Moderate to Severe TBI
Change text size
Consequences of Moderate to Severe TBI
Personality and Behavioral Changes Following TBI
Changes in personality and behavior commonly occur following brain injury.
- Impulsiveness: Often, particularly in the early stages of recovery, the child has difficulty control his impulses and tends to act before he thinks. It is important to give the child feedback and guide him through activities both verbally and physically.
- Poor Judgement: Due to an inability to see the "big picture" and consider all the options, the child tends to make poor choices and will require guidance from caregivers initially. Usually this improves, but this may also be a persistent deficit.
- Lack of Inhibition: Similar to impulsivity, the child is unable to stop a behavior. Often it is referred to when discussing behaviors inappropriate to a situation. For example, the child who has difficulty keeping his clothes on, touching people in unacceptable manner, or using inappropriate language.
- Dependency: This refers to feeling of lack of control or helplessness, Though children are dependent on their caregivers for many things, this is experienced in an exaggerated or in appropriate manner. Most of ten, as the child becomes more aware of his strengths and weaknesses, he will be able to cope with more independence.
- Anger Outbursts: Initially, these are often seen as the child is progressing through the stages of agitation and confusion in the recovery process. Persistent anger control problems can be an exaggeration of a pre-injury problem or an inability to deal with the losses associated with the injury.
- Poor Motivation: The child with a brain injury may show a lack of desire to play with friends, socialize with family or do the things that he used to love to do. This may be related to a lack of confidence that he can do those things again, and depression related to those feelings. Medication may be required to help this problem.
- Denial: This often occurs as the child is faced with the losses associated with the injury. In the early stages of recovery, the denial may simply a lack of insight and self-awareness and diminish as the child improves. Persistent denial results in the child having difficulty making appropriate choices regarding his schoolwork, activities, and behavior.
- Emotional Lability: The child may have difficulty controlling his outward expressions of emotions. He may laugh or cry in a manner not appropriate to the situation and may be unable to stop laughing or crying.
- Apathy: This is when the child shows a very neutral sense of interest in people and activities, which were previously very stimulating to him.
- Lethargy: This is a profound feeling of fatigue and drowsiness coupled with the lack of motivation and apathy, which can significantly interfere with a child's ability to improve. Medications may be helpful for children who experience this problem long-term.
- Inability to plan action to meet desired goals.
- Inability to learn from peers or social situations.
- Getting easily distracted in noisy surroundings.
- Becoming lost in unfamiliar surroundings.
- Acting uncharacteristically bossy and argumentative.
- Demonstrating poor responsibility and dependability.
- Inability to anticipate and plan for the future.
It is rare for a child to show all of these problems. A change in personality or may be temporary (i.e less than a year) or permanent. Whether a change will be permanent depends upon a number of interactive factors including the nature and extend of brain damage, the age/developmental stage at the time of injury, the environment and the child's psychological response to the changes. When the injury produces severe brain damage there is potential for distortion of the normal course of development. Brain damage can effect the cognitive processes upon which personality development is dependent.
Changes in behavior can be the product of cognitive dysfunction (e.g. a child that is "overloaded" with too much stimulation from her environment becomes physically aggressive), exacerbation of pre-existing problems (e.g. the child with ADHD now shows an increase in the frequency and intensity of symptoms). Damage to different areas of the brain can produce alterations in inhibitory control of emotions, attention and behavior (e.g. damage to the frontal lobes) which can cause a child to be impulsive, moody, irritability and have reduce tolerance for frustration. The child's psychological response to the physical (e.g. facial scarring, problems in the motor control making participation in sports impossible) and cognitive consequences of the injury can produce depression, social withdrawal, anxiety and other forms of maladaptive behavior. Finally, in many situations the changes in behavior are the result of an interaction of all the above.
There are usually no "quick fixes" to these problems. Effective intervention at home and at school requires that problems be properly conceptualized. For example Tony, a thirteen year old male is physically aggressive towards peers while in the cafeteria during the noon hour. In this scenario, the problem behavior (aggression) may be the secondary consequence of the primary problem which is that Tony gets overstimulated in the noisy and busy cafeteria, which leads to diminished inhibitory control of emotion and behavior which is seen as aggression.