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.

My Out-of-Control Teen: Help for Parents

How can I tell if my 16-year-old son is abusing drugs?

Do you think your child or adolescent may be using street drugs or abusing prescription medications like painkillers? Many moms & dads are faced with the difficult question of "Is my adolescent using drugs?" Read on to find out how to tell if your adolescent is using illicit drugs.

Things You’ll Need:

• A Drug Sniffer Dog for Hire

• A Home Drug Test

• A Notebook

• An Adolescent Who You Suspect May Be Using Drugs

• An Internet Connection

• An Observant Eye

• ADMINISTER A HOME DRUG TEST: Home drug tests are now available over-the-counter at most major drug store chains. Moms & dads can give their adolescent a drug test for marijuana, opiates, methamphetamine, cocaine and an array of other illicit drugs.

• DOES YOUR ADOLESCENT ACT DIFFERENTLY? Drug users experience high highs and low lows. Is your adolescent giddy, talkative and energetic one minute and sleeping excessively the following day? Is your adolescent edgier and moodier than usual? Also very common in drug users. Again, write down your observations in a notebook - it's often a lot clearer on paper.

• DOES YOUR ADOLESCENT LOOK DIFFERENT? Drug users will rapidly gain or lose weight. They will stop showering as frequently and you'll see a drop off in meticulous grooming that's common of adolescents. Pay attention to the adolescent's eyes. Are they bloodshot? Are the pupils dilated? Are the pupils tiny? These are all signs of drug use.

• DOES YOUR ADOLESCENT SEEM SICK VERY FREQUENTLY? Drug withdrawal can be easily mistaken for a stomach flu or virus, so if your adolescent seems to vomit frequently or gets the "flu" on a regular basis, this suggests drug use. Does your adolescent sniffle frequently? Is he reluctant to blow his nose? The sniffles or a stuffy nose are commonly associated with drugs like heroin, cocaine and other drugs that are snorted. When a drug user snorts drugs, this causes nasal inflammation that causes sniffling. Many drug users also sniffle frequently after they snort drugs, but they'll be hesitant to blow their nose, lest they blow out the powder that they've sniffed.

• HIRE A SNIFFER DOG TO SEARCH FOR DRUGS: Moms & dads can now hire a drug detection dog service to perform a search of the home and car. This can provide moms & dads with the confirmation they need before they confront a adolescent about drug use. A drug sniffer dog can also ease fears of adolescent drug use. These drug detection dogs can detect minute amounts of residue and they are known to be very accurate.

• IS YOUR ADOLESCENT STEALING MONEY OR VALUABLES? When recreational drug use turns into a full blown drug habit, a adolescent will need money and lots of it to support his or her drug habit. Is the adolescent suddenly focused on earning money that does not seem to go toward any obvious purchases (i.e. clothing)? Is the adolescent stealing money from family members? Are valuables disappearing from the home? These are all signs that can suggest that a adolescent is seeking money to support a drug habit.

• LEARN ABOUT DRUG PARAPHERNALIA AND BE ON THE LOOKOUT FOR IT IN YOUR ADOLESCENT'S ROOM: Did you know that a light bulb can be used as drug paraphernalia? Drug paraphernalia can be obvious - like a pipe - or less obvious, like a light bulb. Surf the internet and learn about what household items can be associated with drug use.

• LOOK FOR BEHAVIORS THAT INDICATE DRUG USE: There are many behaviors that indicate drug use. Does your adolescent always wear long sleeves, even when it's hot outside? He may be hiding needle marks on his arms. Does your adolescent try to avoid making eye contact after returning home from friends? This may be due to bloodshot eyes, or dilated/pinpoint pupils that result from using certain drugs. Is your adolescent sneaky and deceptive? Sneaky, deceptive behaviors are very common in adolescents who are using drugs. Look at your adolescent's behavior with a critical eye and keep a notebook recording your observations.

Tips & Warnings—

• Home drug tests (and even professional physician-administered drug tests) are not fool proof. False positives and false negatives can occur. If a adolescent tests positive for a drug, proceed to the nearest hospital or doctor's office for a more reliable drug test. But do it quickly, as some drugs leave the system within a matter of a day or two.

• Surf the internet and learn about the effects of various drugs. If a parent understands how a particular drug affects the body, the parent will be more likely to recognize signs of drug use.

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