5.1 Describe behaviours that challenge

This guide will help you answer 5.1 Describe behaviours that challenge.

Working in health and social care, you might encounter people with acquired brain injuries who display behaviours that challenge. These behaviours are sometimes called “challenging behaviours”, and they can affect the safety and wellbeing of both the person and those around them. An acquired brain injury (ABI) is any damage to the brain that happens after birth. Common causes include trauma, stroke, tumour, infection or lack of oxygen.

Behaviours that challenge in this context can look very different to those seen in other health conditions. The impact of a brain injury can change the way a person thinks, feels and acts. This can come as a shock to both the person and their family. It is important to remember that these changes are due to damage in the brain, not a reflection of the person’s character.

What Are Behaviours That Challenge?

A behaviour that challenges is any action or response that puts the person, or others, at risk. It can also affect quality of life or limit access to everyday activities. These behaviours can cause distress, harm, or make it difficult for staff to offer care.

Common examples include:

• Aggression or violence
• Self-injury
• Screaming or shouting
• Refusing to cooperate
• Damaging property
• Inappropriate sexual behaviour
• Wandering or absconding

These behaviours are not done on purpose or with malice. Most often, they happen because the brain injury has changed how the person processes information, controls impulses or handles emotions.

Causes of Behaviours That Challenge After Brain Injury

Acquired brain injuries can damage different parts of the brain. This can cause a range of physical, cognitive and emotional effects, leading to challenging behaviours.

Main causes include:

• Cognitive difficulties: The person may misunderstand what is happening, forget instructions, or become confused.
• Communication difficulties: Some people can no longer express themselves clearly or understand others. This can lead to frustration and acting out.
• Loss of inhibition: Damage to the frontal lobes can make it hard for someone to stop themselves saying or doing things that are not appropriate.
• Emotional changes: The person may be more irritable, angry, anxious or depressed.
• Difficulty handling stress or change: The brain injury may affect how the person copes with stress, noise, change in routine or environment.
• Pain or discomfort: If the person cannot clearly explain their needs, pain or illness may cause them to act out.
• Fatigue: After a brain injury, tiredness can affect mood, behaviour, and frustration levels.

Each person’s experience is unique. The type, severity and location of the injury all play a part in how behaviours present.

Examples of Specific Behaviours

To better understand what you might see, let’s look closer at several behaviours that challenge linked to acquired brain injury.

Aggression

Aggression is one of the most distressing behaviours. It can be verbal, such as shouting, swearing or threats. It can also be physical, like hitting, kicking, pushing or throwing objects. Some people may lash out with no clear warning.

Reasons for aggressive behaviour include:

• Misunderstanding the situation
• Frustration at not being understood
• Feeling threatened or scared
• Pain or discomfort
• Impulsivity (acting without thinking)

Aggression is an expression of distress, not intent to hurt.

Self-Injury

Some people with brain injury may hurt themselves. This can include scratching, biting, head-banging or hitting themselves. Self-injury may happen because the person is trying to deal with overwhelming emotions or sensations, or as a response to pain they cannot communicate.

Refusal and Non-Compliance

A person might refuse to do what is asked, ignore instructions, or be uncooperative. This is not defiance in the usual sense. Instead, it might be:

• Struggling to understand what is being asked
• Forgetting what to do
• Feeling unable to cope with the task
• Anxiety about change or a new situation

Disinhibition

A person with disinhibition loses the ability to control impulses. This can lead to socially inappropriate acts such as:

• Swearing
• Making rude or personal comments
• Undressing in public
• Acting on sexual urges in unsuitable places

Disinhibition can be very distressing for the person and those caring for them.

Wandering and Absconding

After a brain injury, some people wander without purpose or try to leave familiar places. This can put their safety at risk, especially if they have problems with memory, judgement or understanding danger.

Sexual Inappropriateness

A small number of people may display sexual behaviours that challenge. Examples are touching others without consent, making sexual remarks, or exposing themselves. This is typically due to damage affecting self-control or misunderstanding of social rules.

Emotional Outbursts

Sudden crying, laughing or shouting can happen with no clear trigger. The brain injury might have affected how the person controls their emotions. These are sometimes called emotional lability.

Perseveration

Some people get stuck on certain ideas or repeat the same words or behaviours. This is known as perseveration. For example, asking the same question over and over, or getting stuck in an activity.

How Behaviours That Challenge Affect Care

Behaviours that challenge can make providing daily support harder. Care workers need patience, skill and teamwork to keep everyone safe and calm.

Possible impacts include:

• Increased risk of injury (to staff, other residents or the person themselves)
• Disruption of daily routines
• More time and resources needed for supervision
• Emotional strain on staff and family
• Possible isolation for the person if others avoid them

Behaviours that challenge are a direct result of changes to the brain. Understanding this helps workers respond with empathy.

Triggers for Behaviours

A trigger is something that leads to, or worsens, a behaviour that challenges. It is rare for people to act out for no reason.

Common triggers after brain injury include:

• Pain, discomfort or illness
• Noise, crowds, or too much stimulation
• Confusion or loss of routine
• Hunger, thirst, tiredness
• Being asked to do something too difficult
• Feeling ignored, left out or bored
• Emotional shock, stress or loss

Care workers can help by spotting and reducing these triggers wherever possible.

Functional Assessment

Functional assessment means looking at the reasons behind a behaviour. Ask: What happened before? What need might the person be expressing? This approach finds patterns and enables better support.

Ask yourself:

• What was the person doing before the behaviour?
• Who was present?
• What happened after?
• Was there a change in routine?
• Is there a medical problem or pain?

This kind of thinking helps find solutions that respect the person’s needs.

The Role of Care Workers

Supporting people with acquired brain injury often requires teamwork and a flexible approach. Here are some steps you might take:

• Treat every person with dignity and respect
• Build an understanding of each person’s history and personality
• Communicate clearly using simple, direct language
• Use visual prompts if language is a barrier
• Stay calm during incidents and keep everyone safe
• Use positive behaviour strategies (praise, routines, reassurance)
• Document and share incidents for learning and improvement

Working closely with the person, family, and other professionals is important for success.

Myths and Misconceptions

There are many misunderstandings about acquired brain injury and challenging behaviour. Here are some key facts:

• The person is not choosing to behave badly
• Brain injury is a physical, not “mental”, cause
• Recovery is possible, but some changes may be life-long
• Hidden disabilities (e.g. memory loss, noise sensitivity) affect behaviour
• Support, rather than punishment, works best

Understanding and patience help people rebuild their lives after a brain injury.

Strategies for Managing Behaviour

There is no single way to manage challenging behaviour. Plans must be adapted to each person’s strengths and needs.

Some proven approaches include:

• Predictable routines and clear expectations
• Giving extra time to process information
• Breaking tasks into smaller steps
• Creating a calm setting with minimal distractions
• Making time for rest and quiet
• Checking for pain, hunger or other basic needs first
• Helping with memory aids (notes, pictures)
• Gentle redirection if the person is getting upset
• Avoiding arguments – distractions can work better

Positive behaviour support is popular. It focuses on understanding what the person is trying to communicate and adapting the environment to suit them better.

Involvement of Other Professionals

Support for people with acquired brain injury often includes a team:

• Psychologists (help manage emotional and behaviour issues)
• Speech and language therapists (support communication)
• Occupational therapists (help with daily tasks and routines)
• Physiotherapists (help with movement and physical needs)
• Social workers (help coordinate care and support the family)

It is important to work together and share information.

Recording and Reporting

Keeping good records helps see patterns in behaviour and shows what support works best. You should record:

• When and where the behaviour happened
• Who was involved
• What happened before and after
• What actions were taken
• How the person responded

This information helps to plan future care and keeps everyone safe.

Final Thoughts

Supporting people with acquired brain injuries who display behaviours that challenge can be rewarding but often difficult. While these behaviours may seem hard to understand, each has a cause rooted in the person’s injuries and experiences. Your role is to look beyond the behaviour and see the person, their needs, and their potential.

Patience, empathy and skill are the best tools you can use. By learning more about acquired brain injury and how it affects people, you make a real difference to lives every day. Clear communication, working closely with others, and understanding triggers will help you find solutions that are right for each individual. You are supporting not just recovery, but dignity and hope for every person you care for.