Morning Zen Guest Blog Post ~ Rahmi Elahjji ~
In 1999, the New York Times covered (what is now understood to be) a landmark study by Dr. Antonio Damasio on how early childhood brain injuries contribute to the expression of abnormal behavior, inappropriate emotional responses and impaired social skills. Dr. Damasio and his team studied two individuals, both of whom sustained brain damage by accidents or disease early in life. Both individuals had significant problems adjusting to normal life: they had trouble following rules and planning for the future; they could not express normal emotions of guilt, remorse, or empathy; and they engaged in risk-prone behavior throughout adolescence and early adulthood.
Dr. Damasio's study did much for expanding how brain injuries can affect mental and behavioral health throughout adolescence and adulthood. However, research about what effects childhood brain injuries have on children's emotional and behavioral development is still limited. In the studies that have been conducted, the research suggests that the incidence of early childhood brain injuries, depending on their severity, strongly correlates with the onset of emotional and behavioral issues in adolescents and adults.
Children form a specific subset of the greater population who are most at risk for acquiring brain injuries. More specifically, children from disadvantaged backgrounds are especially at risk. Children are also the most likely to experience the long-term consequences of brain injury. Damage to the brain in the critical early stages of development can have serious consequences on processes like emotion, memory, decision-making and self-awareness.
For most parents, brain injuries are most associated with sports concussions, yet brain injuries with similarly significant consequences can come in many other forms, including:
- Infection that results in high fever
- Loss of oxygen (asphyxiation, hypoxia)
- Pediatric stroke
- Shaken Baby Syndrome
- Falls as an infant or toddler
- Blows or external wounds to the head
- Use of addictive substances
- Resected brain tumors
For more resources on the risk of brain injury in children:
- CDC's HEADS UP Initiative
- Brain Injury Association of America
- National Center on Shaken Baby Syndrome
- American Stroke Association - Pediatric Stroke
New research also suggests that the most prominent risks of brain injury differ among different age groups of children. Toddlers and younger children are more likely to experience brain injuries as the result of falls, while adolescents and teenagers are more likely to experience them as a result of sports concussions or motor vehicle accidents.
The risks of brain injury, especially among children, have recently evolved into a major public health concern, making a marked presence in multiple policy arenas. The state of Texas for example, instituted a comprehensive program in 2012 for reentry into school for students with brain injury. Attention at the national level has generated a traumatic brain injury imitative within the U.S. Department of Health and Human Services with a substantial amount of federal funding.
In preventing the most harmful consequences of brain injury, early identification and treatment is absolutely crucial. Parents should be vigilant for signs of mental, behavioral or emotional changes after their children sustain an injury to the head. These signs could manifest as any one of the following:
- Difficulty concentrating or maintaining focus
- Limited attention span
- Consistent mood swings, without apparent cause
- Increased anxiety or irritability
- Risk-prone behavior
- Difficulty planning or prioritizing
- Inappropriate or inconsistent emotional responses to events in their surroundings
- Decreased "social awareness" - trouble interpreting the actions, emotions, and behaviors of others
- Challenges with speech production and comprehension
- Occasional dizziness, or lack of balance
For more information on the signs and symptoms of a potential brain injury in children:
- Mayo Clinic
- National Institute of Child Health and Human Development
- National Health Service (UK)
The challenge for parents is in trying to figure out which of these signs might be attributed to a possible brain injury and which might be attributed to normal developmental changes in childhood or adolescence. Something like consistent mood swings, for example, could be caused by a previous brain injury, but they could also be caused by normal emotional changes during early adolescence.
This is why it's important for parents who suspect that their child or teenager is exhibiting these emotional or behavioral changes as a result of some kind of brain injury consult their doctor, who will be able to perform neuropsychological tests as part of a wider assessment of mental and behavioral health.
Of course, the most obvious thing that can be done is to try to prevent brain injuries from happening in the first place. Although the risk of brain injury for children can never be outright eliminated, meaningful steps can be taken to mitigate that risk:
- Wear a helmet when riding bicycles, skateboarding, roller boarding, skiing as well as other outdoor activities
- Always wear a seatbelt as well as a car seat when appropriate
- Follow proper protocol for concussions prevention and management during contact sports like football and hockey
- Follow posted rules for swimming in pools and beaches; avoid head-first diving at low water depths
While the research is still unfinished on the nature of the relationship between brain injuries and mental health, we at least know that one exists. The upshot of more effective prevention and identification programs for brain injuries is that they lead to better treatment outcomes, improved mental health and a vastly increased overall quality of life.
For comprehensive information on childhood brain injury prevention, diagnosis and treatment:
- National Institute of Health - Medline Plus
- Texas Office of Acquired Brain Injury
- Boston Children's Hospital
- Child Brain Injury Trust (UK)
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Rahmi Elahjji is a summer intern in the Office of Acquired Brain Injury at the Texas Health and Human Services Commission in Austin, Texas. The Office of Acquired Brain Injury is the primary Texas agency that provides service referral and coordination, guidance and consultation for individuals living with brain injury and their families; it also supports brain injury prevention and awareness efforts throughout Texas. Rahmi is currently a junior at Washington University in St. Louis, where he is double majoring in History and Cognitive Neuroscience. He is especially interested in how far brain research has come and how far it has to go. He is excited for the possibility of the latest advancements in research translating to better health and improved quality of life for all communities. Rahmi is originally from San Antonio, Texas.