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Fact Sheet: Changes in Behavior After a Brain Injury by Charles Watson


Posted on January 7, 2021

Behavioral changes following a TBI or ABI can often be more devastating for the sufferer, family members, and friends than the physical deficits. Since society judges an individual according to their behavior, hence those that exhibit challenging behaviors face being criticized and socially excluded.

What are some of the potentially challenging behaviors or emotions after a brain injury?

  1. Impaired control or impulsivity is usually associated with a lesion to the frontal lobe and associated with executive function difficulties like: 
    1. Aggression, agitation, and violent behavior resulting from poor frustration and stress tolerance. 
    2. Drug and alcohol abuse
    3. Impatience, lack of mental flexibility, and restlessness
    4. An increase or decrease in libido
    5. Financial irresponsibility
    6. Emotional lability

Inability to control emotions results in impaired social behaviors such as

  • Reduced emotional sensitivity
  • Childlike behavior
  • Self-centeredness, Tactlessness 
  • Change in self-care behaviors
  • Lack of gratitude
  1. Lack of insight associated with frontal lobe lesions can result in either refusing to recognize obvious impairments or feeling as though others are exaggerating about their condition. This causes a loss of self-monitoring abilities and refusal to understand the implications of one’s own actions. This can lead to frustration, mood swings, and anxiety, sometimes dangerous behaviors like attempting to drive with a visual impairment.
  2. Catastrophic reactions to loss: this may include behaviors like 
    1. Depression and anxiety leading to withdrawal
    2. Helplessness and suspiciousness
    3. Fear and anger
    4. Apathy or a motivational state
    5. Paranoia and associated secretive behaviors.

What are some of the management strategies for behavioral/emotional issues?

Caregivers and family members need to maintain discipline, patience, and consistency in teaching and retraining individuals’ lost functions. Also, strategies to manage anger and emotional distress must be developed. 

  • Learn to identify early signs of anger and situations that can act as triggers
  • Use anger management strategies and try to maintain a routine and regular exercise program
  • If a person is stressed, ask him to write down his feelings in an accepting/ non-judgmental manner.
  • Acknowledge the person’s sense of loss but at the same time provide supportive feedback and highlight the positive aspects, and identify their strengths and weaknesses
  • Spend time with the person and engage him in social activities or hobbies to avert feelings of loneliness
  • Use relaxation techniques with the help of healthcare professionals such as a neuropsychologist and therapist. Join support groups so that the person can get help with common issues.
  • Do not criticize the person for inappropriate behavior; instead, talk to the person about the pros and cons of his decisions/behaviors. 
  • Do not try to convince the person to change his behavior when his/her emotionality is high or in the middle of an outburst; it will only make matters worse. 
  • Develop a subtle signal, a hand gesture, or a nod to let the person know to think before acting, especially in a social setting.
  • Develop a schedule of daily activities, slowly increasing activities and responsibilities over time.
  • Reward the person for successfully completing tasks and doable alternate activities with less interesting tasks.

What is the impact of a brain injury on children?

While the symptoms of a brain injury are similar to those experienced by adults, it can have a more devastating functional impact. Earlier, it was thought that a young brain has more plasticity hence would recover better, but recent research suggests that may not be the case.

The cognitive impairments may not be obvious immediately after an injury in children, but as the child grows older, he may face changes in the ability to think, learn, and develop socially appropriate behaviors.