Research Reports - Prevalence, comorbidities, and correlates of challenging behavior among community-dwelling adults with severe traumatic brain injury

J Head Trauma Rehabil. 2014 Mar-Apr;29(2)

Sabaz M(1), Simpson GK, Walker AJ, Rogers JM, Gillis I, Strettles B

OBJECTIVE: Investigate the prevalence, comorbidities, and correlates of
challenging behaviors among clients of the New South Wales Brain Injury
Rehabilitation Program.
SETTING: All community-based rehabilitation services of the statewide program.
PARTICIPANTS: Five hundred seven active clients with severe traumatic brain
injury.
DESIGN: Prospective multicenter study.
MAIN MEASURES: Eighty-eight clinicians from the 11 services rated clients on the
Overt Behaviour Scale, Disability Rating Scale, Sydney Psychosocial Reintegration
Scale-2, Care and Needs Scale, and Health of the Nation Outcome Scale-Acquired
Brain Injury.
RESULTS: Overall prevalence rate of challenging behaviors was 54%. Inappropriate
social behavior (33.3%), aggression (31.9%), and adynamia (23.1%) were the 3 most
common individual behaviors, with 35.5% of the sample displaying more than 1
challenging behavior. Significant associations were found between increasing
levels of challenging behavior and longer duration of posttraumatic amnesia,
increasing functional disability, greater restrictions in participation,
increased support needs, and greater degrees of psychiatric disturbance,
respectively (P < 0.004). Multivariate binomial logistic regression found that
premorbid alcohol abuse, postinjury restrictions in participation, and higher
levels of postinjury psychiatric disturbance were independent predictors of
challenging behavior.
CONCLUSIONS: Challenging behaviors are widespread among community-dwelling adults
with severe traumatic brain injury. Services need to deliver integrated anger
management, social skills, and motivational treatments.

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