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Impact of Brain Injury on Children and Teens
(Portions re-printed with permission from the Minnesota Low Incidence Project, Deb Williamson)
Brain injury is the leading cause of injury and death of children in Minnesota. The most common way children and teens sustain a brain injury is through falls, motor vehicle crashes, sports concussions and abuse. Minnesota strives to reduce and prevent brain injuries in children and teens through changes to legislation (i.e. booster seat legislation in 2009, Sports concussion legislation in 2011) and collaborative work with statewide injury prevention specialists.
Impacts of Brain Injury on Children
When children are hospitalized after brain injury a care conference is often held before they are discharged back into their parents'/guardians' care. These meetings include many members of the child's medical care team, the child's parents/guardians and potentially a school representative. This meeting is to plan a smooth transition and to ensure that communication paths are established with the school and medical team. Inpatient rehabilitation is just the beginning of the healing and recovery process for a child. Many children will continue their rehabilitation after returning to school with the support of school professionals.
It can be difficult to know how a brain injury is affecting infants and very young children as they are still developing. Professionals say children grow into their injuries as the impact of brain injury can be seen as the child struggles to meet developmental milestones. For these reasons it can be very helpful to use all of your community's resources. For more information, contact the Minnesota Brain Injury Alliance at 612-378-2742 or 800-669-6442.
Children who have had mild brain injuries may be seen in urgent care or the emergency room and then sent home. It is important to note repeated mild brain injuries occurring over an extended period of time can result in more severe injuries.
Children may experience cognitive, emotional, or physical change; they may experience a change in one or more areas. As the child grows and expectations of greater independence emerge in school, symptoms of brain injury may become more evident. Sometimes it will take a child longer to learn a new skill or to reach a developmental milestone. It is critical that parents and guardians speak with their primary care doctor and school team about any concerns regarding development. It is also important to remember the brain injury may be impacting a child's ability to learn new information at the same rate as their peers. When children experience a significant change in social relationships or academic performance after a brain injury it can be important to know how to ask for support for your child.
Impact of Brain Injury on Teens
Teens should receive information on their medical diagnosis and have the meaning of that explained by a knowledgeable professional (e.g. their neuropsychologist). Throughout this process, they will need support from parents/guardians and school professionals. It is recommended that teens be part of meetings with school staff and medical professionals as they prepare for greater independence at college and in the community.
A critical aspect of being a teenager is that teens are working towards independence from their parents and part of this independence is marked by social acceptance from their peers. A brain injury can make people feel less confident, which can lead to a loss of friends, decreased involvement in extra-curricular activities and an increase in depression.
Brain injuries that are sustained during the adolescent years may lead to a teen needing a few more years to meet the emotional or cognitive milestones of their peers. When a significant difference in a teen is noticed post-brain injury, it is important to communicate this across the teen’s support system (e.g. parents, guardians, teachers, healthcare professionals).
Teens generally work towards independence through employment activities and higher education opportunities. It is important that teens have the opportunity to learn in school how to advocate for modifications and accommodations in their jobs and in their college classroom. Informal supports may be sufficient or a teen may need support in learning how to communicate their needs. For a young adult this may be a learning process of trial and error. College applicants can receive accommodations when taking ACT or SAT exams when they have a medically documented brain injury. It is also advised that students attending college meet with representatives at the office for students with disabilities to begin to discuss potential accommodations in classrooms.
Some of the referrals we're getting for special education services might on the surface look like a child with emotional behavioral disorder or ADHD, when in fact it could be residual effects from a previous brain injury. — Deb Williamson
Changing Family Dynamics and Brain Injury
It can be challenging for the entire family when a child has a brain injury. Unique new roles arise due to unexpected traumatic changes. Even after a child's medical condition has stabilized, their doctor's appointments and rehabilitation will continue to require additional time, resources and attention. Sometimes, parents will need to take leave from work or change dynamics in their spousal/co-parenting relationship as the demands within the family have greatly increased.
When the immediate crisis has resolved many siblings continue to feel like they are not getting the same attention from their parent, but may feel guilty to openly discuss this. This can be an important time for the entire family to seek support from loved ones, extended family, friends and helping professionals. During this time it is often important for parents and guardians to remember to take care of themselves so they can continue to support their child and family.
One dad's recommendations to others:
Be a little selfish: pay attention to your own emotional health and how it affects you and your spouse's relationship; how it affects you and your kid’s relationship."
Education Supports and Rights
School interventions can vary from general accommodations in the classroom to more extensive modifications that may require customized special education services and the development of an Individual Education Plan (IEP). Determining appropriate accommodations often depend upon the severity of injury, how the injury impacts the student's functioning and the length of time the student is symptomatic.
Educational needs and accommodations can change quickly in the first weeks and months following a brain injury, especially a mild injury. This may require frequent checking in with the student to assure general classroom accommodations are sufficient or need to be changed. This will ensure that the plans are reflective of current educational needs.
Available School Supports and Services
General Accommodations - Symptoms resulting from most mild brain injuries/concussions are temporary and resolve within a few days or weeks. General Accommodations are short-term and may include a shortened school day schedule, minimal/no homework, rest breaks, quiet environment, extended transitions between classes, and preferential seating.
504 Accommodations - For students with more long-term issues, a Section 504 Plan might be implemented. Parents can request that their child be evaluated for a 504 Plan. The school district has a legal responsibility for learners who qualify for 504 accommodations, and once eligibility has been determined, a Section 504 Plan is prepared and implemented in accordance with applicable regulations, including the identification of accommodations to the environment, curriculum, materials and instructions in the least restrictive environment.
Individuals with Disabilities Education Act (IDEA)/Special Education Services
If the student's educational needs resulting from a brain injury are chronic and/or severe, a parent or education staff can request a special education evaluation. Determination of eligibility for special education services must be established before those services can be provided. An Individualized Education Plan (IEP) will be written and annually reviewed by the educational team, of which parents are a vital part.
For more information, contact the Minnesota Brain Injury Alliance at 612-378-2742 or 800-669-6442.