by others in the classroom environment.

  • Pre-existing abilities

Behavior issues are typically experienced with all brain injuries. The behavior a student displays after injury depends a lot on the student’s personality traits. A brain injury typically magnifies a person’s pre-existing personality traits. It is quite possible that a student may behave differently or more intensely after sustaining a brain injury. A lot depends on a student’s pre-existing behavior patterns. A student who was well-organized prior to their injury might have a tendency towards obsessive/compulsive behavior. A student who was aggressive might now have a tendency towards acting out.  

Managing behaviors after injury

While it is important to understand the underlying reasons and interaction of variables involved in behavioral issues after brain injury, unless these behaviors can be changed or modified, the student will have long-term problems in the school environment. Without proper intervention techniques, behaviors tend to get worse rather than better over time.  This is why it is important to develop in-school behavioral management programs in the Individualized Education Plan (IEP).

While behavior management is largely determined by the recovery stage the student has reached, the IEP should emphasize behavioral goals that will allow the student to return to the highest level of independent, physical, and social functioning. The IEP goals need to be modified and changed as the student experiences positive behavioral outcomes. Behavior change occurs when goals are relevant and there is motivation for change.

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