title: Prevalence, comorbidities, and correlates of challenging behavior among community-dwelling adults with severe traumatic brain injury: a multicenter study.
abstract: OBJECTIVE
  Investigate the prevalence, comorbidities, and correlates of challenging behaviors among clients of the New South Wales Brain Injury Rehabilitation Program.
  
  
  METHODS
  All community-based rehabilitation services of the statewide program.
  
  
  METHODS
  Five hundred seven active clients with severe traumatic brain injury.
  
  
  METHODS
  Prospective multicenter study.
  
  
  METHODS
  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.
authors: Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital (Drs Sabaz and Simpson), Rehabilitation Studies Unit, Sydney School of Medicine, University of Sydney (Dr Simpson), Westmead Brain Injury Rehabilitation Unit, Westmead Hospital (Dr Walker), Australian Catholic University (Dr Rogers) School of Psychiatry and Black Dog Institute, Faculty of Medicine, University of New South Wales (Ms Gillis), and Agency of Clinical Innovation (Ms Strettles), Sydney Australia.
authors: Mark
authors: M
authors: Sabaz
authors: Grahame K
authors: GK
authors: Simpson
authors: Alexandra J
authors: AJ
authors: Walker
authors: Jeffrey M
authors: JM
authors: Rogers
authors: Inika
authors: I
authors: Gillis
authors: Barbara
authors: B
authors: Strettles
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000374:Aggression; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology* / Q000523:psychology* / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003153:Community Health Services / Q000379:methods*; D015897:Comorbidity; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D057187:Independent Living; D015601:Injury Severity Score; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000503:physiopathology; D008875:Middle Aged; D020380:Needs Assessment; D009483:Neuropsychological Tests; D009517:New South Wales / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012919:Social Behavior; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult