Behavior after Brain Injury Changes and Challenges

Behavior after Brain Injury Changes and Challenges

Nina M. Marchese, Andrea Potoczny-Gray and Ron Savage, Ed.D.
The behavior of a student with a brain injury can be disruptive, frustrating and challening in the classroom. This tip card helps families, therapists and educators recognize the relationship between brain trauma and changes in behavior. It gives strategies for parents and educators to address challenging behaviors and change disruptive behaviors.
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Full Description

A student with behavior changes after a brain injury is often seen as a “problem” in the classroom. The ABC approach to understanding behavior – antecedent, behavior and consequence – is explained. This tip card explains why antecedent management of behavior for children and students with brain injury is more effective than traditional behavior management approaches. It gives checklists for identifying changes in behavior, defining behavior, assessing behavior, evaluating behavior, and using successful strategies at home and in school to help the child or student with an acquired brain injury.

For more detail, see the manual Strategies for Managing Challenging Behaviors of Students with Brain Injuries.

Pages 6

2008, second edition


Nina M. Marchese

Ms Marchese is a Special Education Teacher and has worked with children with special needs at the May Center.

Andrea Potoczny-Gray

Ms Potoczny-Gray is a Special Education Teacher.  She worked at the May Center for children with special needs.

RonSavage, Ed.D.

Dr. Ronald Savage has worked with children, adolescents and young adults with neurological injuries and disabilities for over 25 years. Dr. Savage is the Executive Vice President of the North American Brain Injury Society. He is the former Executive Vice President of the Neurosciences Institute at Bancroft NeuroHealth in New Jersey, Senior Vice President of Behavioral Health and Rehabilitative Services at The May Institute in Massachusetts and Director of Clinical Services for Rehabilitation Services of New York.

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.


This tip card helps families, therapists and educators...

  • recognize changes in behavior
  • deal with challenging behaviors
  • change disruptive behaviors

Changes in Behavior

Defining the Behavior

Assessing the Behavior

  • Antecedent is what happens before the behavior occurs
  • Behavior is what happens in observable and measurable terms
  • Consequence is what happens as a result of the behavior

Ongoing Evaluation

Antecedent Management

Strategies for Changing Behavior

Checklist for Understanding Behavior after a Brain Injury

  • Identify changes in behavior
  • Define the behavior
  • Assess the behavior
  • Evaluate regularly and often
  • Make strategies successful



Sample excerpt. Preview only – please do not copy.

Changes in Behavior

Families, friends and teachers often see changes in a child’s behavior and personality after a brain injury. The child may have difficulty with control over temper, actions and feelings. Certain areas of the brain, such as the frontal and temporal lobes, monitor and direct many of these behaviors.

Other changes in behavior and personality may include:

  • restlessness
  • acting younger
  • hitting
  • acting on impulse
  • swearing
  • not following directions

Antecedent Management

The model of “antecedent” behavior consequence emphasizes the consequence of a behavior. This results in trying to manage the behavior after it has occurred. “Consequential” management strategies are discipline, time-out, or punishment.

Consequential management often does not work for children with brain injuries because the child...

  • doesn’t remember the rules
  • sees the consequence as a punishment
  • does not learn adaptive skills
  • can not learn from consequences if this ability has been affected by the brain injury