A wide variety of factors may influence the presentation of executive functioning impairments. A person may appear to have no problems and manage tasks and challenges on one occasion but then struggle on another occasion due to finding the demands of the task too difficult. At times, this may result in the person potentially exhibiting behavioural difficulties.
This variability in performance in the context of executive functioning impairments may be due to the influence of a number of factors including:
- Emotional factors i.e. emotional lability, depression, anxiety, irritability, agitation
- Frustration in the context of difficulty adjusting to disabilities subsequent to brain injury.
- Sleep disturbance and fatigue.
- Physical health issues e.g. infection, dehydration, nutritional deficiencies, endocrine problems, sodium balance.
- Disorientation and confusion arising from cognitive problems.
- Boredom arising from the inability to initiate self directed activity, apathy and reduced motivation. Frequently there is a lack of a normal range of opportunities to engage in activity within hospital, rehabilitation and care settings.
- Environmental factors e.g. noise, high levels of stimulation, temperature, living with other people with brain injuries.
- Unable to get out and about.
- Carer approach. A particular type of approach may work well with one brain injured person but not with another. Lack of a consistent approach to the management of care procedures may result in anxiety, confusion, distress and potentially challenging behaviour.
- Some basic everyday tasks, communicative and cognitive demands may be challenging for the person, often leading to them feeling overwhelmed, stressed and anxious.
