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Behavior – Help for Families and Caregivers by April Groff, PhD

Behavior after TBI challenges families and caregivers

TBI behavior challenges everybody

Changes in behavior after a brain injury are common and particularly stressful for families and caregivers. “Why does he act that way? What can we do? She’s like a different person.” These are just a few comments repeatedly heard by clinicians when talking with families and caregivers. It’s not only the person with the brain injury who has changed. Families and caregivers now find they have to change their expectations about the survivor’s behavior. They also learn to change how they respond to these new and often frustrating and challenging behaviors that they see at home and out in the community.

Behavior and memory are connected

Someone with a brain injury may have short or long-term problems with memory. This means that learning new information can be very difficult, and the person may become confused about how to act. A person with a brain injury may also do or say something over and over—like repeating a word, question, or activity. In most cases, repetitive behavior isn’t harmful. But it can be incredibly annoying and difficult for families and caregivers, who will need much patience and understanding while trying to figure out how to respond.

Below are some tips that families and caregivers can use to prevent behavior difficulties associated with memory problems. There are also tips for responding to these behaviors.

Prevention strategies

Tips for responding


A person with a brain injury may feel easily overwhelmed, which can lead to agitated behaviors. He may become restless, and pace, fidget, or move around. He may become unsettled or upset more easily than before or for reasons that aren’t readily apparent to families and caregivers.

Many factors can interfere with a person’s ability to think. A person with a brain injury has a lower threshold for interference, causing more sensitivity to anything that interferes with the natural ability to think and is more susceptible to cognitive overload. This often leads to agitation.

Below are some tips for preventing agitation, as well as tips for responses by families and caregivers.

Prevention strategies

How to respond

Aggression and anger

Angry outbursts and aggressive behaviors can occur when confusion and cognitive overload escalate. Or they can occur suddenly and unexpectedly. Aggressive behaviors can be either verbal or physical. They tend to be triggered by environmental factors like extreme overstimulation or internal factors like pain, physical discomfort, or inability to communicate effectively. Provided that the situation does not present a physical threat, various approaches can help prevent or diffuse anger outbursts and aggressive behavior. The above prevention strategies for agitation are also effective in reducing the likelihood of angry outbursts and aggression.

Prevention strategies

How to respond

About the author

April Groff, Ph.D. is a licensed clinical psychologist specializing in neuropsychology. She currently is the clinical director at Learning Services in North Carolina, where she oversees post-acute residential rehabilitation and supported living program for individuals with acquired brain injury.  Her previous roles include director of the Polytrauma Transitional Rehabilitation Program and staff psychologist within the Polytrauma Rehabilitation Center at the VA Palo Alto Healthcare System. She has extensive experience working with active duty service members, veterans, and civilians with brain injury and their family members.


This article is posted with permission from Brain Injury Journey – Hope, Help, Healing, Vol 1, 2014.