Behavioral Problems

Behavioral sequelae are also common after TBI in children. These can include impulsivity, personality changes, depression, anxiety, becoming easily frustrated, aggression, and sleep problems (146).

These problems persist long-term and are reported in 10% to 50% of children with TBI (147,148). Some authors report an increase of emotional and behavioral symptoms over time (148). Also, a number of authors note that those who sustain TBI are more likely to have a preinjury history of behavioral or psychiatric concerns (147,149). Behavioral problems can be significantly disabling even in the absence of significant mobility or activities of daily living impairment (147). Behavioral problems appear to be more significant and more common in those injured at a younger age (149). Approaches to address behavioral concerns include providing structured environments and daily routines but allowing the individual to make choices when possible, as well as assisting in breaking down tasks to their component parts, providing cues or aids for organization, creating situations in which the individual will be successful, and helping the individual to communicate the need to escape a task or situation. Positive reinforcement of desired behaviors has also been used. Involvement of family members in the process is important (149,150). Various medication interventions have been tried in the past, but none has been shown to be ultimately superior to others in addressing this variety of behavioral symptoms. It is imperative that those working with the individual understand that the behavioral problems are neurologically based. Behavioral symptoms are strong predictors of family burden over time (148).

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Source: Alexander M.A., Matthews D.J.. Pediatric Rehabilitation: Principles and Practice. 4 th. еd. — New York: Demos Medical Publishing,2010. — 540 р.. 2010

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