Behavioral Changes in Children and Adolescents with Brain Injury

Brain Injury Blog by Katherine Kimes, Ed.D., CBIS

August 10, 2012

How does a brain injury change a child’s behavior?

A brain injury can wreck havoc on a child or adolescent’s emotions, behavior and essentially their overall quality of life. Brain injury can cause behavioral, emotional and psychosocial changes and problems, issues that were not once there. A student can lack the cognitive skills to realize that behaviors are inappropriate. Sometimes the root of the behavioral issue deals with the student not having the social skills or ability to control their emotions.  

What is behavior?

Behavior is ultimately social in nature. Behavior is the external expression of our emotions, our feelings. It, like our executive functions, is what the world sees. It dictates how we appear to others. Our emotions reflect our behavior. Our emotions are a complex interaction of behavior, biology and cognition. 

What can behavioral issues look like in the classroom environment?

  • increased aggression or poor anger control (verbal or physical outbursts)
  • emotional lability (instability, mood-swings, crying over a wrong answer or becoming angry because the wrong answer was given)
  • self-induced isolation (anti-social, loss of self-esteem)
  • egocentricity (insensitive, focuses all classroom conversations/activities on him/herself)
  • hyperactivity (always needs to be doing something and can’t sit still or stay in one place)
  • impulsivity (blurts out inappropriate comments during quiet time)
  • social disinhibition (unrestrained, sensation-seeking, risk taking behavior)
  • poor judgment (lacks self-awareness, does not make thoughtful decisions)
  • interaction difficulties (immature or childish behaviors). 

The complex brain/behavior relationship:

While the primary reason behind behavioral issues is the brain injury itself, behavioral issues can be influenced by other issues as well. These factors include: age at the time of the injury, severity of injury, length of coma; pre-injury intelligence and personality traits, types of post-injury environments, personal motivation and family supports. 

The concept of behavioral issues after brain injury is not easily understood. A student does not have to have physical impairments in order to have behavioral issues.  It is important to understand that the behavioral issues experienced after injury are rooted in the interaction between three variables:

1. the direct damage sustained to the brain;
2. the reactionary disturbances/behavior response of the student to the injury and
3. the state of the brain prior to injury (the student’s pre-existing abilities).

How these three variables interact and influences behavior is described next.

  • Damage to the brain

The underlying principle that drives behavioral issues/disturbances is the state of the brain after injury. The behavioral issues a student displays correspond directly with the part of the brain that was injured as well as the specific brain function that was damaged. This damage can directly influence behavioral control and emotional responses because the student’s brain is no longer working like it used to (the wiring in the brain, the neurotransmitters, no longer function as they once did).  

  • Behavioral responses

The behavioral issues a student experiences after brain injury vary from one student to the next.  However, one thing is certain; the injury has disrupted the brain. It is only reasonable that the injury can result in reactionary disturbances/behavioral issues. A brain injury impacts how a student behaves in the classroom in relationship to environmental influences. A trigger in the environment can cause a spontaneous or unrestrained emotional response. These reactions can be intentional or unintentional behaviors.  Unintentional behaviors are spontaneous behaviors caused by the brain injury. These spontaneous, reactionary disturbances can negatively impact a student’s education goals and how the student is perceived by others in the classroom environment.    

  • Pre-existing abilities

Behavior issues are typically experienced with all brain injuries. The behavior a student displays after injury depends a lot on the student’s personality traits. A brain injury typically magnifies a person’s pre-existing personality traits. It is quite possible that a student may behave differently or more intensely after sustaining a brain injury. A lot depends on a student’s pre-existing behavior patterns. A student who was well-organized prior to their injury might have a tendency towards obsessive/compulsive behavior. A student who was aggressive might now have a tendency towards acting out.  

Managing behaviors after injury

While it is important to understand the underlying reasons and interaction of variables involved in behavioral issues after brain injury, unless these behaviors can be changed or modified, the student will have long-term problems in the school environment. Without proper intervention techniques, behaviors tend to get worse rather than better over time.  This is why it is important to develop in-school behavioral management programs in the Individualized Education Plan (IEP).  

While behavior management is largely determined by the recovery stage the student has reached, the IEP should emphasize behavioral goals that will allow the student to return to the highest level of independent, physical, and social functioning. The IEP goals need to be modified and changed as the student experiences positive behavioral outcomes. Behavior change occurs when goals are relevant and there is motivation for change.

About the Author

Dr. Kimes is the President of ABI Education Services, LLC a consulting business that addresses the educational needs of children and adolescents with acquired brain injury (ABI). 

Recommended Reading 

Students with Brain Injury: Challenges for Identification, Learning and Behavior in the Classroom

By Katherine Kimes, Ed.D., Marilyn Lash, M.S.W. and Ron Savage, Ed.D.


8 responses to “Behavioral Changes in Children and Adolescents with Brain Injury”

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  2. Shannon Jackson says:

    Hello. I read this and was very interested. I am doing my Doctoral Dissertation on the effects brain injury has on human behaivor, mainly because of my brother who had been misdiagnosed as an Epileptic as an infant but when he died at age 43, we found out he had benign lesions in the brain all his life that laid dormant until a car accident jarred one and caused its growth. Because of its location, operation was too dangerous. In any case, he had a lot of emotional issues as a teen, was suicidal, abusive to his siblings and he sexually acted out, meaning he had younger ones have sex with him as a teen. Once his medication was balanced more and he lost his leg in an accident, those behaviors disappeared. I really just want to know what extreme brain injury or lack of oxygen might have had on him. As a 20 year old he went back, got a GED, went to college and graduated with a 4.0 and did very well for himself. I cannot off hand remember the name of the condition but it is known as genetic lesions In addition, I of course am curious about athletes and soldiers who suffer TBI and we see drastic behaviors.

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  4. Dhyan Sandhya says:

    My nephew and I suffered with a brain injury…..and did not know it. We knew he had issues but they were attributed to ADD …….not so…..It was after two falls hitting his head within two years. I knew I was different now after the car accident but didn’t know the cause. Finally I read a book that described our symptoms. I contacted Brain State Technology and we did their work correcting many symptoms. We had out lives back again. Easy and not too expensive. He was 3 and 5 years old and took sessions at 15 years old. My injury was about 7 years old when I did sessions…..later I realized I had also fallen on my head when I was 5 as well….developed epilepsy from scar tissue….now healed as well. I was 59 years olds when healed…..accident happened at 52 years old. Good luck.

  5. Sarina says:

    I can definitely understand how difficult it is as a child, growing up with a brain injury, as that was how I was described when I was younger. I was in a car accident when I was 10 and in the 6th grade. I spent 4 days in a coma and 2 weeks in the hospital.

    Growing up became difficult for me because I was faced with new challenges each day. Emotions became harder to control and learning became more challenging. Before the accident, I was in an all French public school and after trying to get into my regular routine. After finishing the 7th grade, with many struggles, I was put into an English school for the 8th grade and continued my high school education at an English school.

    As a 20 year old who is currently proceeding with post-secondary education, I still find myself facing different obstacles each day. From experience, I feel that it’s important for ABI children to access all the help they can possibly get. Whether it be a tutor, occupational therapist, rehab therapist, anything that can help the child feel like they can still succeed at the same rate as everyone else their age, even if it means that things have to be done a little differently.

  6. Dear Kimberly,

    It’s unfortunate but misdiagnosis of brain injury happens all too often. I agree with Marilyn that you should have your child seen by a pediatric neuropsychologist.

    You stated that the school system is still educating your child as if he has William’s syndrome. Are you sure that they are aware of his current diagnosis of brain injury? If not, make them aware. If they do know, they need to begin providing him with appropriate services and supports that coorespond to his new diagnosis. That means he needs someone, an advocate, who is aware of his deficits due to his brain injury diagnosis (and a pedatric neuropsycholist is a good starting point).

    His Individual Education Plan (IEP) should reflect his new diagnosis. As parents, you have the right to schedule an IEP meeting at anytime to change his program plan, the services and supports that he receives in school under the law.

    In the meantime, it is also important that your family works with him hands-on in order to provide him with an enriched environmet at home. Although it’s not right that your son is not being educated based on his new diagosis, it is important for the family to reitterate what he is learning at school to help him process the information. It is so important that the family works with a child to help him compensate for and hopefully learn overcome his deficits.

    Feel free to visit, as it outlines the services and supports that can be offered by the school system to help him reach his potential. If I can be of further assistance, please feel free to contact me.

  7. Marilyn Lash says:

    Dear Kimberly,
    My suggestion is to have your child seen by a pediatric neuropsychologist for an assessment of educational strengths and challenges. This is a psychologist who has additional training on the brain and will be familiar with the developmental effects of brain trauma. At 11 years old, this is an important time of both brain maturation and new challenges in school as learning becomes more complex. The brain injury association in your state may be able to help you identify a pediatric neuropsychologist.

  8. Kimberly Bland says:

    Hi I have a child received brain injury at birth We just got this, diagnosis last year and he’s 11 years old neow. We were told it was Williams syndrome and he didn’t receive the proper help for the brain injury right away and Im lost the school systems are still treating this like Williams and I don’t think they know what to do I see so much potential im him and yet I see the deficits too there’s so many emotions tied into this with him and our family he is a wonderful funny child there’s no support for us and no answers if we whould of known at birth I think he would have been much better off and more advanced what can I do and where do we start.Help! Thanks Kimberly Bland and Family.

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