After a brain injury, a child or adolescent may have less ability to control their own behaviour and may say things or behave in a way that is inappropriate, unsuitable or unacceptable. The child or adolescent is not always aware that their behaviour is inappropriate.

What is disinhibited behaviour?

During development, children learn to hold back certain responses and behaviours that are not appropriate for a situation. After a brain injury, if the part of the brain that helps a child to control their behaviour is damaged, the child may say things or behave in ways that are not acceptable. Sometimes children, and particularly adolescents, may behave in ways that seem inappropriate to others. But a brain injury can make the scale of the problem larger, and it can make it harder for children to realise or understand they may be doing something inappropriate.

Examples of inappropriate behaviour:

• saying things that are tactless and socially inappropriate (swearing)
• overly friendly and affectionate to strangers
• making inappropriate sexual advances or engaging in other sexualised behaviour inappropriately (eg. masturbating in the lounge room)

What strategies might help?

• If the child swears or shows inappropriate behaviour, quietly redirect the child using brief explanations to suggest how to act more appropriately.
• Provide praise and attention in response to appropriate behaviour.
• If the child has an outburst, move away from the source of frustration and if possible offer an alternative activity.
• Role playing may be useful to teach appropriate behaviour.
• Ensure a consistent approach is being used by family and at school.
• Be aware of triggers that may have led to previous outbursts.
• Establish clear rules and make sure your child understands them, the consequences of breaking them, and also the rewards for complying with them.
• Offer alternatives and reinforce their use, such as a more appropriate or acceptable place to engage in the behaviour, or a more appropriate and acceptable response to a situation.

When to see a doctor?

If inappropriate behaviour happens a lot and is affecting the family, referral to a clinical psychologist may be recommended. The clinical psychologist can develop individual strategies to change and cope with the child's disinhibition. A program would usually involve ways to develop alternative responses and consequences for problem behaviours.

Key points to remember

• After a brain injury, your child may have less ability to control their own behaviour.
• They may say things or behave in ways that are not acceptable. However, they are not always aware that their behaviour is inappropriate.
• If behaviours occur frequently and are impacting on the family, referral to a clinical psychologist may be recommended.

For more information

• The Royal Children's Hospital
  Paediatric Rehabilitation Service
  T: (03) 9345 9300
  E: rehab.service@rch.org.au
• The Children's Hospital at Westmead Brain injury Service
• Kids Health Info series of factsheets listed under 'Brain injury.'

Developed by The Royal Children's Hospital Paediatric Rehabilitation Service based on information from the Brain Injury Service at Westmead Children’s Hospital. We acknowledge the input of RCH consumers and carers.

Reviewed September 2020.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.