Question: I am interested in whether to support Applied Behavior Analysis (ABA) for people who have suffered TBI. In the remote past I had some clinical experience with a few patients who responded well to ABA after TBI, focused on specific maladaptive behaviors that were barriers to them being able to live in the community. I’ve not, however, found research literature to support this.

Answer: I have worked with patients with TBI for many years and have found ABA to be one of the most effective approaches for reducing maladaptive behavior following brain injury. The key is having a staff that can implement the protocols/behavior plans consistently and staff to provide the structure and follow-through that the patient needs. It is not easy work but it does pay off. 

Recently, there have been articles published on the use of ABA in people with brain injury. An article by Levin (2016) discusses guidelines that France has established for treating neurobehavioral disorders following TBI. The one thing to keep in mind is that these studies are often single subject designs because not everyone has the same behavioral challenges following brain injury and each person's brain injury affects their behavior in a different way. These are great studies where the patient serves as their own control; but unfortunately, sometimes the scientific community does not give these types of studies enough credit because they are not randomized, controlled trials which we know is literally impossible to do with patients that have severe maladaptive behavior.

I would also like to alert you that the Brain Injury Association of America, in conjunction with Mt. Sinai are working to develop guidelines for treating behavior following brain injury. This group is focused on the chronic phase of brain injury (greater than one year post-brain injury) and will be coming out with their guidelines in the next few years. Here is the link to the website so you can follow their progress:


Question: My Brother, 49 now, survived a tbi. In 2007 a pole injected into the right temple area. He has lived with me for approximately one year now. As of yesterday l read an article on tbi and the right frontal lobe. My Brother is a miracle survivor. He seems to be normal when socializing with new people. However, when in the presents of family members He can be verbally abusive and create bizarre and untrue events. If asking him a question, he automatically gets defensive and verbally can make you feel terrible. He has never been physically violent. My question, Is there any known physical violence with any tbi survivors?

Answer: I am sorry to hear of your brother's accident. Unfortunately, sometimes individuals with TBI cannot control their emotions and can act impulsively which can result in physical violence in its extreme form. Do you think that your brother is even aware that he is acting this way towards your family? Many times injuries to the temporal and frontal lobes can damage the very structures of the brain that help us to understand our behavior and provide us with insight to our actions.


Question: My son has a TBI, from age 2.7 when he fell into a pool and almost drowned. He was in the hospital and Childrens rehabilitation center 72 days. He receives some school services such as speech, adaptive PE, OT. He's also in a SDC Class. He has been having horrible rages for last year. I put him in therapy but it's not specialized and I'm lost where to go from here. He has attacked me and his siblings. Any info will help.

Answer: I am sorry to hear of your son's accident and subsequent brain injury. Have you tried a behavior analyst? These are individuals that are board certified (usually a masters or a Ph.D. level) who are specially trained to deal with children that have challenging behavior due to injuries. The school system may be able to help set you up with these services. The behavior analyst will work with you and your son to figure out what is driving the behavior; how to reinforce the behaviors you want to continue (being polite, not hitting etc) and how to manage those behaviors that you do not want to continue (hitting, attacking, etc).


Question: I have no Libido now and this has strained my relationship with my Girlfriend. I also have Road Rage and other unexplained moods and anxiety that I did not have before.

Answer: I would suggest a endocrine workup that would include a thyroid panel (TSH, T3, T4), testosterone (free and total), Follicle stimulating hormone, Luteinizing hormone, insulin-like growth factor-1 and cortisol. This would rule out any endocrine/hormone issues that could be causing the low libido issues, as well as the mood issues.