Emotional and Behavioral Changes in Children After Brain Injury

Everything affects the outcome after a TBI -- from the severity of the injury to the ongoing support of family, friends, and community.

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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.
Posted on BrainLine June 8, 2010.

Produced by Victoria Tilney McDonough and Brian King, BrainLine.

About the author: Jane Gillett, MD

Dr. Jane Gillett was a neurologist certified by the Royal College of Physicians and Surgeons of Canada in both pediatric and adult neurology. She created and developed the Pediatric Acquired Brain Injury Community Outreach Program, Children’s Hospital of Western Ontario. She died in 2011.

Dr. Jane Gillett