Anger/Aggression/Irritability

Disclaimer: This information sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

Acquired brain injury can often lead to changes in a child's ability to control their emotions and behaviour. The child with a brain injury may seem very different in nature and temperament to how they were previously.

Low frustration tolerance is common. A child/young person may be more irritable and lose their temper easily over very minor things. Sensitivity to criticism is also common. Children/young people may have deficits in reasoning and thinking skills that lead to misunderstandings and they then become frustrated. Anger may be expressed as both physical and verbal aggression. They may throw tantrums more easily, cry easily and may yell and scream. At times they may lash out at other people or become destructive towards possessions or objects. They may be very difficult to calm and not know why they are angry. The children often know that their behaviour was inappropriate and feel remorseful but because of their injuries and poor control they may still repeat the behaviour.

The irritability and anger may have a significant impact on their relationships with family and friends. It can also impact on their rehabilitation and educational progression.

It is important to understand that the behavioural change is related to the brain injury and that whilst there may be improvement over time there may be lasting changes in the child's/young person's control of their behaviour and emotions. The environment may need to be changed to suit some of the child's/young person's needs but there are also some strategies that may assist to modify problem behaviours.

Where possible:

• Maintain routines and ensure plenty of rest. Fatigue exacerbates behavioural control problems;
• Listen to the child and adjust expectations. If a child is constantly pushed beyond their capabilities they will become frustrated;
• Be vigilant and redirect the child to alternate activities if they are becoming overwhelmed
• Remove them from the situation if necessary (eg. fighting with siblings)
• Try to remove triggers to agitation (eg. noise) and be aware of warning signs of frustration
• Try not to become angry with them, arguing and yelling tends to escalate the situation. It is also unhelpful to say the same thing over and over even though you hope it will eventually "go in". Your child is more likely to switch off.
• Set firm limits regarding unacceptable behaviour (eg "that is not OK. We won't be able to continue this if you yell at me".)
• Provide directed praise for appropriate behaviour (ie. "I really like the way you try things")
• Programmes can be designed to try and assist with anger management but will depend on the age and level of understanding of their behaviour and emotions. Advice regarding different management strategies for parents, carers and schools is available through members of the Brain Injury Team (eg psychologists).

There may be times where the behavioural problems are extreme and having a significant impact on the child's adaptation and progress. In these cases medication may be an option and would be discussed with the child's rehabilitation specialist.

Rehabilitation Department The Children's Hospital at Westmead Cnr Hawkesbury Rd & Hainsworth St, Westmead Locked Bag 4001, Westmead, 2145 Tel: (02) 9845 2132 - Fax: (02) 9845 0685 http://www.chw.edu.au/rehabilitation/