Behavioral Considerations Associated with Traumatic Brain Injury Joan Mayfield, Preventing School Failure (page 2 of 6) Page 2 of 6

In contrast, Taylor et al. (2002) explain that children from socially disadvantaged environments may exhibit more behavior and academic problems than children from more advantaged environments. These problems may be related to the families’ limited resources to aid in the child’s recovery process or other person­al stressors that distract from the need for remedial assistance.

Because family dysfunction, ineffective child management, negative parent–child interactions, and deviant models of behavior are more common in disadvan­taged environments, another possibility is that these characteristics mediated the effects of social disadvantage on child outcomes. (Taylor et al., 2002, p. 23)

Risks in the Developmental Process

A significant proportion of children who suffer a TBI are at risk for impair­ments in the developmental process. A wide range of factors interacts to deter­mine the extent and nature of impair­ments following brain injuries in chil­dren. The type and severity of injury sustained are closely related to outcome (Lowenthal, 1998). Researchers have also found that developmental issues, includ­ing age at injury and preinjury abilities, have an impact or ongoing development postinjury (Anderson & Moore, 1995; Taylor & Alden, 1997). Children sustain­ing early injuries may present with simi­lar patterns of impairment, but have poor­er outcomes than do children sustaining their injuries later in childhood (Ander­son & Moore; Wrightson, McGinn, & Gronwall, 1995). As a child matures and societal demands increase in complexity, problems with cognition and executive function may emerge (Guthrie et al., 1999). The full extent of the effects of brain injury in children may not be real­ized for some time because the long-term consequences may involve impairments in planning, execution of personal goals, and social behavior. 

The brain injury sustained by a child occurs concurrently with development and may create an incomplete collection of abilities (Brazzelli, Colombo, Della Sala, & Spinnler, 1994). When a child suffers a brain injury, damaged brain cells cannot regenerate or repair themselves; however, new neural connections can form between the intact areas of the brain. These new connections allow areas of the developing brain to take over the functions of the injured brain cells (Lowenthal, 1998). However, this reorganization of brain functions usually results in a cost to the child’s overall cognitive capacity. For example, some research has indicated that the young child’s right hemisphere can assume the language functions of the dam­aged dominant left hemisphere (Keefe, Feldman, & Holland, 1989). Other studies, however, reported that general language functioning is compromised in young chil­dren when the right hemisphere has to take over language development (Hemphill et al., 1994).

Because the young child’s brain is incompletely developed, infants and tod­dlers who sustain a brain injury are vul­nerable to significant and persistent neu­robehavioral deficits following insult (Anderson et al., 1997). In the event of a brain injury, the skull of a young child is able to absorb more of the impact of the blow to the head; however, there is greater diffuse injury than would occur in the mature brain (Bruce, 1995). Adverse effects of brain injury often are not appar­ent in young children because there are limited cognitive skills established at a young age. However, as infants and tod­dlers mature, delays are more evident and children may “grow into” their deficits, with new impairments emerging as expected developmental gains are not achieved (Bannich, Cohen-Levine, Kim, & Huttenlocher, 1990; Dennis, Wilkin­son, Koski, & Humphreys, 1995). Chil­dren who sustain a TBI during the preschool years are susceptible to later linguistic (Ewing-Cobbs et al., 1997; Wrightson et al., 1995) and motor deficits (Ewing-Cobbs et al.; Haley, Baryza, Lewin, & Cioffi, 1991). Young survivors of brain injury may exhibit delays in expressive vocabulary and rapid naming of objects. The acquisition of expressive vocabulary may be more difficult for these children than receptive vocabulary, because the former requires word retrieval and pragmatics, whereas the lat­ter requires only word recognition (Hemphill et al., 1994).

In the area of motor skill development, timing of the injury in the maturation process is critical. If the brain injury occurs concurrently with the develop­ment of the neuroskeletal system in which motor skills are emerging, then current and future motor functioning may be compromised (Haley et al., 1991). In toddlers with moderate to severe brain injury, problems with gross motor coordination and balance are com­mon. Other impairments that may occur later in development include deficits in gross and fine motor skills (Chaplin, Deitz, & Jaffe, 1993) and difficulties in planning and initiating body movements (Wilkening, 1997).

In young school-age children who sus­tain a brain injury, impairments are most evident in areas of nonverbal functioning, attention, memory, and learning. Postin­jury performance IQ scores, which involve nonverbal functioning, visuomo­tor ability, and processing speed, are a more sensitive correlate of severity of injury than verbal IQ scores (Max et al., 1998). Perceptual difficulties may persist for many of these children. After suffering a TBI, children may have difficulties with spatial concepts and often have difficulty navigating around the hospital, school, and neighborhood (Guthrie et al., 1999). School-age children who suffer a brain injury often exhibit problems with atten­tion that hinder new learning in the class­room. Anderson et al. (1997) found that children who had moderate to severe brain injury displayed greater impairment in sustained and divided attention, whereas focused attention was relatively intact. In the areas of memory and learning, chil­dren with brain injuries often retain older, overlearned information; however, they have problems with encoding, storing, and retrieving novel information (Reid & Kelly, 1993).

From Preventing School Failure magazine. Heldref Publications. Reprinted with permission. www.heldref.org.

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