Overt Behaviour Scale

Date of completing OBS

Rater’s name

Client’s name / identifier

Informant’s name

Informant’s role (e.g., spouse)

Challenging behaviours How to use this scale

Behaviours can be challenging or problematic For each of the 9 categories of behaviour there is
if they are disruptive, make the client or other a heading (e.g., verbal aggression) and a relevant
people uncomfortable, or go against the rules of subscale. If your client exhibits no sign of that
community living. Such behaviours lead to distress category of behaviour, mark the “no” box and go to
or can disrupt things like social relationships and the next behaviour.
continuance of services. They can also result in
If your client does show this type of behaviour
significant financial cost to the service system.
you need to complete the subscale. Here you
What is this scale for? can indicate more clearly what sort of behaviour
occurs. Under each heading there are a number of
This scale is designed to clarify the types of behaviour descriptions with realistic examples that
observable challenging behaviours that can occur correspond to increasing levels of severity (shouting
following acquired brain injury (ABI). This can help is low severity, threats are more severe). Tick each
to show how behaviours may have changed over of the types of behaviour observed and rate how
time and can inform decisions related to clinical frequently they occur and the impact that they have.
interventions. This scale can also be used to
measure the frequency of challenging behaviours If a behaviour appears to fit 2 categories, use the
and the impact that they have on people living and/ single most appropriate one. See the Administration
or working with the client (including family members Guidelines for further information.
and service providers).
Timeframe
What does this scale measure? This scale represents behaviour that has occurred
There are 9 categories of behaviour that can be over the most recent 3 months.
scored on this scale; they are:
More information
• Verbal aggression
Developmental and psychometric information
• Physical aggression against objects,
regarding the OBS has been published in Kelly,
• Physical acts against self
Todd, Simpson, Kremer, & Martin (2006). The
• Physical aggression against other people
Overt Behaviour Scale (OBS): A tool for measuring
• Inappropriate sexual behaviour
challenging behaviours following ABI in community
• Perseveration / repetitive behaviour
settings. Brain Injury, 20(3), 307 – 319.
• Wandering / absconding
• Inappropriate social behaviour
• Lack of initiation
Administration guidelines are available at
This scale enables you to score the severity,
www.abibehaviour.org.au
frequency, and impact of each behaviour.

ABI Behaviour Consultancy Page 1 of 7

 How to rate behaviours
Tick each level that is a problem Impact (distress or disruption)
For each category of behaviour there are a number “Impact” means the amount of emotional distress
of descriptions with examples that illustrate and/or practical disruption that a challenging
different levels of severity. Select the level(s) with a behaviour causes. For example, impact refers to
description or example that best represents the your experience of stress, worry, concern, or fear as
sorts of behaviour(s) that you have observed by a result of the behaviour. But impact can also refer
placing a tick ( ) in this column. to practical difficulties including needing additional
staff, altered procedures, dealing with complaints
Remember, these behaviours are only examples; from families or other residents, or having to acquire
if you have seen behaviours that are similar, but are additional supports such as psychiatrists, police, or
not exactly the same, then tick this description. behaviour intervention. Disruption often translates
into additional costs.
Frequency
Rate how much this behaviour impacts upon
Rate how frequently the behaviour occurs using a
yourself and/or other people by using a number
number from 1 to 5 with the following definitions:
from 1 to 5 and the following definitions:
1 = less often than once per month
1 = no impact
2 = once a month or more
2 = minor impact
3 = once a week or more
3 = moderate impact
4 = once a day
4 = severe impact
5 = multiple times each day
5 = extremely severe impact

VERBAL AGGRESSION
Has the client shown any
Frequency Impact
verbal aggression?
Levels 1 = < 1/month 1 = no impact
Tick each 2 = 1/month or more 2 = minor
NO (go to next behaviour) level that is 3 = 1/week or more 3 = moderate
a problem 4 = 1/day 4 = severe
YES (rate the subscale below) Severity ( ) 5 = multiple daily 5 = extreme

Makes loud noises, shouts angrily,

is clearly not directed at some other
person (e.g., “bloody hell!”).
1
Makes mild personal insults clearly
directed at some other person but
does not include swearing/offensive 2
sexual comments (e.g., “You are
stupid!”, “idiot”.).

Swearing, use of foul language,

moderate threats clearly directed
at others or self (e.g., “F*** off 3
you bastard!”).

Makes clear threats of violence

directed towards others or self
(e.g., “I’m going to kill you!” or “I’m
going to finish myself!”) or requests
help to control self (i.e., expresses 4
anxieties that they will engage in
aggressive act beyond own control
unless someone make some immediate
intervention). This includes suicidal
threats.

ABI Behaviour Consultancy Page 2 of 7

PHYSICAL AGGRESSION
Frequency Impact
Levels 1 = < 1/month 1 = no impact
Tick each 2 = 1/month or more 2 = minor
level that is 3 = 1/week or more 3 = moderate
a problem 4 = 1/day 4 = severe
Severity ( ) 5 = multiple daily 5 = extreme

Physical aggression
against objects
Has the client shown any physical aggression against objects?
NO (go to next behaviour)

YES (rate the subscale below)

1
Slams doors, scatters clothing, makes a mess
in clear response to some antecedent.
Throws objects down (without some other person
at risk of being hit by the object), kicks furniture
without breaking it, marks the wall.
2
Breaks objects, smashes windows.
Sets fire, throws objects dangerously
3
(i.e., some other person is at risk of being hit by the
object(s) thrown but is not actually hit) If the object
thrown does hit someone score this as Physical
4
aggression against other people.

Physical acts
against self
Has the client shown any physical acts against self?
NO (go to next behaviour)

YES (rate the subscale below)

Picks or scratches skin, hits self, pulls hair 1
(with no or minor injury only).
Bangs head, hits fist into objects, throws self
onto floor or into objects (hurts self without serious
2
injury).
Inflicts small cuts or bruises, minor burns to self. 3
Mutilates self, causes deep cuts, bites that bleed,
internal injury, fracture, loss of consciousness,
loss of teeth. This includes suicide attempts.
4
Physical aggression
against other people
Has the client shown any physical aggression against other people?
NO (go to next behaviour)

YES (rate the subscale below)

Makes threatening gesture that is clearly directed
towards some other person, swings at people,
grabs at clothes.
1
Strikes, kicks, pushes, pulls hair (without significant
injury) to person(s) aggression directed at. 2
Attacks others, causing mild-moderate
physical injury (bruises, sprain, welts) to
person(s) aggression directed at. 3
Causes severe physical injury (broken bones,
deep lacerations, internal injury) to person(s)
aggression directed at.
4

ABI Behaviour Consultancy Page 3 of 7

INAPPROPRIATE SEXUAL BEHAVIOUR
Has the client shown any
Frequency Impact
inappropriate sexual behaviour?
Levels 1 = < 1/month 1 = no impact
Tick each 2 = 1/month or more 2 = minor
NO (go to next behaviour) level that is 3 = 1/week or more 3 = moderate
a problem 4 = 1/day 4 = severe
YES (rate the subscale below) Severity ( ) 5 = multiple daily 5 = extreme

Sexual talk
Comments of a sexual nature (e.g., “I’ve
got a big dick”, “I want to make babies
with you”, “You’ve got nice tits”, “I could
give you a good time”) where comments
may be face-to-face or in the form of 1
phone calls or letters. Explicit accounts of
sexual activities (e.g., “When I am with a
woman I like to ... .”).

Touching (non genital)

Touching other people who do not want to
be touched (but contact does not involve
genitals). For example kissing hand or
arm, putting arm around shoulder, patting 1
someone’s knee, rubbing or caressing
arm or leg or back. Also includes touching
clothing (e.g., lifting skirts).

Exhibitionism
“Flashing”, exhibiting genitals, undressing in
public. Failing to dress (e.g., walking about
house without clothes on when coresidents
could be or are present. Answering door
2
when naked).

Masturbation
Masturbation in a public or shared setting
when other people are in the area
(e.g., masturbating in a car in a public
carpark where passers by may see; 2
masturbating in a common area in a
supported residential setting).

Touching (genital)
Touching (or making attempts to touch)
other people’s breasts, buttocks, or genitals
(e.g., groping staff who walk by, fondling
breasts of support workers, pulling other’s
3
hands toward own groin).

Coercive sexual behaviour,

Rape
Attempt to forcibly undress another person.
Use of threat to obtain sex.
Sexual penetration of another person who 4
has not consented.

Victim details can be noted here

(The legal consequences of inappropriate sexual behaviour can differ depending on the sex and age of the victim.)

ABI Behaviour Consultancy Page 4 of 7

PERSEVERATION / REPETITIVE BEHAVIOUR
Has the client shown any
Frequency Impact
perseverative behaviour?
Levels 1 = < 1/month 1 = no impact
Tick each 2 = 1/month or more 2 = minor
NO (go to next behaviour) level that is 3 = 1/week or more 3 = moderate
a problem 4 = 1/day 4 = severe
YES (rate the subscale below) Severity ( ) 5 = multiple daily 5 = extreme

Engages in prolonged continuation and

repetition of a behaviour that has not
resulted in physical harm (e.g., continued,
persistent tapping, writing same letter over 1
and over, unrolling entire toilet roll, asking
the same question repeatedly: “do you
watch the Bill?”, “Will you marry me?”).

Engages in prolonged continuation and

repetition of a behaviour that has resulted
in minor physical harm (e.g., continued,
persistent touching, rubbing, or scratching
2
leading to skin irritation; remaining in
shower until skin is shriveled ).

Engages in prolonged continuation

and repetition of a behaviour that has
resulted in serious harm (e.g., continued,
persistent eye rubbing; riding an exercise
3
bike and only stopping upon exhaustion).

WANDERING / ABSCONDING
Has the client shown any
Frequency Impact
wandering/absconding?
Levels 1 = < 1/month 1 = no impact
Tick each 2 = 1/month or more 2 = minor
NO (go to next behaviour) level that is 3 = 1/week or more 3 = moderate
a problem 4 = 1/day 4 = severe
YES (rate the subscale below) Severity ( ) 5 = multiple daily 5 = extreme

Going into areas that are prohibited but

where there no or low risk of harm (e.g.,
entering other resident’s rooms, staff 1
areas, kitchen).

Leaving the familiar, ‘safe’, environment

when there is a good risk of becoming lost
or seriously harmed (e.g, nursing home
resident attempting to return to family 2
home, walking onto freeways, needing to
be located/recovered by police).

Escapes secure premises (e.g., through

a doorway left open, by using security
door codes, by climbing over fence). May
physically resist attempts to stop such 3
escape (e.g., wrestles with or pushes staff
who attempt to stop or restrain them).

ABI Behaviour Consultancy Page 5 of 7

INAPPROPRIATE SOCIAL BEHAVIOUR
Has the client shown any
Frequency Impact
inappropriate social behaviour?
Levels 1 = < 1/month 1 = no impact
Tick each 2 = 1/month or more 2 = minor
NO (go to next behaviour) level that is 3 = 1/week or more 3 = moderate
a problem 4 = 1/day 4 = severe
YES (rate the subscale below) Severity ( ) 5 = multiple daily 5 = extreme

Socially awkward
Inappropriate laughter. Failure to monitor
personal hygiene (e.g., does not shower
regularly). Excessive apologising or thanking.
Standing too close to strangers. Failure
1
to pick up on nonverbal cues (that others
are bored, the joke was not funny, the
conversation is over).

Nuisance / annoyance
Interrupts other people’s conversations.
Actively does things to seek attention (e.g.,
spills food, rings buzzer, “Nurse, can you
come here?”). Inconsiderate of other people
(e.g., hogging TV channel or remote control).
Nagging, impatient (e.g., always wanting
something else to be done; can not tolerate
2
waiting for supermarket queues). “Butts in”
to other people’s affairs (e.g., advising staff/
management on how to improve residence,
reporting on other clients’ activities).

Noncompliant / oppositional
Responds “no!” to prompts to do things.
Refuses to discuss problem behaviours with
staff. Will not follow toilet or shower routines.
Refuses to take medication. Rejects or
dismisses service providers who are helpful
with home care. Intentional lying that is not 3
due to poor memory (e.g., denying drug use
or stealing; fabricating stories to cover tracks).
Will not (as opposed to Can not) follow rules.
(e.g., leaving without telling someone where
s/he is going).

Petty crime or Unlawful behaviour

Driving while unlicensed. Fraud (e.g., writing
dishonoured cheques). Obtains goods by
theft or deceit. Stealing (e.g., steals cigarettes 4
from other residents, steals clothes or food
from shops; materials from building sites).

Presents a danger/risk to self or others

Lights fires dangerously. (e.g., smoking in bed,
starting bonfire near gas cylinder). Crosses
road without evaluating traffic. Wheeling
wheelchair in middle of road.
Climbs ladders when perception and / or 4
balance impaired. Excessive use of alcohol,
cigarettes, or other substances where that
is the key behaviour leading to risk or actual
harm to self or others. Uses provision of sex
to gain access to goods (such as money,
cigarettes, drinks) or services.

ABI Behaviour Consultancy Page 6 of 7

LACK OF INITIATION
Explanation
This behaviour is different from the others because it is a lack of overt behaviour.

The person has difficulty getting tasks started or completed and is characterised as having a lack of motivation,
initiative, or interest in day-to-day activities.

Examples
• The person may not wash, eat, or drink, shower or groom themselves without prompting from others.
They may sit on the couch all day, not initiate social conversation or attend social activities without
someone taking them.

• However, the person may engage in activities if someone else prompts them. Once asked to “wash the
dishes”, the person may then commence and complete the task.

• Some people need more prompts: they might only wash dishes and then need another prompt for cutlery:
“okay, you’ve finished the plates, what about the cutlery”?

• In severe cases, a person may not eat despite having a meal placed in front of them or fail to wash himself
or herself even if standing under the shower. They would require constant prompts such as “put some soap
on the washer, soap up your arms, now rinse etc”.

Has the client shown any Severity

lack of initiation? i.e., Amount of
prompting required Impact
Levels 1 = less than once/day 1 = no impact
Tick if lack 2 = approx. once/day 2 = minor
NO of initiation 3 = more than twice/day 3 = moderate
is a problem 4 = many times/day 4 = severe
YES (complete scoring this item) ( ) 5 = all tasks, everyday 5 = extreme

SCORING
The OBS produces 3 key indices: Cluster, Total Levels, and Clinical Weighted Severity.

Cluster
Sum the number of YES boxes ticked. Range: 0 to 9

Total Levels
Sum the number of Levels boxes ticked. Range: 0 to 34

Clinical Weighted Severity (CWS)

Sum the severity numbers associated with each level ticked.
For Lack of Initiation, use the Severity/prompting score. Range: 0 to 84

Note.
The two other measures, frequency and impact, do not form the structure of the scale, but rather provide
additional clinical data.

ABI Behaviour Consultancy Page 7 of 7