4. Challenging Behaviours

Challenging behaviours

Challenging behaviours are recognised as one of the most disabling consequences of traumatic brain injury (TBI) and produce some of the most complex challenges in post-injury management.

In children challenging behaviours are associated with learning difficulties, poor educational engagement, increased costs in managing such clients and significant distress for family and staff exposed to such behaviours, as well as the child and adolescent with TBI.

There is evidence that the course of these behaviours can persist for many years post-injury and even worsen over time; this has been consistently shown for those children with more severe injuries.

Principles for working with challenging behaviours in children

1: Early identification and intervention is required to prevent challenging behaviours becoming entrenched patterns of client functioning

2: An interdisciplinary approach to managing challenging behaviour is required at all levels and types of impairment and disability

3: Clients require adequate levels of long-term care, support and environmental modification

4: Consideration must be given to the medical, psychosocial and environmental context of children’s challenging behaviours (i.e. whole-of-client approach

5: There is a need for equitable access to all services throughout NSW based on need

6: Client-centred communication pathways must be established and maintained to ensure smooth and timely delivery of education services needed by clients

7: Specialised assessment and management is required for challenging behaviours in the TBI paediatric population.

8: The community and social participation of TBI clients needs to be promoted.




Practical Tools On-line


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Project Learnet Website produced by the Brain Injury Association of New York State which includes detailed information on approaches to rehabilitation, behavioural issues, support in schools, communication supports, facilitating self regulation and physical and medical issues post brain injury.
Resilient Building in Kids Parentwise Podcast Series - This Cerebral Palsy Alliance podcast series offers practical tips for parents on a variety of issues including encouraging positive behaviour and resilience
Practical Tools
Practical tools for working with children and teaching self regulation strategies.
Synapse Behaviours Fact Sheets Synapse fact sheets on a variety of behavioural issues and management approaches. These are not paediatric specific but with clinical discernment will have application to the paediatric population




Factsheets and Documents


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SWIBRS - Challenging Behaviours Booklet    Information and strategies for parents and all people involved in supporting a child with  behaviour changes post brain injury.  In depth analysis and problem solving strategies explored.
"Big Deal/Little Deal"    Practical tools for working with children and teaching self regulation strategies.
ACI Challenging Behaviours Paediatric Project    This report details a statewide project investigating the prevalence and burden of challenging behaviours associated  with brain injury in order to improve outcomes for patients and families/ caregivers.  A useful tool to understand the depth of these issues and ACI input in this area.

Best Behaviours video