Our youngest daughter was hit by a swing more than two years ago in the playground. She was only 2 at the time. She sustained a severe TBI and has a lot of physical and cognitive issues that we are still working on in rehab. My question, though, is about her older brother who is now 6. He has become more withdrawn since his sister/s injury. He used to be a very happy, outgoing little guy and now doesn’t want to talk much or tell us what is bothering him. I can't tell if he feels guilty for some reason (he had nothing to do with her getting hurt though he was in the playground when it happened). And sometimes I think he might even be jealous of the constant attention that his sister gets, even though it's not the kind of attention a kid would ever want in the first place. We try our best to give him lots of attention and praise and involve him in activities he likes, but he seems to be falling deeper inside himself. What should we do?
It is certainly perceptive that you have connected the changes in your son to your daughter's injury. As you already know, a serious brain injury affects everyone in the family. You and your spouse know the stress and strain you have lived through and no matter how much you have tried to shield your son, he, too, has felt these pressures.
You are absolutely right that he might feel both responsible and jealous. He was 4 years old when your daughter was injured — exactly the age when children can over-attribute others behavior to their own, and think that they have the ability to cause changes in the world. Four year olds can believe that their anger at a sister or brother could cause an accident. You’ve taken an important first step in recognizing this possible connection. The next step is to talk with your son about his feelings. Pick a quiet time when it's just the two of you and ask him if he even thinks about the accident. You can tell him directly that it wasn't his fault. Even though he saw it happen, he was only four and couldn't have prevented it. You can also let him know that feeling jealous is normal. It's okay to wish that sometimes he could have all the attention. You can talk with him about how your daughter’s injury has affected the whole family.
Finally, consider several sessions for the whole family with a mental health therapist. This way, the spotlight would not be only on your son and he might feel more comfortable talking about his thoughts and feelings. And you might learn ways to help him regain his energy and optimism. He may require individual play-oriented therapeutic assessment to better understand his emotional needs if he is not able to articulate them. There are also resources for the special needs and issues of siblings of children with developmental, medical, and neurological disorders. Sibshops is a good one that you might consider looking in to as there are many such support groups around the country that recognize the unique needs of the brothers and sisters of disabled children.
Gerard Gioia, PhD is a pediatric neuropsychologist and the chief of the Division of Pediatric Neuropsychology at Children's National Medical Center. He is an associate professor of Pediatrics and Psychiatry at the George Washington University School of Medicine.