The transition to adulthood
This section talks about the steps towards adulthood, including education, relationships, sexuality, drugs and alcohol.
They may also be under different kinds of social pressure, and it’s in these formative years that drugs, alcohol and sexuality may become things young people need to think about. In short, our teenage years are when we make some of our most important steps towards adulthood. An acquired brain injury can make these difficult choices that little bit more complex. Deciding whether or not to stay on in full-time education is a big decision for most teenagers. But for a young person with an acquired brain injury, there may be other things to consider.1 On a very practical level, a young person with an acquired brain injury may start to access adult services during their teenage years.2 This is a shift in itself.
3, 4 They may be anxious about the effects of their injury on taking part in sport, socialising or dating.5 Some young people with an acquired brain injury may feel ‘out on a limb’ and distant from people their own age. This in turn can make parents feel anxious, as their son or daughter heads out into the world under their own steam.6
Michael went back to school and found himself very isolated. In all honesty, he’s more comfortable around younger children than he is with his peers."Parent's experienceLet’s look at some of the more specific things that may be going on in a young person’s life.
Education post 16:Back to topAll young people face tough decisions as they think about whether or not to stay on at school. If they do, there may be questions about what qualifications and subjects are going to suit them. If a young person has a statement of Special Education Needs, then the annual review in year nine is particularly important.7 ayour child’s move towards adult life. It’s an action plan that aims to set out the steps needed to move from school life to adult life. It may start with your child working with a Connexions/careers adviser. It’s up to the head teacher to make sure the Transition Plan is completed after the year nine annual review. This plan is very much about where children see themselves, and what qualifications they might need to get there.7 Sometimes this is called a ‘Moving On’ plan. The transition plan is not set in stone. It can be discussed and changed at later review meetings. But as always, parent and child should be asked to help with this plan.
There are a range of options ahead of a young person after 16.
Depending on their interests and abilities, they can stay on at a mainstream school.
If there is a relevant curriculum for them, they may be able to stay on at a special school.
Alternatively, they might want to move on to a college of further education or some form of work-based training.
Staying on after 16: what options does a young person have?7
Lots of schools have developed ‘link’ courses with local colleges, so pupils in their last years at school can go to college on a part-time basis. This can be a good way of ‘testing the water’, by preparing young people for further education and giving them the chance to sample new subjects that might interest them. Further education is available for every young person over 16. If ayour child has a statement of special educational needs, everyone involved in transition planning will consider what the options are. If your child has a statement of special educational needs and wants to leave school at the end of year 11 to go on to a further education college or to work-based training, the jobs advisor will carry out an assessment.
Must a child have a Statement of Special Educational Needs to benefit from support?No. The local careers service can carry out these assessments for other young people with special educational needs who want to go on to further education or training. They will work with further education colleges and training providers to make sure the young person gets the help they need.
What about university?Universities and colleges of higher education offer education beyond A levels, AS levels or NVQs from the age of 18. It is open to all young people who have the required qualifications to be accepted by an institution. Different universities will have very different entry requirements.
Sexuality and relationshipsBack to topOur teenage years are when our sexuality emerges more rapidly. The rush of feelings and urges can be overwhelming for many teenagers. And it’s complicated by social situations and pressures. Many young people with acquired brain injury are no different from the youngsters around them in feeling pressure to develop relationships with a boyfriend or girlfriend.8
Many young people want to fit in, but understandably, parents may feel protective and concerned for their children. There are some young people with an acquired brain injury who may be vulnerable, and this may cause genuine distress to parents.4 Some children and young people with acquired brain injury struggle to understand ‘cause and effect’ relationships (if I do X, then Y will happen). This may make it difficult to make informed decisions. We also know that judgment and the ability to make decisions can be affected.9 A young person with an acquired brain injury can also act impulsively. They may not think things through.10 So if a young person experiences some or all of the effects mentioned above, they may not be able to make sound judgments about sex and relationships. Important to note, however, is that this will not be the case for all young people with acquired brain injury. Many are capable of, and are entitled to, the same relationships all young people have. Talking about sex is rarely easy, but communication is key here. Some parents may feel their child’s change in circumstances makes talking about sex irrelevant. Some might worry about “giving them ideas” in talking through some of the issues.11 But – as with all young people – education about sex is extremely important. Young people may need information about what sex involves on a physical level, and contraception.12
The Brain Injury Rehabilitation Trust has some excellent resources on some of the issues young people face. You can download these publications here.
Drugs and alcoholBack to topThere are aspects of acquired brain injury that mean some young people will be more vulnerable than those around them. As we’ve already said, some children and young people with acquired brain injury struggle to understand ‘cause and effect’ relationships (if I do X, then Y will happen). This can make it difficult to make informed decisions. We also know that an acquired brain injury can affect someone’s judgment. A young person with an acquired brain injury can also act impulsively. They may not think things through. Our judgment, inhibition and understanding of cause and effect all act as a ‘brake’ on our behaviour. And without that brake, a young person’s ability to make sound judgments about drugs or alcohol may be affected. None of which is to say a young person with an acquired brain injury is automatically bound to do these things. It simply means they may be more vulnerable than their peers. But it isn’t just someone’s vulnerability that makes drugs and alcohol an issue. There are some other important reasons for young people with acquired brain injury to avoid drugs and alcohol. The instruction to ‘just say no’ is given to most young people at some point in their lives. But drugs and alcohol may be particularly hazardous for a young person with an acquired brain injury.13
So what are these hazards?A simple practical reason is that the influence of drink and drugs can make someone prone to another injury.14 Some youngsters with acquired brain injury are told to avoid contact sports because another impact could be very dangerous for them.15 Alcohol makes us unsteady on our feet and more likely to fall. It also clouds our judgment and makes our responses slower. So the chances of someone being injured in these circumstances may be that much higher. And a second injury could cause complications to a young person’s long-term recovery.
Seizures and medicationSome children and young people have an increased risk of seizures after an acquired brain injury. Many of these will be given medication to prevent seizures. Recreational drugs and alcohol can interfere with this kind of medication, leaving a young person more prone to seizures.16
People with acquired brain injury are more easily affectedA young person with an acquired brain injury might get drunk or high more quickly and to a greater extent than their friends. Naturally, this makes them more vulnerable. And as discussed above, they may be more prone to further injury.
Overlap with existing difficultiesWhen we think of some of the difficulties associated with brain injury, we can see that there is plenty of overlap with the effects of drugs and alcohol.17 The combination of an acquired brain injury and these effects can make these difficulties seem more magnified.
Balance and co-ordinationSome people with an acquired brain injury have difficulties with balance and co-ordination.18 Alcohol and other drugs can make these difficulties more pronounced.
Impulsive behaviourDoing things without thinking them through – or ‘impulsive behaviour’ – is a common effect of acquired brain injury. The use of drugs and alcohol can ‘fan the flames’ of this kind of behaviour. It can mean people are more prone to arguments, inappropriate behaviour and risk-taking. In a situation like a busy pub, this could lead to aggression and confrontation.
Memory, concentrationWe know an acquired brain injury can cause difficulties with memory19, concentration, problem-solving and judgment.20 Again, these are all difficulties drugs and alcohol can make more pronounced.
Depression, feeling lowSometimes, people who are feeling low try to feel better through alcohol or recreational drugs. Young people with an acquired brain injury may be prone to depression, anxiety and feelings of low esteem.21 And sometimes those who feel this way may be tempted to use drugs or alcohol as a way of relieving these feelings. But the effect of alcohol and drug use is often that these feelings are made worse in the long-term.22 If you have any concerns about drug or alcohol use, there are a number of organisations who can provide support.
People who can helpFrank offers free and confidential advice to parents and young people. Visit Frank here or call 0300 123 6600.
DrivingBack to topBeing able to drive is of great importance to young people, and often represents a milestone in our move towards adulthood and independence. But there are some things to consider. If the acquired brain injury has happened to a young person who already holds a driving licence23: If the brain injury affects their ability to drive, then there is a legal obligation to inform the DVLA – the Driver and Vehicle Licensing Authority. Failure to do so is a criminal offence. As always, speak with your doctor if there is any doubt at all. Find guidance on informing the DVLA here. If an adapted vehicle is needed to allow someone to drive, then financial support may be available. If a young person receives the higher rate mobility component of the Disability Living Allowance, they may be able to get help through Motability. Visit Motability.
If a young person has had an acquired brain injury before they were old enough to drive: They may now want to learn. If parents are in any doubt whatsoever about this issue, then they must contact their GP.