There is a range of executive functioning impairments which is likely to have a significant impact on behaviour.

Apathy and lack of motivation can result in the person being unwilling to carry out basic activities of daily living, co-operate with necessary care procedures and therapy. There may be a decreased motivation to engage in social pursuits, leisure and work. Putting pressure on the person to engage in activities, care and therapy etc may result in challenging behaviour being displayed.

Reduced Insight i.e. impaired awareness and understanding of the consequences of the brain injury, the extent of impairments and the implications for everyday life (e.g. need for care, inability to live independently, inability to return to work.  Reduced insight can contribute to the development of behavioural difficulties for the following reasons:

  • The person with reduced insight is more likely to become upset and angry by restrictions placed upon them and by the demands other people may place upon them (e.g. need to cooperate with care/treatment).
  • The person may become irritated and confused by carers offering assistance (e.g. the person believing that they are able to carry out daily tasks independently), by therapists offering rehabilitation, by family members trying to be supportive.
  • The person may lack insight into the consequences of their behavioural difficulties both in the short and long term. Therefore they may impulsively react in a challenging manner, but with no awareness or thought for the impact of the behaviour. This may result in increasing restrictions being placed upon them, for the safety of themselves and others, which in turn may lead to an escalation in behavioural difficulties.

Reduced impulse control means that the person tends to act impulsively.  This is frequently associated with reduced patience and tolerance. Reduced impulse control may present as the person being observed to be quick to lose their temper, often resulting in impulsive angry/aggressive outbursts.  The person may appear to over-react in the context of what appears to be little or no provocation (e.g. noise, reasonable requests, attempts to provide care, boredom etc).

Disinhibited behaviour is characterised by a range of behaviours from the relatively trivial to the potentially extremely inappropriate and possibly associated with risk. Examples include:

  • Displaying an over-talkative communication style.
  • Acting in an overly friendly and an overly familiar manner (including with strangers).
  • Asking over personal questions.
  • Invading another person’s personal space including physical contact which the other person finds socially uncomfortable (e.g. inappropriate touching, hugging).
  • Shouting, swearing and being verbally abusive.
  • Behaving in an aggressive manner.
  • Behaving in a sexually disinhibited manner (in word or action).

Reduced empathy means that the person struggles to view things from other people’s perspective, understand the impact of their actions upon others and to care about this.  They may struggle to demonstrate compassionate, caring and thoughtful behaviours. Reduced empathy may result in the person being only able to act and respond in terms of their own needs, particularly their immediate needs and impulses. This means that when the person feels that their demands/impulses are not met or they are being thwarted, then they are more likely to respond with unhelpful behaviours including the use of blunt language, swearing, verbal abuse and aggressive outbursts.

Lack of concern for social rules may present with a reduced ability to make appropriate social judgements and behave in a socially appropriate manner in certain situations. High levels of stress, anxiety and confusion as well as reduced tolerance for noise and high levels of stimulation tend to exacerbate this problem. Behavioural difficulties may therefore be observed in busy, noisy social environments e.g. restaurants, pubs, supermarkets, shopping areas, train stations etc.

Impairments in problem solving, reasoning, judgement, planning and organising may affect the person’s ability to make appropriate decisions about how to act in a range of different situations. Therefore the person may present with behavioural difficulties rather than being able to consider and implement a range of more helpful constructive behaviours. Additionally, these cognitive impairments may result in the person being unable to consider and evaluate the full consequences of their actions, both for themselves and others.