Behaviour in Brief – Challenging Behaviour After Brain Injury

Changed behaviour, Behaviours of concern, Difficult behaviour, Bad behaviour, Challenging behaviour after brain injury – .

Whatever term you use, it is one of the BIG topics in brain injury.


It can mean challenges for the person living with brain injury, their family and friends, supporters, and community members.

Behaviour changes can be mild to severe. From creating difficulties in social situations, to unlawful behaviour. From awkward moments to harmful, even dangerous behaviours.

My challenge to myself for today is to take a BIG topic and turn it into a small article and still be useful.

Just to let me off the hook a little: Over time I will cover more about behaviour and will link back to this article (remind me) so it becomes a hub of resources for Challenging Behaviour After Brain Injury.

That is my vision, let’s see what happens.


Why Do We Need to Know About Challenging Behaviour After Brain Injury?

  • Challenging behaviour after brain injury is a common outcome whatever the cause of brain injury.
  • Without strategies and appropriate support, changed behaviour can impact on a person’s ability to fully participate in family and community, and to live their life of choice.
  • A well formed and agreed plan to work on behaviour can have a positive impact.
  • Challenging behaviour can be harmful even dangerous to the person, their family or community. It is often the reason young men with brain injury find themselves in trouble with police.
  • We can easily forget that we do not all view behaviour in the same way. Our view of behaviour depends on our own experiences, not just the behaviour we might be seeing.
  • Understanding as much as possible about changes in behaviour and how it affects each person can help supporters be more effective.
  • Each person is different and gathering more information about challenging behaviour can help us not to generalise. Not everyone has difficulty with behaviour.

What Is Challenging Behaviour

Brain Injury -many multi coloured question marks
Defining Challenging behaviour.

A simple explanation may not be the wisest path here as there are many factors influencing behaviour.

Most of us though – we like simple – so here goes:

Challenging behaviour is:

Behaviour that interferes with daily life, success, social interaction, learning and development for the person.  It may be harmful to self or others.

It may be because it occurs at the wrong time or place, it causes distress,  gets people into trouble, is against the rules, or limits people’s opportunities.

If you feel like you want meatier definitions here are three links to more information:

What is Challenging Behaviour

Challenging and Complex Behaviours – An Introduction

Challenging Behaviour Booklet

Behaviour Diversity

Tapestry of brain outlines. Neurodiversity

Flickr Image by Hey Paul Studios

Rather than challenging behaviour as one blob it can be helpful to think about it as a continuum of behaviours. Maybe we could call it ‘behaviour diversity’ in a similar way we talked about neurodiversity.

Think about:

a diversity in the level of a behaviour

a diversity in the range of behaviours that are found to be challenging. Like all things to do with brain injury – behaviour outcomes can be different for each person.

a continuum of the level of behaviour each of us tolerates. It is not as simple as the behaviour we see. There are a range of factors that influence how we each respond to behaviours. 

Three Things To Remember About Challenging Behaviour After Brain injury?

  1. Not all people with brain injury will have challenging behaviours
  2. People without brain injury can have these behaviours
  3. Some people with brain injury will have some of these behaviours.


Factors Influencing Behaviour: The Internal and the External.

A way to think about factors that influence behaviour changes after brain injury. Well in anybody really:

The Internal Factors

Outcomes that result from damage to the brain – whatever the cause of brain injury.

Damage to the brain influences and sometimes creates behaviour changes.

It might also be the mix of outcomes that result from brain injury that creates challenging behaviour.  A mix that might include; Physical, Cognitive, Emotional, Communication and Behaviour outcomes.

The brain controls everything we do – therefore anything we do can be changed. Depending on the part of the brain damaged a wide range of outcomes including behaviour changes can occur.

Effects of brain injury on behaviour from the Internal Factors can include:
  • Egocentricity  – not being able to put yourself in another persons shoes
  • Irritability – becoming irritable or angry more easily
  • Disinhibition – doing and saying things without thinking and monitoring the impact.
  • Lack of Insight – reduced awareness of ones abilities and limitations.
  • Lack Of Initiative And Poor Motivation – Reduced ability to start things off by themselves, and reduced drive to want to achieve something and follow it through.
  • Verbal aggression – being verbally or physically aggressive
  • Physical aggression
  • Risky behaviours – not being aware of personal space and limits – challenging others.  Excessive alcholol or illicit drug use.
  • Repetitive behaviours – making the same action, statement or asking the same question over and over again
  • Low Frustration Tolerance – becoming easily frustrated and angry.
  • Socially inappropriate behaviours – not following cultural rules. Refusing to maintain personal hygiene.
  • Sexually inappropriate – being sexually inappropriate for instance touching strangers in a sexual way, making sexually suggestive comments,
  • Impulsivity – rushing into things without thinking first.
  • Wandering – wandering away from people or places. Becoming lost and not able to find your way back.

These outcomes of behaviour vary in degree and may increase with fatigue or with other changes happening in life.


The External Factors

Challenging Behaviour After Brain Injury -Photograph of a peach with one leaf attached
Outside influences (not organic, physical changes)  that impact  a person’s behaviour

Our behaviour can be affected by many outside influences. Here are broad headings under (another acronym) PEACH to help think about these factors:


Person – Age, Previous injury, Severity of injury, Social, emotional and health issues, Cognitive damage,Social, Cultural, Emotional and Health issues.

Environment – Surroundings, Where a person is living.

Activity – Type of activity, Amount of activity, Appropriateness of type and timing.

Communication – Interpretation of others communication. Ability to make self understood. understanding / Comprehension.

History – Past life. Previous drug / alcohol abuse. Previous behaviour.


The above is based on a technique we developed that can be used in a number of ways (more later): lovingly called ‘PEACH’.  Used here it provides a way that may help you to think about the different external influences that can influence behaviour.


Image by Thistle Girl Clipart

Image by Thistle Girl


A key point to remember is All Behaviour Is A Message. Understanding this can be a key strategy

– work to find out what the message behind the behaviour is.


What Can You Do About Challenging Behaviour After Brain Injury?

It is helpful to have a framework for developing strategies, a framework that helps a consistent, respectful, personal approach:


A strategy for sudden or crisis behaviour situations

Challenging Behaviour ACORN drawing of a green acornA checklist such as ACORN  can be helpful when you need to respond to out of the ordinary or sudden behaviour change. Being:



And a longer term, planned response:


The What Model and Challenging Behaviour After Brain Injury:

Challenging Behaviour after Brain Injury - The What Model-Diagram with 3 blue boxes

A model we developed to help look at behaviour in a planned and consistent way is the WHAT model.

Simplified here are the three steps to work through:

WHAT is the behaviour?     And what do you want the behaviour to be?

WHAT is the message?        What happens before, during and after the behaviour?

WHAT can be done?             What are the best strategies?  What worked?


Step1     What is the behaviour to work on changing?

Selecting the specific behaviour the person is most committed to changing and will make the most difference.


Step2     What is the message?

Detailed analysis of why the behaviour might be happening. Looking at WHAT leads up to the behaviour occurring.


Step3    What can be done?

In consultation with everyone involved identify the range of strategies that might be useful and carefully examining what would likely be the most effective.

Once implemented review how it is working. An ongoing review of how the strategy is progressing. Identifying any changes in the number or severity of the behaviour occurring. Adjusting strategies where necessary.


There are a few more WHAT’s and working detail in the full model – this is broad overview with more to come.

Or you can EMAIL ME HERE for more information.


And Finally

As I said at the beginning this is a brief overview to the huge and complex topic of challenging behaviour after brain injury. There will be many more words devoted to the topic.

Meantime if you are aware of any resources,  or you have any questions or comments please Email me or share in the comments below.




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