Handling Challenging Behaviours and Emotions

There are several possible symptoms associated with brain injury—some are temporary and others, permanent. The following table provides general approaches to dealing with challenging behaviours and emotions. Consultation with a specialist, such as a rehabilitation psychologist or occupational therapist, may be necessary to provide recommendations specifically for your loved one.

BEHAVIOUR OR EMOTION

WHAT YOU SEE HOW YOU CAN HELP
Agitation
  • Alternates between being hyperactive and sleeping
  • Cries, yells, flails arms or thrashes in bed
  • Hits others
  • Is self-destructive
  • Touch or talk to the person during periods of attention.
  • Ask simple, short questions. Limit the number of distractions to create a quiet setting.
  • Know your loved one will likely have reduced tolerance for stress; think about how to reduce stressors before episodes happen.
Confusion
  • Is inattentive
  • Forgets
  • Asks questions over and over again
  • Give one-step instructions.
  • Use memory tools, such as a calendar or date book.
  • Repeat answers patiently.
Denial
  • Does not admit to changes or problems
  • Believes that they are ready and able to do things the same as before
  • Makes excuses for not completing certain tasks
  • Manipulates others into performing tasks
  • If it is not dangerous, let the person try a desired activity.
  • Once you feel the person is ready, show that a seemingly “impossible” activity is simple to do.
  • Make sure that lack of confidence or ability is not the real root of the problem.
Depression
  • Cries frequently
  • Lacks interest in life in general
  • Exhibits changes in appetite and sleep patterns
  • Lacks motivation
  • Withdraws from social contacts
  • Talks about dying
  • If symptoms persist or suicidal thoughts are expressed, seek professional help.
  • Give praise for progress made.
  • Try to engage the person in activities that they can tolerate.
Disorientation
  • Talks in a disorganized, disconnected way
  • Mixes fact and fantasy
  • Isn’t aware of location, date, own identity or identity of others
  • Mixes up time periods
  • Review details like who and where you are and what the date is.
  • Talk about familiar things and people.
  • Use calendars, pictures and favourite music to orient the person.
Egocentricity
  • Is self-centred and insensitive
  • Misinterprets other people’s responses or actions
  • Do not allow the person to get everything they want.
  • Do not expect the person to understand your point of view and respect your rights; you may have to stand up to them.
  • Get the person involved in a brain injury support group.
Emotional Instability
  • Can’t control emotions
  • Expresses emotions at the wrong time and in the wrong place
  • Has mood swings
  • Do not criticize.
  • Praise the person when they show self-control.
  • Do not confront the person about their behaviour; it may cause embarrassment.
  • Be a model of calm behaviour.
Excessive Eating
  • Constantly eats
  • Secretly eats
  • Doesn’t remember eating
  • Frequently complains of hunger despite having recently eaten
  • Seek medical advice.
  • Provide other activities, such as exercise or hobbies.
Excessive Talking
  • Talks constantly
  • Doesn’t remember previous discussions
  • Can’t come to a conclusion or solution
  • Can’t break the cycle
  • Can’t take turns in a conversation
  • Redirect the person’s attention to a task.
  • If the talking seems related to anxiety, tolerate some talking.
  • Do not feel obligated to respond.
  • Suggest listening to music.
Memory Problems
  • Forgets to complete tasks
  • Can’t remember events since the injury or certain periods of time before it
  • Recalls information slowly
  • Has trouble remembering things like names or appointments
  • Often misplaces things
  • Repeats the same things over and over again
  • Has a hard time learning new things
  • Provide a quiet, calm setting.
  • Correct wrong answers gently.
  • Give reminder clues (e.g., “Was it this or was it that?”)
  • When clues don’t work, provide the forgotten information.
  • Use signs or other visuals to reinforce what needs to be remembered, including a memory book, calendars, and clocks or watches.
  • Exercise the person’s memory by asking for a recap of events or activities.
  • Try not to interrupt because it may cause the person to forget what they wanted to say.
  • Try to maintain a consistent routine.
  • Label cupboards and drawers.
Change in Sexual Interest
  • Makes inappropriate sexual remarks or advances
  • Manipulates partner for the sake of physical contact
  • Becomes threatening when partner is not willing to be sexually involved
  • Has a decreased libido
  • Tell the person that their behaviour is unacceptable.
  • Make them aware of the consequences of such behaviour.
  • Do not feel obligated to respond to the person’s sexual demands.
  • Ask about medication and counselling.
  • Discuss self-gratification options.
  • If necessary and possible, remove yourself or the person.
Lack of Awareness
(Anosognosia)
  • Seems unaware of the existence of their disability
  • Lacks insight into the effects of personal actions
  • May not be able to fully appreciate or understand the effect that the brain injury is having on their life
  • Be as active as possible in the rehabilitation process.
  • Do not let the person drive a car or operate any dangerous equipment unless approved by a doctor.
  • Help them set realistic goals.
Apathy
  • Diminished initiative, motivation or interest
  • Provide a routine by structuring daily activities.
  • Set up multi-step procedures in which one step leads directly to and cues the next step.
  • Seek professional help.

Impulsivity

  • Tends to speak or act first and think later
  • Acts on inappropriate or confused thoughts
  • Is excessively demanding
  • Set short-term rewards for brief periods of self-control.
  • Suggest more acceptable behaviour.