Descriptive analysis of challenging behaviours shown by adults with acquired brain injury

Abstract

The neurorehabilitation field has been slow to embrace the practice of functional analysis prior to behavioural intervention. In this study we employed a descriptive functional assessment using continuous recording techniques facilitated by observational software. The aim was to explore whether challenging behaviours shown by nine ABI survivors were socially mediated. Analyses appraised the likelihood of challenging behaviours and environment events occurring concurrently and in sequence to test if a mutual social reinforcement hypothesis was applicable. All nine participants exhibited at least one behaviour that was socially reinforced. Across all participants, 88% of challenging behaviours showed a significant concurrent association with an environmental event. A demand escape function was identified for 13 behaviours and an attention maintained function in 13 cases. The complete behavioural repertoire of three participants served the same function. Five participants presented challenging behaviours with multiple functions. Only 8% of the concurrent analysis results were not explicitly corroborated by the sequential analysis. The findings indicate that challenging behaviours shown by these nine ABI survivors adhered to a social model of reinforcement and were functional. It is suggested that formal functional assessments within the field of neurorehabilitation may lead to better treatment outcomes.

Keywords:

• Brain injury
• Challenging behaviours
• Descriptive analysis
• Functional assessment
• Observation

Acknowledgments

This study was jointly funded by the University of Birmingham, UK, and St. Andrew's Healthcare, Northampton, UK. The following people carried out the role of the second observer: Inga Stewart (in relation to participants 1 and 2), Jenny Churchley (in relation to participants 3, 4, 5, 6, 7, and 8), and Louise Birkett-Swan (in relation to participant 9). The authors are greatly appreciative of their invaluable assistance and enthusiastic support.