Responding to Challenging Behaviour Linked to Executive Dysfunction in ABI
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Challenging behaviour in acquired brain injury services is frequently linked to executive dysfunction affecting impulse control, emotional regulation and problem-solving. Without appropriate understanding, responses can become punitive or overly restrictive. Commissioners and inspectors expect ABI services to respond in ways that reflect neurological need.
This article focuses on responding to challenging behaviour linked to executive dysfunction. It should be read alongside Positive Risk-Taking & Risk Enablement and Quality, Safety & Governance.
Why executive dysfunction drives behaviour
Executive impairment reduces the ability to pause, reflect and adjust behaviour in the moment.
Risk of punitive responses
Punitive approaches increase distress and escalate behaviour.
Commissioner and inspector expectations
Expectation 1: Non-punitive responses. Inspectors expect behaviour to be managed supportively.
Expectation 2: Least restrictive practice. Commissioners expect restrictions to be justified and reviewed.
Operational example 1: Behavioural response frameworks
An ABI service developed clear frameworks for responding to executive-driven behaviour.
Using proactive strategies
Anticipation and prevention are more effective than reaction.
Operational example 2: Early warning indicators
Providers identified early indicators of escalation linked to cognitive fatigue.
Post-incident learning
Learning should focus on adjustment rather than blame.
Operational example 3: Behavioural review meetings
Teams reviewed incidents to refine proactive strategies.
Evidencing good practice
Providers should evidence:
- Clear response frameworks
- Reduced use of restrictions
- Improved behavioural outcomes
Behaviour support as neurological support
Understanding executive dysfunction transforms behaviour support outcomes.
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