There may be a child with acquired brain injury (ABI) within your school, since it is one of the largest causes of disability in the UK. ABI describes damage to the brain occurring after birth following a period of normal development. Most brain injuries are due to a traumatic event such as a car accident. Fewer are caused by stroke, illness or brain tumour. Unfortunately, some children will never recover sufficiently to return to their previous life but others, after a period of rehabilitation will reintegrate into their community. However, after the initial ‘welcome back’, life can be far from straightforward.

You may hear ABI referred to as a ‘hidden disability’ because many children function physically as before, yet damage to their developing brains is unseen. Difficulties with cognition, communication, behaviour or emotions may only emerge as they get older. Subtle problems with speech and language can often affect everyday communication for instance:

  • Understanding and remembering spoken or written language
  • Expressive language affected by slow processing
  • Word finding and naming abilities
  • Understanding humour, sarcasm or abstract language
  • Initiating and taking turns in a conversation
  • Using socially appropriate language
  • Following conversations in noisy environments or groups

Ethan – a Case Study

As a speech and language therapist working with children following ABI, I recognise the importance of giving them opportunities to talk openly about their communication experiences. Ethan was one of the children I interviewed for a study as part of a Clinical Research Masters. Ethan had a fall when he was 5 years old. At age 11, he was struggling to cope with the demands of a mainstream classroom environment and relationships with his peer group were poor. Ethan explained to me how his teachers became annoyed when he failed to get on with his work. Often, he did not understand what a teacher was saying and therefore, he would just ‘muck around’. He said he never ‘did this on purpose’ but when everyone else was getting on with their work in the class, he felt isolated and ‘didn’t know what to do’. Ethan felt there were some teachers in his school who understood his brain injury. They gave him more attention and were happy to repeat their instructions so they made sense to him. However, Ethan did not want everyone at school to know about his ABI. He felt this would identify him as different from his peer group; that no one would want to be friends with someone perceived to have a disability. Ethan’s views were similar to other children I interviewed. Negative experiences of communication in classroom, with teachers or peers impacted on confidence and self-esteem. Yet, those who reported positive experiences of communication, were reasonably happy at school and felt well integrated.

Advice for School Staff

Due to the idiosyncratic nature of the ABI, specific strategies are best developed with the individual child. These tips incorporate advice on common issues which have arisen in my work with children following ABI:

  • Social communication difficulties can have a huge impact on relationships with peers, leaving a child feeling isolated. Parents are often at a loss to know how to help. Consider a support plan to reduce the risk of social exclusion and bullying on a child’s return to school.
  • Children with brain injuries can suffer from fatigue for several years. Their brains have to work much harder than those of other children, leaving them exhausted. Give them more time to process spoken or written information and formulate expressive language.
  • Extra help, for example, support from a teaching assistant or use of assistive technology needs to be balanced with how a child feels about being seen as different from their peers.
  • Ascertain their views on the strategies they find most helpful.
  • Several years later, the ABI may seem less relevant and the reasons for a child’s communication or behavioural difficulties overlooked. Liaise with the child and parents about cascading information sensitively, to all teachers and support staff within the school, especially at times of transition.
  • Some difficulties only emerge in adolescence as curriculum demands increase and peer relationships become more challenging. If you are concerned about a child who had a brain injury in early childhood, contact your local speech and language therapy team or see if they can put you in touch with a specialist service.

Useful resources for education professionals working with a child following ABI:

Details of Katherine’s research study ‘Adolescents experiences of communication following acquired brain injury’ can be found at: http://www.sussexcommunity.nhs.uk/get-involved/research/chaileyresearch/completed-studies.htm

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