Brain Injury among Children and Youth: Myths and Facts
• Marilyn Lash, M.S.W.
• Lash and Associates Publishing/Training
• www.lapublishing.com
Traumatic Brain Injury
• External force– blow, beating, assault– collision (speed and force)– fall
• open versus closed– gunshot– penetrating wound
Acquired brain injury
• strokes• tumor• anoxia (near drowning, strangulation,
choking)• disease (encephalitis, meningitis)• toxicity (lead, chemicals)
Primary injury
• coup - contra coup effect• damage from brain striking another
surface• brain moves around inside skull hitting
bony surfaces• shearing and rotation as tissues stretch
and tear
Secondary effects
• occur after the initial impact
• swelling, bleeding, infections
• increased intracranial pressure
Mild brain injury
• brief or no loss of consciousness
• signs of concussion
• post concussion syndrome
• 90% recover within 6-8 weeks,
often within hours or days
Moderate brain injury
• coma more than 20-30 minutes but less than 24 hours
• skull fractures with bruising or bleeding
• signs on EEG or CT scan or MRI
• 33-50% have long-term difficulties in one or more areas
Severe brain injury
• coma more than 24 hours
• persistent vegetative state
• 80% have multiple long-term impairments
Predictors of outcome
• length of coma
• duration of post traumatic amnesia
• area of brain damaged
• mechanism of injury
• age when injured
Myth: Looks good, is good
Facts• Physical recovery outpaces cognitive
recovery.
• Better the student looks, harder it is to recognize cognitive needs.
• Misidentified as ADD or LD
Myth: More severe injury = permanent disability.
Fact: Types of disabilities vary.
Fact: Changes in behavior and learning jeopardize independent adulthood.
Fact: Not all disabilities are equal.
Myth: Younger child is when injured, better the recovery.
Fact: Younger brain is more vulnerable to damage.
Myth: Tests in normal range, therefore can learn okay.
Fact: Testing old knowledge not
indication for new learning.
Fact: Testing environment not indicative of classroom
Myth: TBI means student is eligible for special education.
Fact: Diagnosis not automatic qualifier for eligibility.
Fact: Educational impact may change as brain matures and school work changes.
Children are different than adults.• Less likely to lose consciousness
• Higher survival rates for serious injuries
• Quicker physical recovery of motor skills
• Damage to developing brain
• Harder to learn new skills
• Effects not always seen immediately
• Long term impact on development
Incidence• Leading cause of death and disability in children
• Incidence estimated at 2/1,000 or1 out of every 500 school age children hospitalized for TBI annually.
• Most frequent diagnosis in National Pediatric Trauma Registry
Causes vary by age
• infants: physical abuse• toddlers: falls and mva passengers• preschoolers: falls, mva passenger/peds.• elementary school: motor vehicles,
bicycling, falls, recreation.• adolescents: mvas, sports, assaults
and gun shots.
Screening questions to ask…has this student ever
• been involved in a motor vehicle crash• fallen from a height over 8 feet• been hit in head during sports or play• seemed dazed, confused, unlike “normal”
self for period of time• had one or more concussions• lost consciousness
Wording affects responses
• head injury vs. brain injury
• concussion vs. mild brain injury
• foster children
Physical changes• seizures
• headaches• reduced stamina and fatigue• hearing and vision impairments• coordination and balance
• one sided weakness
• paralysis
• respiration
• swallowing
Cognitive changes• memory
• attention and concentration• new learning• easily distracted• unable to generalize learning• lack of initiation• disorganized• impulsive
Behavioral changes
• disinhibition
• temper outbursts
• low frustration tolerance
• mood swings
• inappropriate sexual language or behavior
• altered personality
Social changes
• acts younger than age
• poor social skills; interrupts; misses cues
• doesn’t fit in with peers
• lacks self-awareness of changes