How Does TBI Differ for Those Injured as Children?

Mount Sinai Medical Center
What Is the Situation for Children with TBI?

How does TBI differ for those injured as children?

The effects of TBI on children differ in several ways from the effects on an injured adult:

  • Because the child’s brain is still developing, injury may alter the course of development of the brain and its functions. It is not clear whether this works in the child's favor. Because the child's brain is less "set" than the adult's, its plasticity offers hope that damaged tissue and areas of deficit will be bypassed in the child’s brain by other parts taking over for these areas that no longer work well. Recent research, however, suggests that this may not be the case.
  • After a brain injury, previously learned information, which provides important building blocks for subsequent learning, is retained and used. However, in very young children, these building blocks are relatively few, handicapping them as learners in comparison to similarly brain-injured older children or adults, who have larger foundations of intact information.
  • The effects of the TBI on the child may not be seen directly after injury, but only become apparent in the child’s life when, during the course of the child’s development, affected skills are called upon. For example, problems in abstract thinking may not be evident until the child with a TBI reaches an age when abstract thinking enters the realm of possibility for any child at that developmental level. Because of this lag in the emergence of problems, the cause of the problems (the TBI) may not be identified. Frequently, such problems are dealt with inappropriately as if they are due to learning disabilities or emotional causes. This misperception by teachers, parents, and others can devastate the child, because the strategies used to help a child with TBI are different from those used to address similar problems that stem from other causes. A child will suffer in two ways: feeling diminished or confused because no one knows what is really wrong, and being damaged as a learner because no one can nurture learning based on understanding his or her real needs.

What should schools know about helping children with TBI?

We spent several years (under the auspices of a New York State-funded project) providing training on TBI to more than 10,000 educators in all districts and schools in New York City. The focus was on three key aspects of addressing the education needs of children who have experienced a TBI:

  • Identifying the children — both those who have been hospitalized and the many more who have not, who are often unknown to their schools as children with a TBI.
  • Assessing educational needs of these children appropriately — implying a shift in the assessment paradigm to one that includes a clear focus on defining cognitive challenges in terms that classroom educators can run with.
  • Modifying classrooms to fit the needs of children with TBI — which typically means modifying classrooms to better teach all children.

As a result of this work, training modules broadly useful in educational settings were developed. The major ideas that were developed and shared with New York City educators, have been published in Students with Traumatic Brain Injury: Identification, Assessment, and Classroom Accommodations.

The staff at Mount Sinai provides technical assistance to educators who wish to initiate a program to better identify, assess and meet the classroom needs of the large number of children in schools today who have identified or unidentified TBI. After consulting with the interested party, a plan is developed to implement a program suitable for that educational site. The plan describes the activities constituting the program and, if relevant, may cover the purchase of training materials, technical assistance to "train the trainers," travel, and continuing technical assistance to support implementation of the planned program.

If you are interested in obtaining more information about technical assistance, please e-mail Dr. Wayne Gordon at wayne.gordon@mssm.edu or Dr. Mary Hibbard at mary.hibbard@mssm.edu who together lead the effort to help educators address the needs of students with TBI.

Posted on BrainLine July 25, 2008

From Mount Sinai Medical Center. www.mssm.edu.

Comments

My son suffered a TBI due to a car accident in 2012. He struggles with depression, lack of motivation, and behavioral issues in addition to battling drug and marijuana dependency.  His acute care was great but once you get home and these issues arise where do we turn for treatment? 

My daughter suffered a severe TBI at 9 months old. Today she turns 14 yrs old. She/we have struggled to obtain thorough assistance through her schools (we have been in two districts). We have found the schools in our area are ill-equipped to successfully identify, and accommodate, her ever evolving needs. It seems as though schools are trained to handle severely handicapped students or the average student...with not many resources for the students in the middle. It's been a roller coaster ride and we keep our fingers crossed that things turn out fine in the end.

I had a mild tbi when I was 5-6 years old. I had climbed on my dresser, thinking I was a wrestler on the top rope, and slipped off and hit the front of my head on the floor. I was knocked out for a moment and spent the night in the hospital with concussion symptoms like constant vomiting. By the next day though I was feeling better and was released. After a few days everything seemed to be fine and I went back to being a completely normal child. I always did good in school, hardly ever made a B, and I never had problems making friends. Fast forward to about 12-13 years old and everything began to change. I could never focus on anything, especially school. My grades began to suffer. It was frustrating when I couldn't figure something out that I felt like I should know. When I was about 13-14 I broke the desk in my room because I couldn't figure out my math homework. I also began to feel extremely awkward in any kind of social situation. I try to even avoid going to places like the grocery store because of this. My short term memory is terrible. It is actually a running joke with people who know me well how absent minded I can be. I have bad mood swings where I will feel depressed for multiple days. This along with my social anxiety will cause me to want to stay in my bed forever at times. I never showed any of these problems before I was 12. I have always thought something just wasn't right with my brain. At first I thought I had something like add along with a social anxiety disorder. But the more I read about the long term effects of head injuries in children it makes me think my past concussion has something to do with it. I was also the passenger in a bad car wreck when I was 16, and was knocked out again for a moment. I'm sure this didn't help any. Ultimately though, I think it was the injury at 5-6 that had a profound effect on my personality later in life. I'm 28 now and if anything my problems have gotten worse. I dropped out of college. I found it extremely difficult and uncomfortable to even go to class, and focusing was impossible when I was actually there. I am a hard worker though. I've never had trouble keeping a job, but they've always been dead end jobs. I'll make plans and have ideas about my future but I never follow through with any of them.

Im working with a 72y.o. woman who had serious head injury as a child. She has lived her life with depression, problems with motivation and verbal disinhibition. . or blurting out things you really shouldn't say. After 6 months of neurofeedback symptoms are dramatically improving. Just passing it on. Children are even easier!

Your article states, "After a brain injury, previously learned information, which provides important building blocks for subsequent learning, is retained and used. However, in very young children, these building blocks are relatively few, handicapping them as learners in comparison to similarly brain-injured older children or adults, who have larger foundations of intact information."

Brain injury is different for everyone no matter what age.  I was 44 when I acquired a TBI from an MVA.  I have had to relearn almost everything.  Although my body seemed to know how to perform my brain could not remember how or why I should do many things.  I am still re-learning over six years later.  Some of that learning is what is called "awareness".  I call it functioning outside of the "twilight zone or matrix." 

No one should assume they know how a person is affected by a TBI.  Plasticity or not, nothing remains the same as it was before TBI.

Reading educational books about the brain like the Nerves in Collision book by Walter C. Alvarez, M.D. and the How to Cure Hyperactivity book (1981) about Inattentive ADHD/auditory processing/dyspraxia by C. Thomas Wild, introduction by Anita Uhl Brothers, M.D. can be enlightening. Both educational books look at subtle aspects of cognition and perception which are often overlooked. No miracle cures but small insights, here and there.
My son was hit by car Nov 11, 2009. He was in a coma for 3 mos. and was unable to walk, talk, eat, and sleep. I have been trying to get the right kind of help for him but there is none here in Colorado. He has been taken away from me twice because he was unable to control his anger. Kids around here tease him because of his asthma and the when he thinks. To make a long story short its been hell for the both of us and for him to make friends has not been easy. If anyone have information please call me at 720-269-4731.
My husband was hit by a motorbike when he was around 12 years old and has suffered various forms of depression since I met him when he was 21. I blame the motorcyle for the state hes in today and would appreciate anyones advice on this.
I have an 11 year old niece who was in a coma for 1 month and since then has been in a vegetative state as a result of serious traumatic brain injury. She was hit by a car, hit her head/broke the windshield, then the care threw her and she hit her head on the pavement. for the past 3 months, it's been surgery after surgery in her brain because of infection and fluid that they are not able to keep out of her brain. Anything hope and information that someone can provide with similar cases and outcomes would be greatly appreciated. my number 845-517-9881. Thank you
When my son was a baby he fell and hit his head. He seemed fine at the time, but now I wonder if he has always suffered because of that injury. When he was growing up he suffered night terrors, and halucinated when he had a fever. He had great difficulty relating to people, and never wanted to take part in group sports, or clubs or church groups. He did very well in individual sports.To make things worse,he was in boxing for awhile,and had more hits on the head.He is now an adult in his thirties and is married. They have worked out their marriage problems, but he has no friends because of his social troubles. In many ways, he seems totally normal. However,he has obsessive thoughts and, in groups, blurts out things that he thinks about,and other people avoid him because he doesn\'t seem to be able to blend in anywhere. He gets very vivid dreams which he always remembers. Sometimes he seems to have great empathy, but in other situations none at all. He works in the family business,and is very good at his job,working really hard,but sometimes has trouble concentrating,(he\'s thinking about his dreams or problems),and forgets things. My son suffers greatly. He doesn\'t understand why he can\'t relate,but at the same time he has persistently worked at it,trying to change. He thinks it is a spiritual problem, but I think it might be physical. I wonder if anyone else can relate to this, and if my suspicions about his injury are correct.
These same challenges are reflective for children of hypoxia but under identified and not given the same identification of "brain injury" like TBI. I have always felt this is a form of discrimination because they classify the child as developmental delay and do not ghive the child the proper screening until they lag behind for far too long. My son experienced a hypoxic event at birth because of a Dr. who took to long to perform a c-section. Hypoxia with grand maul seizures. It terrible to constantly fight with no true path and no support through the brain injury organization. Exhausting uphill battle. Mother from Maine.
When I was 7, I was hit full force in the face. I was a bright child until that time. I could no longer read. I remember I had no idea why everthing was different. The family member that did this was no longer allowed in the house. My dog was removed because we had to leave to life in a town where my Uncle was my doctor. My mother suffered tremendously because her marriage was about to end. I knew enough to realize I was the cause of the calamity. I had no friends. Could learn little. Walked strangely and had no medical care other then my Uncle. I am now 67. I have benefited from help in college in California by people who found out what happened as I began to mature and use my brain normally by age 17. But as an adult it took years to find out what had happend and even today, there are only pieces to remember. Too much has happened to discuss here but all of what has happened has a direct connection to that day when I was 7. Depression is a continuing problem but it is usually absent when I am in a daily situation where I am able to be alone, draw, write, and have gardening to fill my time. I enjoyed working in Recreation in a nursing home but found the emotional and physical issues which I considered to be abusive of vulnerable patients was standard procedure. I enjoyed working with scientists and using all those skills I thought I had lost and would never have as an adult. I wish I could have had more information before I became an adult and I am ever grateful for the few teachers in the 1950\'s that took it upon themselves to make my life better and worry about my confidence.
As the survivor of a 3 moth coma at the age of 12, I've been blessed to achieve success. I'm a substitute teacher, who does volunteer at libraries, schools, clubs, police, etc., to get the word out that early childhood cognitive challenges don't have to be limiting like the terms in the disability environment suggest (i.e., disabled, retarded, handicapped.) Thank you all for the wonderful work you do! I provide hope for those dealing with cognitive challenges/brain injuries. If I can provide hope, please contact, since I survived open-heart surgery at age 4 & a cognitive challenge (3 month coma) at age 12. I'm a substitute teacher, also. www.lapublishing.com/blog/2009/brain-injury-words-people/ Shaun Best, Protector of the Natural State Challenged Conquistadors, Inc. 1110 Pine Circle Smackover, AR 71762 (870)725-3612

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