Traumatic Brain Injury

a young lady hugging another sitting in a wheelchair holding a laptopTraumatic brain injury (TBI) is caused by an impact to the head, or rapid movement or displacement of the brain within the skull. It can also be called “acquired brain injury” or “head injury”. Children may sustain mild to severe traumatic brain injuries from abuse and/or accidents. Children with TBI may show developmental delays, poor academic performance, and possible delays in social development. Brain injuries may also cause physical, cognitive, emotional, and communication disabilities. Some children develop long-term medical complications such as seizure disorder.

Symptoms vary depending on the extent and location of the brain injury, but the greatest challenges to children with TBI are changes in their ability to think, learn, remember, and interact socially. Symptoms of TBI in children and adults are similar, but a brain injury can actually be more devastating for children than adults because their brains are continuing to develop. In addition, the impact of a brain injury may only become apparent as the child gets older and learning becomes more complex.

(Adapted from Brain Injury Association of America; American Speech-Language-Hearing Association; and American Psychiatric Association, 2013.)

What You Might Notice

Traumatic brain injuries can range from mild to severe and can impact physical, cognitive, communication, and social-emotional functioning. Symptoms can include:

Physical Impacts

      • Problems speaking, seeing, hearing, smelling, tasting, and touching
      • Sleep disturbances
      • Headaches and fatigue
      • Trouble writing and drawing
      • Spasticity—muscles suddenly contracting or tightening
      • Difficulties with balance and walking, tinnitus, vertigo, and dizziness
      • Paralysis on one or both sides and seizure disorders

Cognitive Impacts

Difficulty with:

      • Memory, concentrating, focus (may only be able to focus for a short time)
      • Reading, writing, planning, judgment
      • Understanding the order of events
      • Understanding non-verbal communication and social cues
      • Communication skills—speaking or understanding spoken language
      • Learning—the ability to process information can be slowed

Social/Emotional Impacts

  • Mood swings, anxiety and depression; the child may be restless or laugh and cry a lot
  • Aggression, suspiciousness, trouble relating to others
  • Lack of motivation or control over emotions; easily frustrated
  • Increase in risk taking and impulsivity

After a TBI, caregivers may notice these symptoms in children:

  • Seizures
  • Dizziness or confusion
  • Change in personality
  • Change in nursing or eating habits
  • Becoming upset easily or increased temper tantrums
  • Sad or lethargic mood
  • Lack of interest in favorite toys

(The above section adapted from Brain Injury Association of America & Center for Parent Information and Resources.)

Before Meeting the Child

  • Consult with audiologist or speech therapist if the child has a communication disability.
  • Consult with teachers, family members, therapists, and the child’s Individual Education Plan (IEP) about the extent of the TBI and its impact, and adaptive methods the child uses to function in daily life.
  • Adapt questions for children with memory issues.
  • If fatigue is an issue, find out when the child is most rested and schedule the interview accordingly.

During the Meeting

Attention

If the child shows reduced concentration, attention, or focus, try to:

  • Meet when the child tends to be more alert.
  • Have shorter, more frequent meetings.
  • Limit distractions (both visual and verbal) by meeting in a quiet environment.
  • Focus on one topic during each meeting, if possible, or focus on one topic at a time.
  • Encourage the child to rephrase what you said to check comprehension.
  • Modify any written material so that it is concise and to the point. Ask the child to read the material out loud to make sure they can read and understand.
  • If you are not sure the child understood the question, ask them to summarize.
  • Use words to alert the child, such as listen, look.

Processing Speed

If the child has difficulty in processing information, speaking, or writing:

  • Speak slowly and check in to see if the child understands your question.
  • Frequently repeat and summarize information.
  • Allow additional time for the child to answer.

Communication

If the child has difficulty with speech, finding the right words, naming objects, or has disorganized communication, help the child stay on topic by bringing the focus back to the original question.

When possible, include yes/no or structured formats.

Learning and Memory

If the child has problems with immediate memory, short-term, and/or long-term memory storage and recall, as much as possible, keep meetings short.

Be consistent.  Whenever possible, meet on the same days in the same place and at the same time.

Be as concrete and concise as possible when talking with the child.

Emotional/Behavioral Changes

If the child is depressed, anxious, has a poor tolerance for frustration, is showing impulsivity, does not recognize social cues, or is restless or irritable:

  • Be reassuring and provide structure to minimize anxiety.
  • Recognize that a lack of emotion may not indicate a lack of interest.
  • Suggest breaks if the child becomes irritable or agitated.
  • Establish an agenda and follow it.
  • Avoid discussion when the child is fatigued or over-stimulated.
  • Be flexible if the child is resistant. Confrontation can shut down thinking and make the child rigid.
  • Be direct and clear about what you are asking.

Physical Changes

If the child has headaches, dizziness, sleeping problems, fatigue, sensitivity to noise, nausea, problems with balance, or sluggishness, keep the environment as quiet as possible, keep noise and lights to a minimum, and keep sessions shorter.

(The above section was adapted in part from P. Campbell, personal communication, November 8, 2005; Campbell, Fawber & Pramuka, 2001; Johnstone-Smith, 2004; Ohio Valley Center for Brain Injury Prevention and Rehabilitation, n.d.; all as cited in SAFE, 2007.)

Investigation

If you suspect a TBI, arrange for a medical examination, if it has not already happened.

The child may not have a documented history of trauma. In some cases, parents or other caretakers may not report a history of TBI, because they were not aware of it or because they are hiding it. Be cautious: If a child with TBI from abuse is returned to a violent home, they are at high risk of being hurt again or killed.

(Adapted in part from Brain Injury Association of America.)