Parent's Guide - Your Child's Development - Fact Sheet

A brain injury can disrupt the long and complicated process to move from childhood through to being a mature adult.

• Increasing ability to handle complex ideas
• Growing ability to concentrate and to remember what is learned
• Increasing physical and social independence—for example, coming to rely increasingly on peers as well as family members for opinions and social contact
• Growing physical abilities, stamina, strength and coordination
• Increasing self-awareness and a growing sense of who they are as an individual person (a sense of identity)
• Growing ability to express negative feelings and frustrations in words, rather than physically.

HOW ACQUIRED BRAIN INJURY AFFECTS DEVELOPMENT

Direct and indirect effects

Direct effects of an Acquired Brain Injury often involve social, intellectual and language development. They might, for example, affect abilities such as getting organised, controlling impulses, learning new skills or remembering things. Many young people with Acquired Brain Injury also have slowed reactions and weakness in some parts of the body, which may affect what they can do and take part in, and their self-image. People with a severe injury may also have major physical problems that affect their ability to move about, care for themselves, and communicate.

Indirect effects result from the way the young person and others respond to the direct effects. These can include loss of confidence, changes in behaviour, social isolation, frustration, emotional problems and low self-esteem. Acquired Brain Injury is not widely understood and some people may confuse it with mental illness or intellectual disability.

If there are no visible signs of having acquired a brain injury then a child’s behaviour can be easily misunderstood.

Cognition

Generally, ‘cognitive’ (that is, thinking or intellectual) skills are most affected. It is often harder for young people with Acquired Brain Injury to remember things, harder to concentrate, work logically through a process that involves a number of steps, or manage several things at the same time. They may also have some physical issues, for example, slower reaction times and poorer coordination than before the Acquired Brain Injury.

These difficulties don’t just affect school work. Because thinking skills play a large part in getting along with others, social interactions can be changed. People with Acquired Brain Injury may also have a tendency to be impulsive, irritable, even aggressive, and this can affect relationships.

The myth of the resilient brain

It used to be thought that younger children were more resilient and ‘bounced back’ after a brain injury. But as children develop and grow, they build up an ever-increasing ‘bank’ of memory, learning, knowledge, language and life skills – the younger the child when the Acquired Brain Injury occurs, the smaller is the bank of stored learning. The young child has less to draw on.

This makes good recovery and adjustment more challenging. Effects of the injury may continue to appear over years, as the child’s brain matures and is challenged to learn new and more complex tasks and skills.

HOW TO ASSIST YOUR CHILD’S DEVELOPMENT

If children with Acquired Brain Injury are to achieve the best results possible – in overcoming and/or adjusting to their difficulties – it is essential that they have assistance and support designed to meet their particular needs. Helping the young person to deal with and/or overcome these effects can involve:

• Taking special care to teach him or her the necessary skills; and/or
• Concentrating on finding ways around the problem – ‘compensating’ for it.

The best approach will vary from person to person, and problem to problem. Professionals with experience working young people with Acquired Brain Injury can provide advice. The key to success is to identify the nature of the difficulties, and to deal with them before the young person becomes discouraged and loses confidence. Young people with Acquired Brain Injury need lots of opportunities to practise skills that others learn more easily.

Assessment

The first and essential step is to obtain a clear and accurate assessment of all the young person’s abilities and difficulties—whether the brain injury has just occurred, or there are worrying symptoms months or years after the event. Assessment is the basis for planning a specific program to build on the young person’s strengths and address their particular needs, and set short-term and longer-term goals.

Setting goals

This planning and goal-setting should always be a team effort, with the young person, the family, and the professionals involved – a partnership that works to find the best ways of meeting each young person’s needs, and the needs of the family as a whole.

The program needs to be tailored to your child’s and your family’s priorities and circumstances, to build on your particular strengths and skills. It needs to help you and your child adapt positively to the way things are now, and to foster your child’s learning and independence.

In the first six months after an Acquired Brain Injury, recovery is at its fastest although progress may continue for years in cognition, language, physical skills, behaviour, emotional and social skills.

Re-assessment and planning, both formal and informal, therefore need to continue often over years, to track the young person’s development and progress, and map out the path ahead. Remember that predictions made by professionals—even the most competent—may not always turn out to be accurate. This simply reflects the difficulty of making accurate long-term predictions with something as complex as Acquired Brain Injury.

Some general strategies

Individualised plans are important, but some general strategies may also help:

• Pitch your expectations at a level where success is likely
• Praise or reward small but significant steps toward a goal
• Break larger tasks (be they physical or cognitive tasks) down into small steps that can be learned and practised separately
• Practise how to deal with difficult situations, recognising that it may be hard to apply existing skills to new situations
• Focus on tapping into the young person’s strengths, and changing the surroundings to compensate for things he or she finds difficult
• Respect the young person’s dignity, help them achieve their goals for themselves and aim continually to build self-esteem and confidence
• Be consistent in your expectations and approach – don’t chop and change the ground rules for the young person.
• Use a ‘problem-solving’ approach to difficulties, to find the solution that best suits the needs of everyone involved.
• Think about building informal supports for your child – for example, contact with other young people who have had similar experiences.

Try to give yourselves time off from rehabilitation every now and then, and just be together for a bit. Don’t expect to change everything at once. It’s easy to feel impatient when the young person is struggling to learn or re-learn skills.

Many thanks to Brain Foundation Victoria for permission to adapt their material for this fact sheet.