Structured flexibility and context-sensitive behavioral support for the chronically cranky

Abstract

BACKGROUND: A significant number of individuals with brain injury demonstrate behavioral challenges that negatively affect their ability to live successfully in community settings. While there are a number of treatment approaches that have demonstrable effects in well controlled clinical settings, it is very difficult to implement these approaches in natural settings. OBJECTIVES: The goal of this study was to report the results of an investigation of the effects of a multicomponent behavioral intervention on the challenging behavior of an adolescent and young adult with growing behavioral concerns after acquired brain injury (TBI). METHODS:The participants were an 16 year old adolescent male and a 24 year old female, with escalating behavior problems after severe TBI. Multiple baseline designs were used to document the effects of an intervention package that integrated cognitive and executive function intervention to address severe challenging behaviors in natural settings. The following dependent variables were used to establish the effectiveness of the interventions: frequency and intensity of aggressive behaviors and participation in scheduled activities. The intervention included integrated components of positive behavior supports, cognitive supports and specific executive function scripts. RESULTS: These single subject experiments demonstrated the effectiveness of a multicomponent intervention on the reduction of the frequency of problem behaviors and the increase of pro-social behaviors. CONCLUSION: These two successful interventions extended the findings of previously published data for the successful treatment of behavioral challenges using a flexible support-oriented intervention that combines behavioral, cognitive, and executive function components. severe TBI had aggressive behavior after the injury, with no significant difference between the aggressive and non-aggressive groups in severity of injury. Furthermore, behavioral excesses (e.g., aggression) and behavior deficits (e.g., reduced initiation) have long been judged by family members, teachers, employers, friends, and others to be the most problematic consequence of the injury (Brooks et al., 1987).Poorly controlled behavior has also been linked to difficulty in both family reintegration and educational,

Psychological interventions for treating neuropsychiatric consequences of acquired brain injury: A systematic review

“…Anger management sessions were effective in decreasing aggression, wherein counselling (Chang, Zhang, Xia, & Chen, 2011), psycho-education, behavioural methods and cognitive challenging seemed to be particularly effective elements (Medd & Tate, 2000). Next to these high-quality studies, moderate-quality studies supported the effectiveness of anger-management sessions (Hart, Vaccaro, Hays, & Maiuro, 2012;O'Leary, 2000;Walker et al, 2010) and increasing self-awareness might be of interest for managing aggression in community-based settings (Feeney & Achilich, 2014).…”

Positive behaviour support for people with dementia

“…PBS is a service response to challenging behaviours 27,28 that has an increasing evidence base for its application across the lifespan, and relevant to a range of disability types including neurological conditions. [29][30][31] PBS is presented as the standard framework for promoting best practice behaviour support to people with disability within policy documents and professional guidelines across North America, 32 the United Kingdom, 33 and Australia. 34 In a preliminary study conducted by Lawson and James, 35 it was suggested that PBS could add value beyond other treatment frameworks.…”

Friendship Quality, Friendship Quantity, and Social Participation in Adults with Traumatic Brain Injury

“…Furthermore, future research should aim to identify predictors of friendship quality and quantity, which might include severity of cognitive impairment in areas such as executive functions, which can affect planning of social activities, 46 or social cognition, which may affect interpersonal interactions. 47 This would improve understanding of why some adults with TBI have better outcomes than others, with the potential to identify risk factors for poor outcomes and supports for better outcomes.…”