Behavioral Changes Following a Brain Injury

Executive functions

Executive functions such as planning, goal setting, self-monitoring, self-control, self-initiating, self-evaluation, flexibility, and problem solving are often altered following a brain injury. Behaviors observed following a traumatic brain injury may include any of the following:
  • Fatigue: may persist after all injuries are healed. Can affect other functions, motor skills, speech, concentration;
  • Forgetfulness: can be temporary, memory of recent events is often more affected, may affect only certain types of information;
  • Distractibility: difficulty concentrating or completing tasks because of surrounding noises or activities;
  • Poor organization: difficulty identifying steps to complete a task or ordering and prioritizing tasks;
  • Irritability and anger: trouble controlling emotions, may act out verbally or physically with sudden temper flare-ups;
  • Sexual inappropriateness: inability to control or inhibit sexual thoughts or behaviors, engaging in embarrassing or inappropriate comments or gestures;
  • Impulsiveness: acting without thinking, interrupting, taking risks without regard to consequences;
  • Social immaturity: lacking age appropriate social skills, unable to interpret reactions, unable to fit in with peers;
  • Self-centeredness: unaware of other's feelings, not sympathetic or able to understand how behavior affects others;
  • Passivity: difficulty getting started, appears unmotivated, daydreams, doesn't cause any problems but cannot initiate or plan; and
  • Depression: lacks interest in life, withdraws from friends and activities, feels hopeless and that life isn't worth living.
Changing behavior can be a long and slow process requiring trial and error and obtaining the cooperation of teachers, family members and peers. Parents may need to consult with experts, obtain a neuropsychological evaluation and consider the use of medication. It is also very helpful to seek out and communicate with other parents of children suffering from a TBI; see Brain Injury Support Groups in Utah or Online Support Groups. Sharing experiences and strategies can be informative and supportive.


Change is particularly difficult for a child who has suffered a brain injury; the more severe the injury, the more difficult transitions become. Anticipation of change, planning ahead and providing necessary support can lessen the trauma of routine transitions. Examples of routine transitions that growing children experience:
  • new teachers, moving up in grades and changing schools (grade school to junior high, junior high to high school);
  • physical growth, puberty and adolescence;
  • developing age-appropriate emotional responses, humor, and social interactions;
  • increasing academic requirements with the need for better time management;
  • expected increase in the level of independence and the abilty to acquire one's own transportation; and
  • graduation, moving away from home, attending college or holding a job.
In addition, life is filled with all kinds of transitions and changes, some expected (vacations, the introduction of a new pet, moving to a new house, holidays, an older sibling leaving home) and some not expected (last minute changes in plans, a death in the family, illness). Parents need to develop a strategy for addressing both planned and unforeseen transitions.

Special Occasions

Many occasions and events have special meaning for children, young adults and their families (birthdays, parades, Halloween, holidays, school functions, graduations). While these are highly anticipated events, they also disrupt routine, contribute to excessive excitement and have the potential to escalate behavioral problems for children with a TBI. Often the transition from the event back to normal routine is as difficult as the preparation for the event itself. Keeping things simple and on a smaller scale can help the child and the family celebrate special occasions.


Helpful Articles

Ylvisaker M, Turkstra L, Coehlo C, Yorkston K, Kennedy M, Sohlberg MM, Avery J.
Behavioural interventions for children and adults with behaviour disorders after TBI: a systematic review of the evidence.
Brain Inj. 2007;21(8):769-805. PubMed abstract

Authors & Reviewers

Initial publication: November 2008; last update/revision: January 2011
Current Authors and Reviewers:
Author: Teresa Such-Neibar, DO