Current literature on sequelae of acquired brain injury reveals that behavioural
disturbances such as physical and verbal aggression and disinhibited behaviour present
a substantial barrier to community re-integration following severe brain injury. This
study applies the concept of 'challenging behaviour', originally applied to people with
learning disabilities, to behavioural disturbance following acquired brain injury.
Definition of challenging behaviour, assessment, intervention, and impact on carers are
discussed. Standardised measures of challenging behaviour are reviewed.
The study has two aims. Firstly, to investigate the degree of shared understanding of the
concept of challenging behaviour within a group of staff working in a specialist unit for
people with behavioural disturbances following acquired brain injury. Twenty-eight
members of staff (21 nurses and 7 other professional staff) completed questionnaires,
consisting of four brief case vignettes. Each vignette was rated on five-point scales for
important defining aspects of challenging behaviour: overall management difficulty,
threat to the physical safety of the patient and others, and impact on the patients' access
to community facilities. Results were analysed for agreement between raters, taking
consideration of demographic variables.
Secondly, the usefulness of screening measures in application to challenging behaviour
was evaluated within the same unit. The measures chosen were the Agitated Behaviour
Scale (Corrigan 1989) and the Checklist of Challenging Behaviour (Harris et. al. 1994).
Three members of staff (2 trained nurses and one other member of therapeutic staff)
rated each patient's behaviour during the preceding week. A total of 22 patients were
assessed, some on more than one occasion, and results examined for inter-rater
reliability and concordance with clinical records. In addition, the behavioural profile of
this clinical population is delineated. The application of standardised screening
measures in general to challenging behaviour, methodological issues and future research
implications are discussed.