ABI during childhood and adolescence [courtesy of BRÍ).
An acquired brain injury at any stage is a traumatic event. Having such an injury during the formative years of childhood and adolescence, however, represents a particular challenge both for the young person themselves and their families/carers.
For many years it was assumed that younger people did better after an acquired brain injury. This idea came from the ability of younger brains to compensate for damage through re-organisational processes.
While there is some evidence to support the greater capacity of the brain for repair following brain injury in children, there is increasing evidence to suggest that this is an over simplistic notion.
Essentially, when a child or adolescent has a brain injury, the insult is superimposed on a developing brain where basic skills, such as reading and social skills, may not have been laid down. Some of the resulting difficulties, known as ‘sleeper effects’ only emerge if the child matures and fails to reach developmental milestones in line with their peers. It has been hypothesised that children with certain injuries may ‘grow into’ the deficits acquired as a result of trauma.
Children with so called ‘mild’ ABI often have no physical deficits but can present with a myriad of problems such as poor attention and concentration problems with processing information and compulsive behaviour. Indeed, may of these children remain undiagnosed having been discharged from acute hospitals or later being misdiagnosed with ADHD and other such conditions.
A long-term perspective is required when assessing the impact of ABI on children. Transition from primary to secondary school, for example, when a young person is confronted with new challenges and increasingly more complex tasks is often a crisis point.
The implications in terms of service provision is that there needs to be specialist multi-disciplinary assessment services available at key developmental stages. The content and focus of any rehabilitation programme must be tailored in accordance with the child’s needs and abilities at a given point and time.
The issues for parents and siblings also change as difficult practical and behavioural challenges are presented to the family.
