My teenaged daughter sustained a brain injury in a car accident more than a year ago. Now she has no motivation and wants to sleep or sit in front of the television all day. What can I do to get her up and more involved?
Your daughter's lack of motivation may stem from a number of factors. One, she is a teenager — not the most motivated developmental age group. But after a brain injury these tendencies may be drastically exacerbated.
A second factor is that she is likely recognizing that she is not able to do some of the things she used to enjoy at the level that she use to enjoy them, and is feeling a lack of confidence in her ability to do them at all. Teens are particularly loathe to stand out from the crowd for making a mistake, and your daughter may be avoiding participation in activities in order to avoid embarrassment.
A third factor to consider is that she may feel overwhelmed by activities more complex than sitting in front of the television, and may not have developed effective strategies to manage situations which she finds overwhelming. So, for example, the prospect of getting involved again with band may be too overwhelming for her to contemplate, but practicing her flute for 10-15 minutes a day might be more manageable.
Finally, your daughter's apparent lack of motivation may be a function of the brain injury itself. Parts of the brain are responsible for alertness and initiation of activity. Frontal lobe involvement may make it difficult for her to engage in activities even if she has a desire to do so. Diffuse axonal injury may induce a level of physical and cognitive fatigue even with what may appear to be a simple activity. A neuropsychological assessment will be able to determine which of these factors are having an impact on your daughter. She may benefit from some cognitive rehabilitation to help her to be better able to initiate and manage a more active lifestyle. Some counseling with a therapist who is familiar with the effects of brain injury in adolescents should also provide some support and strategies to rebuild her self-confidence.
You can help her look at some of the activities she used to enjoy or may be interested in and talk about ways to break them down into more manageable units.
Enlist the assistance of her friends. Look for a mechanism to help them to understand your daughter's brain injury, so that they can provide support and a sense of security for her. Many friends back away because they do not know how to react; engage them in the recovery process and they will be more likely to stick around.
Dr. Celeste Campbell is a neuropsychologist in the Polytrauma Program at the Washington, DC Veterans Administration Medical Center. She has a long history of providing cognitive psychotherapy and developing residential behavioral management programs for children and adults.