An introduction to acquired brain injury for education professionals
As our title suggests, this section is aimed at teachers. Perhaps you’re a teacher reading this information, or you may be a parent who would like to print this article to hand over to a teacher.All children come with their own challenges. But information about acquired brain injury can help staff at school gain a better understanding of the specific challenges children with an ABI may experience.
- Teachers are very much involved in the Special Educational Needs process. Read our guide to this process.
Defining acquired brain injuryThousands of children and their families are affected by acquired brain injury every year.1 It is often shortened to “ABI”. The “acquired” part means simply that the child wasn’t born with their injury – it is the result of an accident or illness that has happened later. Acquired brain injury is divided into:
- Traumatic brain injury (TBI): the result of an impact to the head, eg, in a car accident.
- Non-traumatic brain injury, which some professionals call ‘atraumatic brain injury’: the result of something like meningitis or a brain tumour.
- Children and adults are affected very differently by acquired brain injury.2, 3
- An injury can happen when a child’s growing brain ‘still has unfinished business’. And a child may not go on to pick up some of the skills they otherwise would have.4 Adults who have an brain injury usually have the skills they need under their belt.
- Some children make a full physical recovery, but there may be ‘hidden’ effects of their brain injury.5, 6
- Some of the effects of acquired brain injury may take weeks, months and sometimes years to come to the surface.7 Some may only become clear in secondary school.8
- While there are some broad things we can say about acquired brain injury, each child responds completely differently.9, 10
- Nobody has all the answers with acquired brain injury. It’s not clear at what speed recovery will take place, or if a child will ever be quite as they were.11, 12
- Weakness of limbs, difficulties getting around.13
- Tiredness, struggling with concentration – often talked about as ‘fatigue’ by professionals.14, 15
- Changes in behaviour – irritability, behaving impulsively or inappropriately.16, 17
- Difficulties learning new things (learning difficulties).18
- Problems with memory.19, 20
- Difficulty processing information.21
- Emotional difficulties such as anxiety or depression.22
- Difficulties understanding and using language, difficulties keeping up with conversations.23, 24
- Difficulties organising and planning,25 difficulties carrying out everyday tasks.
- Difficulty with empathy - putting themselves ‘in someone else’s shoes’, and awareness about their own situation.26
We also know that there can be a lot of ‘overlap’ in the effects of an acquired brain injury.27 The effects of fatigue (or tiredness), for example, might make a child more irritable.28 It may also slow down the speed at which they’re able to process information. Not being able to answer a question quickly might lead to frustration on a child’s part, and this in turn might lead to challenging behaviour.
Would teachers of children at different ages see different effects of acquired brain injury?The outcomes of acquired brain injury in children of different ages has been the source of great debate down the years.29 For some time, experts thought that a younger brain was more ‘plastic’, and better able to work around the injury.30 But many researchers now think it isn’t quite so simple. The brain may be able to find new ways of doing things31 around the injured part. But this means the rest of the brain is ‘picking up the slack’ and having to work that much harder.32 It’s also important to remember that an injury in childhood can interrupt the brain before it’s had the chance to pick up some very important skills.33 And that an injury can make it very difficult for children to go on to pick up these skills.34, 35 It is generally thought that acquired brain injury has a more detrimental effect on younger children, simply because their brains have been interrupted at an earlier age, when they have fewer skills under their belt.29
One of the most important aspects of acquired brain injury is that the effects may take some time to manifest themselves.36, 37
One example of this might be an injury to the part of the brain associated with language skills, which may not become apparent until a child starts formal education, and signs of delayed literacy development emerge.38
Another common example of this might be an injury to the frontal lobes of the brain (an area particularly prone to injury).39, 40
This is one of the parts of the brain associated with judgment and problem-solving.
A child might have an injury to this part of their brain at five, but the effects might not be fully evident until the child is transferring to secondary school, at a time when the more complex aspects of these skills often develop.41, 42
The effects of acquired brain injury can be more difficult to identify at certain stages of childhood.
For instance, adolescence can be a time of great change, when they may be prone to being more impulsive, and experience greater mood swings.
It may be difficult to distinguish between these everyday behaviours and the effects of an acquired brain injury.
What can I expect in the future?
What sort of effects will I see in class?The effects of acquired brain injury can be difficult to spot. This is partly because of their ‘hidden’ nature43, but it’s also because these effects overlap and blur into each other.44 From a teacher’s perspective, it might be hard to spot whether a child is struggling to process information, or whether it’s more because they’re particularly tired that day. We might break down different issues at school into three categories:
- Cognitive (which is just a more technical way of describing some of the processes that go on in our head): limited attention span, trouble remembering things, difficulties processing information.45
- Emotions and behaviour16:
Self-esteem, feelings of being behind46, difficulties controlling emotions, distractedness, impatience, frustrations, trouble socialising with other children.47
- Physical48, 49:
Pain or discomfort, lack of access to parts of the school, restrictions to getting involved in PE, tiredness/fatigue, sleep disruption50, seizures.51, 52
In some circumstances it may be helpful for other children to have some understanding of changes their classmate has experienced.
This may form part of the preparation for your child returning to school.
After all, we know that an acquired brain injury may affect the way a child speaks with other children.47
A child with an acquired brain injury might do or say inappropriate things, or things that seem odd to other children.17, 53
Tiredness may mean they don’t have the energy to socialise.54
Other children in the school may not understand these difficulties. Others may ‘sense’ or identify a child’s difficulties and may tease them or ‘set them up’.55
There’s a risk that a child with acquired brain injury may become isolated from their classmates.56, 57
If a child is returning to the same school they were attending before their injury then it may be helpful to prepare peers for the return and make reference to any obvious changes.
Simple, accessible information for a child’s peers can help with the transition back to school.
This information should be adapted and presented at an appropriate level for their understanding.
Any plans to share information should be discussed with the child’s parents first.
This ensures the discussion respects a level of privacy and confidentiality they are comfortable with.
Some children may need reassurance that they can’t ‘catch’ ABI in the same way they might catch 'flu.
Talking with other children in class
Things to considerIdentify the most appropriate member of staff to deliver such information. It may be a young person themselves (with assistance), it may be a therapist, an educational psychologist, or a member of the school’s staff. Encourage social contact between the child and their friends at school before they make the move back. Make a video or take photos of the child (with the family’s agreement) when there have been significant and visible changes. This shows the progress that has been made, and may be a starting point for a discussion with other children before the injured child makes their return to school. Discussion may help dispel any misconceptions about acquired brain injury. It is important that other children understand what’s happening.
There are some publications that might help:Gilley the Giraffe ... Who Changed, available here.
Perhaps the school has a Circle of Friends scheme?Circle of Friends schemes started in America, and are a way of trying to help children who are experiencing difficulties in school feel more included. The idea is that teachers recruit volunteers from among the other children at the school. This ‘circle’ of children or young people will then support your child in their daily school lives. The circle meets regularly with teachers to discuss any problems they’ve had along the way and to set goals. Children with acquired brain injury sometimes struggle with interaction with other children. A Circle of Friends scheme may help them work on the way they talk and interact with others. Some research has suggested that the scheme helps children with difficulties in school or disabilities feel more included. It’s also thought to benefit the other children in the circle, because they’re encouraged to think about their own behaviour and take responsibility for others.
- Sue Walker's book Educational Implications of Acquired Brain Injury, published by the Brain and Spine Foundation, is a useful resource for anyone in the education sector. Email firstname.lastname@example.org to order a copy.
- Susie Aspinall, an occupational therapist from the Brain Injury Community Team at The Children’s Trust, offers a guide to some of the telltale signs, along with some possible interventions in this fantastic article written for special magazine Helping Michael to suceed.