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Behavior Problems & Head Injury

Mark-

Have you ever heard where a blow or brain injury can cause behavioural problems and will show up on a QEEG (quantitative EEG)?

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Yes. Head injury survivors may experience a range of neuro-psychological problems following a traumatic brain injury. Depending on the part of the brain affected and the severity of the injury, the result on any one child can vary greatly. Personality changes, memory and judgment deficits, lack of impulse control, and poor concentration are all common. Behavioral changes can be stressful for families and parents who must learn to adapt their communication techniques, established relationships, and expectations of what the impaired child can or cannot do.

In some cases extended cognitive and behavioral rehabilitation in a residential or outpatient setting will be necessary to regain certain skills. A neuro-psychologist also may be helpful in assessing cognitive deficits. However, over the long term both the survivor and any involved family members will need to explore what combination of strategies work best to improve the functional and behavioral skills of the impaired child.

Even a child who makes a “good” recovery may go through some personality changes. Family members must be careful to avoid always comparing the impaired child with the way he/she “used to be.” Personality changes are often an exaggeration of the child's pre-injury personality in which personality traits become intensified. Some changes can be quite striking. It may be, for example, the head injury survivor used to be easy going, energetic, and thoughtful and now seems easily angered, self-absorbed, and unable to show enthusiasm for anything. Nonetheless, try not to criticize or make fun of the impaired child’s deficits. This is sure to make the child feel frustrated, angry, or embarrassed.

In some cases, neurological damage after a head injury may cause emotional volatility (intense mood swings or extreme reactions to everyday situations). Such overreactions could be sudden tears, angry outbursts, or laughter. It is important to understand that the child has lost some degree of control over emotional responses. The key to handling lability is recognizing that the behavior is unintentional. Parents should model calm behavior and try not to provoke further stress by being overly critical. Help the child recognize when his/her emotional responses are under control and support/reinforce techniques that work.

Provided a situation does not present a physical threat, various approaches may be used to diffuse hostile behavior:

• Coping with behavior problems after a head injury requires identification and acknowledgment of the impaired child’s deficits. A comprehensive neuro-psychological assessment is recommended. This may help both the survivor and the family to better understand neurological and cognitive deficits.

• Do not challenge or confront the child. Rather, negotiate (e.g., if you don’t like what’s planned for dinner tonight, how about choosing Friday’s menu?).

• Help cue the child to recognize thoughtlessness. Remind him/her to practice polite behavior. Realize that awareness of other people's feelings may have to be relearned.

• Help the child regain a sense of control by asking if there is anything that would help him/her feel better.

• In some cases, it may be easier for the family caregiver to recognize personality changes than to resolve the problem behavior. Targeted strategies may be used to deal with specific behavioral issues.

• Isolate the disruptive impaired child. Consider you own safety and his/hers. Treat each incident as an isolated occurrence as the survivor may not remember having acted this way before or may need to be prompted to remember. Try to establish consistent, non-confrontational responses from all family members (children may need to learn some “dos” and “don’ts” in reacting to the survivor).

• It is critical that family members seek and receive support (family, friends, support group, counselor) in dealing with their own emotional responses to caring for a head injured loved one.

• Offer alternative ways to express anger (e.g., a punching bag, a gripe list).

• Remain as calm as you can; ignore the behavior.

• Seek support for yourself as a caregiver. Support groups, professional counselors, and, if necessary, protective services or law enforcement may be contacted.

• The child who has survived a head injury may lack empathy. That is, some head injury survivors have difficulty seeing things through someone else's eyes. The result can be thoughtless or hurtful remarks or unreasonable, demanding requests. This behavior stems from a lack of abstract thinking.

• Try to change the child’s mood by agreeing with the child (if appropriate) and thus avoiding an argument. Show extra affection and support to address underlying frustrations.

• Try to understand the source of the anger. Is there a way to address the child’s need/frustration? (e.g., make a phone call, choose an alternative activity).

• Validate the emotion by identifying the feelings and letting the child know these feelings are legitimate. Frustration over the loss of functional and/or cognitive abilities can reasonably provoke anger.

Good luck,

Mark Hutten, M.A.

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