Synapse - reconnecting lives

One of the most important differences between children and adults who acquire a brain injury is that a child's brain is still developing.

After a brain injury, rehabilitation for adults primarily focuses on helping them to relearn lost skills. However, in many cases a child has not learned many of the skills an adult takes for granted, so extra support is needed to ensure a child's development occurs as normally as possible.  

Predicting the degree of recovery

Predicting how much recovery will occur after a brain injury is always difficult, regardless of the cause - brain tumour, meningitis, encephalitis or traumatic brain injury. it becomes even more so for children as specific problems may only become apparent at certain stages of development. It is important to provide plenty of support to prevent the child lagging behind their peers in key areas.

Professionals used to think that younger children made a greater recovery due to neural plasticity - the ability of the developing brain to reorganize itself. Unfortunately this has been disproved and research suggests children are more vulnerable to a brain injury and will take longer to recover. 

In general, it appears that the earlier a brain injury occurs, the more impact it will have for the child. Recovery appears to be an easier process when basic functional skills have already been developed. However, a child's age only has a limited impact on recovery, and the key factors are still the severity and type of brain injury, how supportive the family is, and rehabilitation and support at school.

Effects of a brain injury

Sensory & motor skills: a child may either lose some previously acquired skills or may have difficulty learning new skills e.g. holding a pen, drawing, using a keyboard, constructing and manipulating objects, using cutlery, getting dressed, recognizing objects and a variety of other eye-hand coordination activities. Other problems may be balance, coordination or swallowing and speech difficulties. Professionals such as physiotherapists, occupational therapists and speech pathologists play an important role in the assessment and rehabilitation of sensory and motor disorders.

Cognitive abilities: a brain injury may lead to a general decline in a number of intellectual abilities. However, similar to adults, a child may be within the normal range on measures of intellectual functioning and yet display significant problems in specific areas of attention, memory, language, visuo-spatial and executive functioning. 

Language & communication: many children experience receptive problems which involve difficulty processing different parts of spoken or written information. Comprehension problems occur when a child cannot understand what he or she is reading or what another person is saying. Spoken or written language expression may be affected in terms of pronunciation, fluency, grammar, intelligibility or meaning and retrieval of words.

Social, behavioural & emotional issues: a child can experience difficulties relating to peers and siblings and have difficulty joining group activities. They can demand a lot of attention from parents or teachers, and have difficulty following rules and instructions. Behavioural problems include depressed or anxious mood, hyperactivity, distractibility, impulsivity, poor judgment, reduced control of anger and frustration, mood swings, aggression, sleep disturbance, and poor motivation. There are various rehabilitation strategies to assist with these issues, the earlier the better. 

Brain injury & your child's development

A brain injury can disrupt normal development in terms language and speech, learning, memory, behaviour, movement, balance and coordination. Children with a brain injury can often still make good progress, even if it is limited to some extent by the injury. Support and assistance tailored to each child's needs will definitely ensure they develop as to their fullest ability. This is especially true at school, where this often a tendency to underestimate the degree of support needed within the education system. 

Balancing risk & independence

One of the important things parents do is to help young people learn to manage and judge risk. It is important to encourage independence and allow a manageable element of risk, but a child's brain injury can cause problems with anticipating danger, judging risk, or showing self-control.

Research has shown that some of the most important factors that protect young people from getting involved in some of the riskier activities of adolescence are a strong and caring family and school, and a sense of connection to family and school, coupled with personal skills that enable the young person to develop self-esteem and confidence. Other things that help are a stable family structure, open lines of communication, a pro-active approach to solving problems, and having a good relationship with an adult outside the family-someone who believes in the young person.

Challenging behaviours

Challenging behaviours are a normal part of growing up as children test the boundaries, but these can be complicated by a brain injury but the fundamentals for responding appropriately are still largely the same. The best basis for helping your child is a loving, caring relationship, so try to see your child as separate from the behaviour - 'I love you, but I don't like what you're doing'.

Set specific rules and structures for particular situations, and rehearse these each time a similar situation is coming up. Structure and routine become even more important after a brain injury. Praise or reward behaviours you want to encourage but don't reward behaviours you don't want to see.

Help your child to learn from experience by talking over what he or she did right or wrong, and how there might be other ways of responding. Show your child, by your actions, how to handle difficulties and get along with others. Most importantly, young people with a traumatic brain injury or other type of brain disorder may need very concrete, detailed and explicit instructions and rules about what to do in particular situations. See our detailed facts about challenging behaviours for more information.