Strategies for Managing Challenging Behaviors of Students with Brain Injuries

Strategies for Managing Challenging Behaviors of Students with Brain Injuries

Stephen Bruce, M.Ed., Lisa Selznick Gurdin, M.S., BCBA, CBIS-CE and Ron Savage, Ed.D.

Behaviors in students with brain injuries are often the most frustrating, confusing and problematic issue for educators and parents at home and in school. This manual explains how brain trauma can affect behavior in a student. It provides a systematic step-by-step approach to using applied behavior analysis to address challenging behaviors in students with brain injuries. The manual comes with a USB flash drive that holds all of the worksheets and forms.

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Full Description

Hereís the manual that educators and therapists have been looking for on challenging behavior after brain injury. Taking a methodical approach to using applied behavior analysis in rehabilitaion programs and the classroom, it covers...

  • Relationships between the brain and behavior
  • Common behaviors after brain injury
  • Overview of the behavioral approach
  • Identification and definitions of behavior
  • Methods for observing and recording behavior
  • Types of behavioral assessment
  • Practical strategies for changing behavior
  • Manipulating antecedents
  • Providing positive consequences
  • Case studies and glossary
CD with forms in PDF format are also included with the manual.
Over 65 pages of forms and worksheets with student samples are†included on the companion CD in pdf format, 8Ĺ x 11 size. These forms are not copyrighted and permission is given to make copies.
These forms include...
  • Scatter plot form
  • Antecedent behavior consequence chart
  • Functional assessment of behavior
  • Interview form
  • Functional assessment interview form
  • Prioritizing challenging behaviors
  • Challenging behaviors checklist
  • Prioritizing adaptive behaviors
  • Assessment instructions
  • Preference assessment data sheet
  • Preference assessment summary

Changes in behavior and learning are often the most challenging deficits to manage following a brain injury.

This manual offers practical ways to successfully improve challenging behaviors, to promote effective learning strategies, and to teach functional skills at home, in school, and in the community.

ISBN# 1-931117-20-9
Pages 116 pages, 7 x 8Ĺ, soft cover, with USB drive
Year 2016 (2nd edition)


About the Authors

Stephen S. Bruce, M.Ed.

He is the Senior Director for Professional Development for the Neurosciences Institute at Bancroft NeuroHealth in Haddonfield, New Jersey. He earned a Master of Education degree in Applied Behavior Analysis from Temple University and is currently completing course work for a doctoral degree in special education from Temple University. Mr. Bruce coordinates staff training and development, teaches courses in applied behavior analysis at Temple University, and directs Bancroft NeuroHealthís professional conferences and workshops. He also chairs a behavior management committee and oversees school consultation services. Mr. Bruce has worked in the field of developmental disabilities and brain injury for the past 17 years and is a Board Certified Behavior Analyst as well as a Certified Brain Injury Specialist.

Lisa Selznick Gurdin, M.S., BCBA, CBIS-CE

Ms. Gurdin is a part-time lecturer at Northeastern University and Chair of the American Academy for the Certification of Brain Injury Specialists (AACBIS) Board of Directors. Ms Gurdin is a Board Certified Behavior Analyst and an AACBIS Certified Brain Injury Trainer. She serves on the Board of Directors for the Brain Injury Association of America and supervises students for their associate behavior analyst certification.

She earned a Master of Science degree in Applied Behavior Analysis from Northeastern University. Ms Gurdin worked at the May Institute, Inc. in Massachusetts for eight years where she managed research and training grants, developed and coordinated a company-wide mentoring program, and taught courses in applied behavior analysis. She also has ectensive experience designing and implementing home and school-based behavioral programming for children and adolescents with autism and brain injury.

Ronald C. Savage, Ed.D.

Dr. Savage has worked with children, adolescents and young adults with neurological injuries and disabilities for over 25 years. Presently, Dr. Savage is President of the North American Brain Injury Society.

In addition, Dr. Savage has taught at the elementary and secondary school level as a classroom teacher and as a special educator. He has also taught courses at several colleges and universities. Dr. Savage is the former Chairperson of the Pediatric Task Force for the National Brain Injury Foundation, the former Co-Chairperson of the International Pediatric Task Force for the International Brain Injury Association, and is a founding member of the American Academy for the Certification of Brain Injury Specialists.


About the Authors
Chapter 1 Understanding Brain and Brain Injury
Chapter 2 Common Behaviors Following Brain Injury
Chapter 3 Overview of the Behavioral Approach
Chapter 4 Identifying and Defining Behavior
Chapter 5 Observing and Recording Behavior
Chapter 6 Types of Behavioral Assessment
Chapter 7 Practical Behavior Change Strategies: Manipulating Antecedents
Chapter 8 Practical Behavior Change Strategies: Providing Positive Consequences
Chapter 9 Case Studies
Resources for Information

Appendix A: Blank Forms (available on the companion CD)
  • Scatter Plot Form
  • Antecedent Behavior Consequence (ABC) Form
  • Functional Assessment of Behavior Interview Form
  • Functional Assessment Interview Summary Form
  • Prioritizing Challenging Behaviors Worksheet
  • Challenging Behaviors Checklist
  • Prioritizing Adaptive Behaviors Worksheet
  • Two Item Stimulus Choice Preference: Assessment Instructions
  • Preference Assessment Data Sheet
  • Preference Assessment Summary
Appendix B:† Sample Completed Forms (available on the companion CD)
  • Prioritizing Challenging Behaviors Worksheet
  • Challenging Behavior Checklist
  • Functional Assessment of Behavior Interview Form
  • Functional Assessment Interview Summary Form
  • ABC Assessment Form
  • Scatter Plot Assessment Form
  • Preference Assessment Data Sheet
  • Preference Assessment Summary


Excerpt from Chapter 1

Understanding the Brain and Brain Injury

The brain is the supreme organ that directs everything an individual does. It makes it possible for a person to think, communicate, act, move about, create and BEHAVE. Behavior is a ďproductĒ of the brain and how the brain responds to the environment. Just as thinking, speech and movement can be disrupted by a brain injury, so too can a personís behavior. The way a student responds to other people, reacts to overwhelming tasks, or feels about himself can be dramatically altered by a brain injury. The example below shows how a studentís performance may vary depending on the structure and format of each particular class.

Juan sustained a severe brain injury to his frontal lobes. Three years after the injury, he has difficulty working independently in his art class and completing assignments. He functions well in math class and reports that he knows exactly what he needs to do every day.

During art class, Juan has been getting in trouble with peers, talking back to his teacher, and walking out of the classroom. Art class involves unstructured projects in which students can work at their own pace. Lately, Juan feels that he never knows what he is supposed to do in art class.

By contrast, his math teacher states that he is doing well. His math teacher gives Juan a checklist each day with assignments that he needs to complete and checks on him every 10-15 minutes.

The brain is comprised of specialized centers that are connected by a complex system of pathways. The parts of the brain work together as an integrated unit. When any one component of the unit is not working properly, the entire system may be disrupted.

Excerpt from Chapter 2

Common Behaviors Following Brain Injury

There are many variables that cause or maintain these often debilitating behaviors. Initially, unwanted behaviors may be related to other physical, cognitive, and sensory deficits that are associated with brain injury. For example, verbal outbursts and physical aggression may be the direct or indirect result of frustration related to memory deficits, disorientation, slow processing, and/or poor communication skills. Challenging behaviors may also occur as a result of environmental factors, such as temperature, noise level, and lighting. For instance, a student who is sensitive to noise may bolt out of the room when several people in the room talk too loudly. Or, a student with an aversion to warm temperatures may show a tendency to be more aggressive during the summer.

Behavior usually is not the result of a single event, but a contribution of factors. Delayed Problems

When he was 10 years old, Sam fell off his bicycle and had a moderately severe concussion. Although he lost consciousness for a few seconds, Sam did not seem to have any major consequences from the fall. Throughout his remaining elementary years, Sam did okay in school. His teachers reported that he was a bit hyperactive and needed help completing written assignments. However, his parents and teachers agreed that Samís behaviors did not require special attention.

After Sam entered middle school, both his parentsí and teachersí perspectives changed. Samís grades worsened. He rarely started or completed assignments, was often disruptive during lectures, and frequently roamed around the school. Initially, his parents thought that Sam was having trouble transitioning to the new middle school environment. However, his behavior did not improve.

Excerpt from Chapter 3

Overview of the Behavioral Approach

Applied Behavior Analysis (ABA) has been successfully used to improve classroom learning, promote participation in community activities, facilitate positive social interactions, and increase independent completion of everyday tasks. For over six decades, researchers have systematically examined the environmental variables that affect behavior. They have conducted research in both the laboratory and clinical settings. This research has led to the development of the principles of behavior. Today, these principles are applied to change numerous behaviors in many settings, including classrooms, therapy sessions, hospitals, homes, and job sites. ABA has helped individuals with many diagnoses eliminate bad habits, take medication regularly, manage stress, and maintain an exercise regimen.

Applied Behavior Analysis (ABA) is concerned with understanding and changing behavior to significantly improve the quality of an individualís life.

One of the most significant aspects of Applied Behavior Analysis is its systematic approach to treatment. The approach involves clearly and precisely defined goals, objectives, and treatment plans. Specific objectives are broken down into responses that can be described in detail, observed on an ongoing basis, and evaluated to determine progress. This avoids subjective statements about a treatmentís effectiveness and a studentís performance.

Excerpt from Chapter 4

Identifying and Defining Behavior

Students may have several behaviors following a brain injury, that interfere with everyday activities. It is critical that the entire educational team be involved to identify and prioritize target behaviors. Each member offers different expertise and a different perspective on the student and on brain injury.

At times, members of the treatment team may have different ideas about which behaviors should be identified for change. Or, they may agree on a list of problem behaviors but not concur on which behaviors to change first. The following checklist can be used to discuss and prioritize behaviors of concern.

  • Identifying Specific Target Behaviors
  • Is the behavior harmful to the student or to others?
  • How frequently is the behavior exhibited?
  • Does the behavior interfere with everyday activities, such as activities of daily living, academic tasks, or transitions?
  • Does the behavior limit positive interactions with peers, staff, and/or family members?
  • Is the behavior age-appropriate?
  • Does the behavior have a long history of occurrence?
  • Is the behavior a problem for staff, therapists, teachers, or family members?
  • Does the behavior lead to a chain of other challenging behaviors?
  • Does the behavior limit community outings?
  • Does the behavior interfere with the achievement of rehabilitation and/or educational goals?

Excerpt from Chapter 5

Observing and Recording Behavior

It can be difficult for teachers and parents to be objective when discussing their student or childís problem behaviors because they are often the ones who are dealing with the behaviors on a daily basis.

Behavioral data collection involves observing the behavior and recording specific dimensions of the behavior. This systematic method enables the team to objectively measure the behavior, identify what is causing or maintaining the target behavior, decide how to most effectively change the behavior, evaluate the effectiveness of the intervention, and document the studentís improvement.

Data Collection Methods

Data collection can seem like an overwhelming and impossible task. However, there are several efficient data collection methods that are practical and easy to use in a busy classroom or at home. These methods include frequency, duration, momentary time-sampling, percent occurrence, and permanent product. Each method is briefly described with sample data sheets to illustrate how data are recorded and graphs to show how data are displayed.

Excerpt from Chapter 6

Types of Behavioral Assessment

Behavioral assessment is an essential and necessary step in designing effective interventions for students with unwanted behaviors in the classroom, therapy, home, or community setting. All behavior serves a purpose. Behavior may occur to get someoneís attention, to stop another personís behavior, to express dissatisfaction, to communicate a desire or need, or to escape or avoid a particular activity or task. Behavior may also occur because it feels good or alleviates pain and discomfort.

Behavioral assessment is designed to determine the specific purpose or function of behavior by systematically observing and recording all environmental events and conditions that may cause or maintain the behavior. These environmental variables are clues as to what function the behavior serves for the student.

There are four main functions of behavior:

To escape or avoid an unpleasant task or interaction

Getting away from a situation or task that the student finds unpleasant is a function of behavior. Unwanted behavior, such as running out of the classroom or becoming disruptive when the teacher gives a student an instruction (i.e., to start working), results in a short break for the student.

To gain attention from other people

Interacting socially with other people is a function of behavior. A student may bang the desk or yell in order to get the teacherís attention.

To gain access to a tangible item

Obtaining an item or gaining access to an activity is a function of behavior. A student may kick the wall until the teacher comes to her table and gets the lunch box that is across the room.

To satisfy a sensory or biological need

Obtaining sensory input or stimulation is a function of behavior. A student may hum extremely loudly or rock in a chair for sensory stimulation.

Behavior analysis aims to reduce behaviors that interfere with learning, restricts access to the community, limits social relationships, and causes personal harm or injury. The goal of ABA is also to promote behaviors that improve an individualís quality of life.

Excerpt from Chapter 7

Practical Behavior Change Strategies:

Manipulating Antecedents

Antecedent-based interventions involve changing the events or variables that exist before the behavior occurs. These environmental changes decrease the likelihood of a challenging behavior occurring and increase the likelihood of a desired behavior occurring. Examples of antecedent-based interventions (also referred to as antecedent control) include the following:

  • Providing reminders for upcoming tasks
  • Reducing task demands
  • Interspersing demands and social comments
  • Choice-making

Recently, there has been an increasing emphasis on antecedent-based interventions in the fields of behavior analysis and brain injury rehabilitation. This focus has evolved from research that has demonstrated that antecedent-based strategies can effectively change a variety of behaviors across many settings. These interventions have been successful with students with autism, learning disabilities and brain injuries.

Excerpt from Chapter 8

Practical Behavior Change Strategies:

Providing Positive Consequences

The principle of reinforcement describes (1) what happens in the environment following the occurrence of a behavior and (2) how the behavior changes as a result of that event. In order for reinforcement to occur, something is added or taken away from the environment with a resulting increase in the target behavior. The following chart summarizes positive and negative reinforcement.

Excerpt from Chapter 9

Case Study: Antecedent-Based Treatment

John was a 14-year-old male who had a traumatic brain injury when he was six years old as the result of a motor vehicle crash. The records indicate that he had a closed head injury to the frontal lobe area. His teachers reported that he often became frustrated in class and left his seat to go into the hallway. While in the hallway, he disrupted other students. Due to these unwanted behaviors, John was suspended from school and was not allowed to return without a treatment plan. Subsequently, a behavior analyst was called to determine how to improve Johnís behavior so that he could return to school and be successful.

Condition: Length of task antecedent analysis

Student: John

Target behavior: Bolting

Operational definition: Any instance in which the student stands up from his seat and takes more than one step away from his seat without returning.

Data collection: The frequency of bolting is collected after 1, 5, and 10 minutes after he has begun working on the assignment.

Excerpt from Conclusion

Many children and adolescents with brain injuries experience cognitive, physical, sensory, psychosocial, and behavioral changes that affect every facet of life. They often exhibit unwanted behaviors (i.e., aggression, inattention, bolting, and inappropriate language) that can negatively impact everyday functioning. These behaviors limit their participation in rehabilitation, home, school, and community activities. Applied Behavior Analysis (ABA) offers a scientific methodology for examining, measuring, and treating behavioral deficits. This methodology includes operational definitions of goals and treatments, functional outcomes, and systematic assessments.

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