Managing Behavior in Children after Brain Injury or TBI

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

September 3, 2012

Behavioral Management Strategies Children and Adolescents after TBI

Managing the behavior of students with traumatic brain injury (TBI) should always be based on the central principle of learning. The ultimate goal of improving a student’s behavior in school is to help the student learn and function in the classroom. Various behavior management strategies are often used interchangeably to achieve similar results. Techniques that center on a positive, learning principle have an A-B-C design (Antecedent, Behavior, Consequence).

The management of behavior is largely determined by the recovery stage that the child or adolescent has reached. It is most beneficial, in the earlier stages after an injury, to remove any stimulus that triggers unwanted behaviors. As a child matures, however, it is nearly impossible to eliminate all environmental triggers. Therefore, it is important to manage behaviors using positive, behavior management techniques. 

Philosophy behind behavior management techniques

Behavior problems are a frequent challenge for children and adolescents after a brain injury. The degree of “problem behaviors” can range in scope from child to child. Environmental stimuli, both observable and unobservable, can contribute to behavioral changes after brain injury.

There are various behavioral management strategies that can help a child to alleviate problem behaviors. Behavior change programs help children develop positive adaptive skills and decrease problem behaviors to allow the student to reach the highest level of functional independence.

What are some different types of A-B-C behavior management strategies?

  1. Applied behavior analysis
  2. Antecedent behavioral interventions (positive everyday routines)
  3. Differential reinforcement of problem behaviors
  4. Rational behavior therapy (RTB) 

Discussion of the A-B-C behavior management strategies

1. Applied behavior analysis (ABA)

This behavior management strategy is based on the A-B-C learning principle and helps identify problem behaviors and environmental influences. Intervention strategies are developed to change problem behaviors.ABAmeasures behaviors before, during and after the intervention. TheABAstrategy has been successful when used post-brain injury because appropriate behaviors have to be re-learned. The steps involved in implementing this behavior strategy include:

  • identification target behavior
  • measurement of the frequency of behavior
  • analysis of behavior using the A-B-C paradigm
  • development a plan for intervention
  • generalization of behavior to different environments
  • evaluation of results

In this model the focus is on managing problem behaviors through the Antecedent, Behavior and Consequence paradigm by shaping behaviors using positive adaptive skills and decreasing problem behaviors.

2. Antecedent control interventions (Positive everyday routines)

This behavior management strategy places the choice and control in the hands of the individual. The strategy is to involve the child in the planning and decision making process. It helps to manage problem behavior before it occurs. The components of successful implementation include:

  • intervention strategies are delivered in natural settings by everyday people
  • children make choices and plan their own intervention
  • intervention is delivered in appropriate context and designed to change everyday routines
  • children are provided the support they need to succeed.

Positive everyday routines teach adaptive skills and engage the individual in the planning and decision making process. For antecedent control strategies to have positive long-term affects on problem behaviors, strategies used should be generalized into real-world context. 

3. Differential reinforcement

This behavior management strategy is used when an undesirable behavior is decreased and a desirable behavior is increased. This strategy presents choices to the child in that positive behaviors are reinforced. The problem behavior is substituted with an appropriate behavior alternative. There are three steps in this limit-setting strategy:

  • acknowledge what the child is feeling
  • communicate the limit of acceptable behavior
  • target appropriate alternatives

For example, a child becomes upset in class and begins hitting his head against the desk. The teacher reaffirms what the child is feeling by saying, “I know that you are frustrated right now, but you may not hit your head against the desk. You may either get up and walk around the room to calm down or you may draw how you are feeling on a piece of paper at your desk.”

4. Rational behavior therapy (RBT)

This is a cognitive-behavioral model that is based on the belief that problem             behaviors and emotions result from cognitive processes (or the absence of them). This strategy believes that it is possible for children to modify their cognitive processes to achieve different ways of feeling and behaving. A child’s view of a situation affects the way s/he acts, behaves and feels. It is not the situation that causes the problem behavior, but rather what a child believes about the situation (refer to the A-B-C paradigm).  There are four processes in RBT:

  • Event or the sequence of information that is processed by the child causes the child to
  • Think—the child thinks through the event, which creates his/her
  • Feelings about the event, which triggers a specific action or
  • Behavior.

RBT alleviates the child’s sense of helplessness and acknowledges the loss of control and the presence of fear in a child’s life. This strategy allows the child to understand that s/he has control over his/her thoughts, feelings and actions. RBT helps the child assume responsibility for his/her behavior and life after brain injury.

Behavior intervention strategies and the child’s IEP

Problem behaviors not only disrupt the classroom environment, but they also inhibit the cognitive progress of the child who is experiencing these behaviors. Problem behaviors need to be examined so that appropriate management techniques can be developed to teach a child new behaviors.

Behavioral management strategies should be addressed in a child’s IEP as a Behavioral Intervention Plan (BIP). Any of the previously discussed behavior intervention techniques can be tailored to meet a child’s specific needs. It is through managing problem behaviors in the classroom environment that a child’s quality of life and potential for success can be maximized. 

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

Strategies for Managing Challenging Behaviors of Students with Brain Injuries

By 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 CD with all worksheets and forms.

 

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.

A brain injury can have many physical, cognitive and behavioral consequences for students. This manual gives educators and parents a foundation for understanding the educational needs and behavioral challenges of children with traumatic brain injuries with in-depth discussions of how to help students think and learn and how to help students with behavioral challenges.

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