Emotional Symptoms

Depending on what part or parts of a person's brain are injured, the individual may experience significant behavioral and emotional changes.

The frontal lobe, for example, helps govern personality and impulsivity. If damaged, there might be no "braking mechanism" for self-control. A person may find he cannot control his anger or aggression. He may also make inappropriate comments to friends or strangers not realizing they are off color. Or the opposite might happen — someone's personality may become muted or seemingly emotionless. This is called "flat affect."

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The Emotional Consequences of Concussion

The Emotional Consequences of Concussion
[Jeffrey Barth, PhD, ABPP-CN - Director, Brain Injury and Sports Concussion Institute University of Virginia School of Medicine] There are oftentimes emotional sequelae related to or consequences of mild head injury and concussion. In sports we don't see it as often, immediately following a blow if it's one single concussion. However, it still can occur there, and actually after multiple concussions, it's very common. What are those consequences? Well, they are irritability that can relate to depression and often fatigue that's associated with that as well. Some people would say you can have the same types of emotional reactions to a concussion that you see in post-traumatic stress disorder. At the high school and college level, again, what we mostly find is the irritability and so on. These people become kind of grouchy and stressed. Of course, the way to treat that is reduce the stress, so we of course don't recommend that people go right back to exercise again. We titrate that in or bring it in slowly. We also try to work with school systems, for example, to reduce the curricular load a little bit, and make people aware that this person has had an injury, even though they look perfectly normal and are acting perfectly normally, and give them time to recover. If we talk about those recovery curves of 5 to 10 days typically, they should be over it relatively quickly. Sometimes though, that irritability lasts for awhile. Again, with our younger players, as I said, this can go for 6 to 10 times longer. That should be just watched by the parents and, again, reduce stress, get plenty of rest. Sleep is really good for those sorts of things.

Emotional and Behavioral Changes in Children After Brain Injury

Emotional and Behavioral Changes in Children After Brain Injury
In terms of emotional and behavioral changes that occur, again, most brain injuries in a traumatic sense occur affecting the frontal lobes and the temporal lobes. And your frontal lobes are the part of the brain that have what we call the pleasure center and the initiation center and the attention-distractability center. And then the temporal lobes have a lot to do with memory as well as emotional control. So you're hitting those areas or you end up isolating those areas from being able to do things. So a number of kids will be more apathetic than anything else, where they'll just sit there like a bump on a log and not really do anything. They tend not to get recognized particularly well in school because they're not a troublemaker because they're just sitting there. Of course, they don't do very well at school, but they're just sitting there. Then there's the group where their ability to stay on task is quite impaired, and so they'll get up and be fidgety and wander around the room and not stay on task and get distracted by the bird flying by the window, the noise outside, all kinds of things like that, and again don't pay attention enough to know what's going on, may not even remember--because they haven't paid attention--that they were being told to do a certain task. So they don't even know to do it. And other kids find them kind of distracting. Teachers really tend not to like kids to do that, so then they get disciplined a lot. The third group that have a lot of trouble controlling their emotions--and we all have trouble controlling our emotions to a certain extent, but their ability is, like, almost nonexistent. So they can be in the classroom and then all of a sudden get really, really angry or suddenly start laughing or crying, and there doesn't necessarily seem to be any correlation to what's going on around. It may be something happening internally, something that they're remembering about what happened at home, but all of a sudden you're having to deal with a child who is out of control. And what are you going to do and how are you going to manage that child? So there is that. And then, of course, there is the combination of any of the above. And then because of the memory problems that you can have, you get further behind in school. Well, if you have the awareness to realize that you're not the same as you were before and that used to be a really good student but now you're not doing as well and you're not remembering whereas before it used to be like that [snaps fingers], then that can get really frustrating which can then make you really angry or get you really down. And then a brain injury in itself gives you a risk of being depressed just because of the brain injury, about 70% of the time, so depression is a factor as well. And then the pleasure center of the brain, if it's isolated, puts these kids at great risk of becoming substance users and addicted because the impact of that substance-- the impact of the alcohol or the cocaine or whatever--is going to be like 5 times greater than what it would be to another kid. So they're going to get a super high and become almost immediately addicted. So then it's really important to try and get them to avoid using those substances, but most kids get into using those substances because it makes them feel good about themselves, and when you're not feeling good about yourself it seems pretty natural to head towards it. And the people who tend to start using substances as a kid tend to be kids who are having trouble in school and are sort of socially isolated, and a lot of kids with brain injuries become socially isolated because they're not learning and they don't interact with their peers the same way as their peers do. They're a little slower at understanding--you know--jokes and understanding what's cool. They just don't quite get it. So there is a lot of sort of emotional behavioral things that you have to deal with.

Testing Memory, Attention, Behavior, and Much More

Testing Memory, Attention, Behavior, and Much More
You know--the hallmark, I guess, of people with TBI is working with memory, attention, and behavioral issues. Memory and attention are fairly easy to understand. There are a lot of strategies and interventions to work with them. But they're very common, and people work with them. The other issue is working around behavioral issues because we often don't realize that our behavior is mediated by our brain, and how our brain processes information. So helping people to increase their awareness of what kind of behavioral changes they're exhibiting, helping other people around them understand what kind of behavioral changes their loved one is exhibiting, and coming up with ways to monitor and be able to intervene and to improve some of those situations for the individual. Those are the more common ones. Some of the less common ones that we see sometimes are some kind of visual deficits, not 20-20 vision, but how you interpret visual information, how you accommodate to perhaps depth perception problems or to focusing problems, those kinds of things. You can get some inner ear and some balance, some body position difficulties. Sometimes we'll work with those. Those are less common. The hallmarks really are the memory and the attention and the behavioral changes.