Toronto-Traumatic Brain Injury In Children

Traumatic Brain Injury (TBI) in children is a global health concern, affecting millions of young people world wide from birth to 21 years of age. Traumatic brain injuries in children, as well as adults range in severity from mild to moderate to severe; mild traumatic brain injuries are the most common.

Young people who have suffered a brain injury, regardless of its severity, may show  various neurocognitive concerns that interfere with their functioning across numerous domains. These include personality changes, memory problems,  executive function concerns (e.g., difficulties with organization, problem solving, planning, thinking and reasoning and with emotional and behavioral control). They may also show social, emotional and behavioral concerns, problems with attention and concentration and academic and learning problems.

No two brain injuries are alike.  The effects of a TBI, mild, moderate or severe, will present differently in each young person. Differing symptoms may interconnect, and may negatively effect the young person's functioning at school, at home and in the community.

Traumatic Brain Injuries in children may have more detrimental and long lasting effects in children than in adults, due to the developing nature of the immature brain. This applies to a mild brain injury or concussion, as well as moderate and severe traumatic brain injuries. The emotional, behavioral and cognitive concerns associated with traumatic brain injury in children may pose life long problems for the injured child and their families. These concerns may interfere with the typical developmental process, creating ongoing problems as time passes; they may go unnoticed until the young person reaches a developmental stage that requires the utilization of that skill. 

This has been conceptualized as "growing into a deficit" (Morrison, 2022).

Understanding the Problem is the Key to Solving It

uRegardless of the severity of the brain injury the young person may show social, emotional and behavioral problems, and/or academic, cognitive and/or behavioral difficulties. These concerns may interfere with the young person's ability to cope successfully at school. Children returning to school after a brain injury require observation and close monitoring to determine whether the brain injury has compromised their ability to function successfully at school.  Some of these brain-injured students will show obvious signs of their injury, whereas others, will show more subtle signs that are difficult to detect, or go unnoticed. Numerous other children will recover, and show no long term effects from the brain injury they suffered.

Nevertheless, just because the young person has returned to school after suffering a TBI, and shows no external signs of physical recovery, this does not mean the student has fully recovered. The negative effects of a pediatric brain injury, including a mildTBI, can linger for years, with detrimental effects that can pose long term difficulties for the young person at school, at home and in the community. It is important to observe and provide close monitoring to children who have returned to school after a head injury, and remain alert for any struggle they show that may be associated with their head injury.

Children who show lingering symptoms of a head injury, regardless of the severity of their injury, can benefit from a comprehensive, in depth school neuropsychological assessment to explore the neurocognitive and psychosocial effects associated with pediatric brain injuries.  The school neuropsychological assessment leads to evidence based interventions to support these injured youth at school, at home and in the commnity. Numerous of these brain injured students, including those with a concussion or mTBI, will require special education supports to address their needs within the school setting.

Unfortunately, not only are these brain injured students underdiagnosed within the school setting, they are also frequently misdiagnosed. These young people need to be appropriately identified as students with a TBI in order to ensure the provision of evidence based supports and interventions to address their classification as brain injured students. This will not occur unless they have assess to comprehensive in depth neuropsychological assessments to explore their needs and lead to evidence based supports to help them. Otherwise they are at risk of being misdiagnosed and provided with a curriculum that does not meet their needs.  

Understanding Traumatic Brain Injury in Children

Unfortunately, our understanding of traumatic brain injury in children, and its potential effects on  young people, including their school functioning is limited. This places the young people who have suffered a TBI at risk. To succeed at school, like all students, they must perform successfully across a number of domains. These include the social, emotional, and behavioral domains, as well as the cognitive/academic and learning domains. Like all students they must learn to function as independently and age appropriately as possible, and to the fullest extent of their capabilities.

Yet, young people who have suffered a traumatic brain injury, whether it is mild, moderate or severe will show problems at school that were not present prior to the injury.  To assist them in achieving to the best of their ability, they will require supports and interventions that rest on an understanding of Traumatic Brain Injury in children. This will apply to injured students returning to school after a period of absence, as well those who are already in attendance, who show behavioral and/or academic problems.

In order to assist these injured students, it is critical that we understand the short and long-term negative effects of  traumatic brain injury in children, and how they can compromise the injured student's behavorial and academic functioning. With this understanding educators, parents and others who support these young people will possess the required foundation to provide individualized, evidenced based interventions to support the behavioral and academic needs of these young people. If parents, teachers and others fail to develop this understanding, and apply it, these injured young people will miss out on much needed support.

A School Neuropsychological Assessment Can Help

Understanding traumatic brain injury and its effects on a child or adolescent's school functioning  is critical to supporting them within the school setting and ensuring they receive the evidence based supports they require.

School neuropsychological assessments increase understanding of how a traumatic  brain injury has impacted the young person's academic and behavioral functioning, and leads to evidence based solutions to address concerns that arise. A school neuropsychological assessment is recommended when a young person experiences increased or atypical behavioral or learning difficulties at school following a traumatic brain injury.

Moreover, It is not unusual for children who have suffered a brain injury, including a mTBI to show signs of recovery and  normal functioning, only to exhibit learning and/or behavorial problems later as their brains mature. Consequently, it is important to monitor young people with a known or suspected brain injury for future academic and behavioral problems.  A school neuropsychological re-evaluation can help when this is the case.

Dr. O'Connor, a Toronto psychologist, offers comprehensive in depth school neuro-psychological assessments to children, adolescents and young people who have suffered a traumatic brain injury.

 Understanding a traumatic brain injury and its effects on a child or adolescent's school functioning  is critical. This applies to young adults who are pursuing post secondary education.  A school neuropsychological assessment increases understanding of how a brain injury has impacted the young person's behavioral and academic functioning, and provides evidence based solutions to address these concerns.

Click here, to learn more about a school neuropsychological evaluation and how it can help, when  a young person has suffered a brain injury and is showing  behavioral and academic concerns.

School neuropsychological testing quantifies the severity of the child's impairments and provides objective, valid and reliable measures of cognition, emotions, personality and behavior. These results can also help inform an effective , evidence based intervention program.

Learn more about traumatic brain injury in children.

Resources Used In This Article

• Morrison,J.R., (2022). Assessing and intervening with traumatic brain injury. In D.C. Miller, D.E. Maricle, C.L. Bedford, and J. Gettman (Eds.), Best Practices in school neuropsychology (2nd ed.,pp. 374). Wiley.