Children’s Behavior after a TBI

By Marilyn Lash, M.S.W. and Ron Savage, Ed.D.

Lash and Associates Publishing/Training, Inc.

Why does our child behave so differently since the brain injury?

Changes in behavior may be a direct result of an injury to the brain. Common changes in behavior include mood swings, withdrawal, emotional lability, temper outbursts, impulsivity, irritability and disinhibitions.

Why has our child’s behavior become so difficult to manage since the brain injury?

Surprise Surprise Surprise!

He was never like this before. Certain areas of the brain, such as the frontal and temporal lobes, monitor and direct behaviors. When these are damaged, a child may have difficulty controlling temper, actions and feelings. Even the child’s personality may seem different. Common changes in behaviors after brain injury include restlessness, hitting, swearing, impulsiveness, and difficulty following directions. Many children and adolescents remember how they were before their brain injury. This can also result in emotional reactions that contribute to changes in behaviors as youths struggle to gain a new sense of self.

Will traditional behavior management techniques work for a child with a brain injury?

The traditional approach to managing behavior is based on the model of antecedent, behavior and consequence. The antecedent is what happens before the behavior. The behavior is the action. The consequence is what happens as a result of the behavior. For example, if a child is asked to turn off the television (antecedent), refuses and throws a tantrum (behavior), the child may be sent to bed or given a time-out (consequence). This approach emphasizes the consequence of the behavior. Most children learn to change their behavior to avoid negative consequences or punishment. This consequential management often does not work for children with brain injuries. The child may not remember the rules. Changes in insight and self-awareness may make it difficult for this child to learn from the consequences of behaviors. Think of the old saying, “The horse is already out of the barn.” Punishing children AFTER the behavior has occurred may not help them learn how to self monitor or recognize when they are overwhelmed or confused.

A more successful approach for youths with brain injuries emphasizes managing what is going on before the behavior occurs. Once the antecedents are identified, they can be changed to prevent the behavior from happening. For example, a student may not be following instructions or paying attention in class because of distractions from other students or hallway activity. This distractibility and difficulty focusing can be the direct result of a brain injury that will not improve with detention and reprimands. Instead, by moving this student’s desk to the front row, distractions may decrease and attention improve.

What is a neuropsychologist and how can this person help?

This is a psychologist with additional special training in the relationship between the brain and behavior. Aneuropsychologistcan evaluate how a brain injury affects a child or adolescent’s learning, communication, planning, organizational skills and relationships with others. Once the causes of the behavior are understood, the neuropsychologist can recommend compensatory strategies for use and help parents and educators respond to behaviors.

How do I know what is “normal” adolescent behavior and what is related to the brain injury?

This is one of the most difficult questions to answer and one of the most frequently asked by parents. Adolescence is known for its emotional turmoil with the many physical and hormonal changes occuring at the same time as social and academic pressures are increasing. The brain continues to develop right up through adolescence so new difficulties may now emerge, especially if the frontal lobes which affect impulse control and emotions have been damaged. The impulsiveness and mood swings that we expect from adolescents may be compounded and worsened by a brain injury that affects these control centers. An evaluation by a neuropsychologist can help identify behaviors that are directly related to the brain injury.

Will medications help?

Many children with brain injuries have short attention spans, are easily distracted and have difficulty following instructions and directions. Some become fidgety, impulsive and hyperactive. Because these symptoms are similar to those in children with attention deficit disorders, many parents and educators ask if medication will help.

This requires careful evaluation by a physician. When a child has a brain injury, it can cause physical injury to the neurons (brain cells) and to brain tissue. But it can also cause chemical changes in the brain. Some medications are designed to help children learn and pay attention better; others are used to control seizures or help manage challenging behaviors. But some medications have side effects that can affect alertness, memory, moods, sleep, or appetite. Any consideration of medication requires a physician experienced in brain injury and careful monitoring.

For more information by Ron Savage on behavioral changes in children and adolescents with brain injury see…

Behavior after Brain Injury Changes and Challenges

By Nina Marchese, Andrea Potoczny-Gray and Ron Savage, Ed.D.

Information for schools and teachers on effects of brain injury on behavior in children and students at home and in school.

Managing Behaviors after Brain Injury in School

By Ron Savage, Ed.D., Roberta DePompei, Ph.D., Stephen Bruce,MEd, BCBA, CBIS and Marilyn Lash, M.S.W.

Information and tips for parents and educators on behavior changes in children and students with acquired brain injury. Gives guidelines and strategies for changing behavior in students with TBI. Explains functional analysis of behavior.

Strategies for Managing Challenging Behaviors of Students with Brain Injuries

By Stephen Bruce, MEd, BCBA, CBIS, Lisa Selznick Gurdin, MS, BCBA, CBIS-CE and Ron Savage, Ed.D.

Brain injury behavior manual with CD for educators and therapists shows how to use applied behavior analysis in the classroom for students with challenging behaviors after brain injury.