Toronto-Traumatic Brain Injury In Children

Traumatic brain injury (TBI) in children is a global health concern that affects young people from birth to 21 world wide.  The severity of traumatic brain injury in young people ranges from mild to moderate to severe, with mild traumatic brain injuries being the most common.

Traumatic Brain Injury in children and adults results from an external force to the cranium and the underlying brain, and can pose significant concerns to a young person, regardless of the severity of the injury. Brain injuries in children and adolescents may be more detrimental and long lasting than in adults, due to the developing nature of the immature brain. This applies to a mild brain injury or concussion, as well as to moderate and severe traumatic brain injuries. The emotional, behavioral and cognitive concerns associated with pediatric brain injuries can pose life long problems for these young people and their families. These concerns can derail the typical developmental process, and may not be evident until the young person starts showing problems at school.   Cognitive deficits, for example, may be subtle and only evident after a young person with a pediatric brain injury has reached a developmental stage that requires the utilization of that skill. 

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

Young people who have suffered a mild, moderate or severe TBI exhibit numerous neurocognitive deficits, that contribute to problems across a range of concerns. These include personality changes, memory problems,  executive function concerns (e.g., difficulties with organization and planning, thinking and reasoning, problems with attention and concentration), visual perceptual concerns, academic problems and social, emotional and behavioral difficulties. 

No two brain injuries are alike.  The effects of a TBI, mild, moderate or severe, will present differently in each young person. A combination of differing symptoms is possible as result of a TBI, and may negatively effect the young person's functioning inside and outside educational settings.

Numerous problems may show up in the school setting. These can include academic, cognitive and/or behavioral problems that can interfere with the young person's ability to learn and perform successfully  at school. Children returning to school  after suffering a pediatrc brain injury, regardless of its level of severity, need to be monitored carefully to determine if and how the injuries they have suffered are interfering with their ability to function at school. Some may be showing subtle or obvious signs of difficulty across various areas of functioning, or perhaps a single one. It is important to realize that just because the young person has returned to school after suffering a TBI, and is showing external signs of physical recovery this does not mean he or she has recovered from the negative effects of a pediatric brain injury. The negative effects of a pediatric brain injury, including a mild TBI, can linger for years compromising the young person's ability to function successfully at school and in other areas of his or her life.

Consequently, it is important to observe these injured young people and be on the alert for any struggle they are showing that may reflect their brain injury. It will also be important to provide these brain injured students with comprehensive in depth assessments to explore the multiple cognitive and psychosocial effects associated with pediatric brain injuries and to inform evidence based interventions to support these injured youth, both at school and in other areas of their lives. These brain injured students, including those with a mTBI, are likely to 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, many of the 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. We need to understand these effects  and how they can compromise the injured student's behavorial and academic functioning. This applies to young people who have suffered a  mild TBI or a concussion , as well as to those who have suffered moderate to severe brain injuries.  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. It is also 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.