Cognitive and behavioural changes

       Problems arising

     Management strategies

Attention and Concentration

• have difficulty concentrating
• being distractible
• finding it hard to cope with more than one thing at once
• getting bored quickly
• switch off and appear not to listen
• not remembering what others have said
• not completing things they start
• changing the subject often

• reduce distractions (e.g. noise, other people)
• use short, simple sentences
• encourage the person to stay with the activity for longer periods
• change activities when necessary
• when distracted, interrupt and bring back to task
• give reminders of next step
• keep to a routine

Speed of information processing

• taking longer to complete tasks
• unable to keep track of lengthy conversations and instructions

• make allowances and give the person extra time
• present information slowly
• present information in chunks
• present one thing at a time
• check that the person is keeping up

Fatigue

• having an overall reduced ability to cope
• getting irritable and distressed
• having other problems exacerbated

• encourage the person to take rest breaks
• schedule more demanding tasks when the person is at their best (often mornings)

Memory

• finding it hard to remember new things
• forgetting appointments
• forgetting things people say
• frequently losing things

• give reminders
• repeat information when necessary
• encourage person to rehearse and repeat information
• encourage use of external reminders, i.e. diaries, post-it notes
• structure a routine by breaking tasks into small steps
• keep belongings in regular places

Problem solving

• reduced ability to find solutions to problems

• train the person to approach new tasks in a systematic manner, e.g. break the task into small parts
• reduce the demands made on the person
• help educate the family and others about the person's problems
• avoid giving the person open-ended tasks

Planning and
organisation

• having difficulty working out the steps involved in a task
• not considering the end result of their actions
• having trouble organising their thoughts and explaining things to others

• avoid becoming frustrated with the person
• give prompts for the following steps
• provide a written list which outlines the steps in order

Rigid and
concrete thinking

• taking statements literally
• insensitive and unable to consider feelings of others
• having a simplistic understanding of emotions
• being resistant to change
• keeping doing things incorrectly despite feedback

• use simple and direct language, avoid abstract terms
• avoid using hints or sarcastic humour
• encourage person to imagine how they would feel in other situations
• explain any change in routine in advance, giving reasons

Disinhibition

• being impulsive and act without thinking of consequences
• making rash decisions
• acting inappropriately toward people (including sexually)
• behaving in a silly, flippant or childish way
• disclosing personal information too freely

• give immediate feedback, briefly
  asking person to stop behaviour
  and explain why
• provide appropriate external
  controls e.g. over finances
• remind person of the sensitive
  nature of some information,
  giving clear examples
• ignore the behaviour where
  possible

Reduced self-control

• losing temper quickly
• being physically/verbally abusive
• having a lower frustration tolerance

• distract or remove the person from anger-provoking situation
• withdraw attention when appropriate
• try not to escalate the situation by shouting back
• identify anger-provoking triggers and avoid when possible

Egocentricity and
self-absorption

• not considering consequences of their behaviour on others
• being unable to 'put themselves in someone else's shoes'
• appearing selfish to others
• not appreciating carers

• try to explain situation from another's or your point of view
• try not to take offence, understand why the person is like that

Emotional lability

• laughing and crying inappropriately
• changing moods quickly

• try to identify triggers which result in mood swings
• be prepared for changes by having alternative plans

Perseveration

• talking about the same topic repeatedly
• returning to the preferred topic when doing something else

• remind person gently they've told you the information before
• distract the person back to the preferred activity
• ignore, as much as possible, future references to the topic
• try not to get into arguments, walk away if you're getting irritated

Reduced insight

• being unaware of both cognitive and physical limitations
• having unrealistic goals, plans and expectations
• resisting efforts of carer/staff
• not realising that they have made errors because they haven't checked their work

• gently remind person of deficits
• explain why proposed action is useful, reason through the steps
• point out possible negative consequences of person's unrealistic plans
• place external limitations where necessary (e.g. removal of driver's licence/access to car)
• gradually expose person to reality testing experiences

Poor self monitoring

• not realising that they are 'hogging' conversations
• being verbose and keep talking when others are no longer interested

• encourage them to check over their work
• use signals, agreed in advance, to let them know they're talking too much
• encourage turn-taking in conversation
• use external aids, e.g. graphs and tables to help the person monitor their behaviour

Reduced social
skills

• interacting poorly with others because of all the above problems
• losing their ability to relate well with others
• not picking up the usual social cues (e.g. looking at watch)

• teach specific strategies like maintaining eye contact, asking questions of others, turn taking in conversation
• try to encourage awareness of others' reactions

Inertia

• appearing to have no motivation and seem apathetic
• not acting until prompted
• not completing tasks
• knowing how to do something, but not doing it spontaneously

• encourage person to commence activity
• prompt first step of the task
• try to find things that are most interesting for the person
• reward and encourage any self-initiated activity and persistence
• accept that the person may need less activity to keep them occupied and happy

Restlessness

• complaining of boredom and be
  restless and agitated

• remind person of activities they usually enjoy
• promote physical activity which may expend some energy