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Children with Brain Injury: Recovery and School

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Children with Brain Injury: Recovery and School

All material Copyright © 2009 Lash & Associates Publishing/Training, Inc
This article is reprinted with the express permission of Lash & Associates as it appears on their website
By: Marilyn Lash, M.S.W.

An injury to a child can be an emotionally devastating event for families. Whether it is caused by a car crash, fall, sports injury or biking collision, many parents feel that have failed to protect their child from harm.

“Traumatic brain injury in childhood is the most prevalent cause of death and long term disability in children and affects all socioeconomic levels” (Bond Chapman, 2006).

How do children recover?

The recovery process for children with a brain injury is complex because the child’s brain is still developing. A new view of brain injury recovery in children describes two phases.

Immediate recovery phase

This is the time from the injury up to about one year. During this phase, the child may receive emergency medical treatment as well as intensive hospital care and rehabilitation with dramatic improvements in cognitive, motor and social skills. Because of this rapid change, families often bring their child home with the expectation of a full or almost complete recovery (Bond Chapman, 2006).

Latent recovery phase

This the period from one year after the injury to years later, even up to young adulthood. The full impact of an injury to a developing brain becomes apparent during this later phase (Bond Chapman, 2006).

Definition of neurocognitive stall

Dr. Chapman proposes that children with severe brain injuries are at risk for displaying a neurocognitive stall during the latent phase of recovery. She defines is as “…a halting or slowing in later stages of cognitive, social and motor development beyond a year after brain injury. Despite remarkable recovery during the first year after severe brain injury, children may appear to ‘hit a wall’ or ‘fail to thrive’ in terms of their continued cognitive growth. It is not so much that they lose already acquired skills as it is a failure or lag in development of later emerging cognitive milestones.” (Bond Chapman, 2006).

Children with severe brain injury are at greatest risk for a neurocognitive stall. With the lapse of time, they appear to grow into rather than out of their deficits. This often becomes evident during adolescence when the frontal lobes have rapid rates of growth and development from age 13 up to age 25 (Bond Chapman, 2006).

School work becomes more complex and so do social pressures with adolescence. These youth may have new difficulties keeping up with classmates and peers as they struggle to reach more complex cognitive levels in the classroom and with homework. The latent effects of earlier damage to the child’s brain emerge with time. Unfortunately, the link between an earlier injury to the child’s brain and emerging cognitive problems in school is often missed. When families and educators do not recognize the latent effect of a childhood brain injury, their behaviors are misidentified as symptoms of learning disability, ADHD or emotional disorders (Glang & Lash, 2004).

What Does this Mean for Schools?

studentWhile there have been many advances and promising research in the acute care and rehabilitation of children with brain injuries, there has not been comparable progress in psychosocial and educational research on children. This population is underidentified and underserved in local schools.

“The challenge of addressing the latent developmental effects of childhood brain injuries is compounded by the fact that families often must assume the primary care giving role and schools often become the sole providers of rehabilitation services. Neither families nor educators have been systematically prepared or trained for this role, despite the inclusion of traumatic brain injury as a category under the Individuals with Disabilities Education Act in 1991? (Glang & Lash, 2004).

So what can be done?

By taking a holistic approach, families and educators can be better prepared and develop the required skills to support and educate children with brain injury

Develop innovative approaches to family training.

Families need information to build a knowledge base about their child’s brain injury. They also need home based training on strategies for managing their child’s cognitive, behavioral and physical challenges. Training must also include advocacy skills for negotiating services at school. It also requires preparing parents to manage services over the course of their child’s development and education. It is important to recognize the emotional trauma of parents and to help them develop coping skills, find support for grieving, and reduce caregiver stress (Glang & Lash, 2004).

Look at instructional strategies used with other student populations

Little research has been done on the effectiveness of educational strategies for students with traumatic brain injury. Yet there is a large body of research on effective instructional and behavioral strategies for students with other disabilities but similar functional challenges such as problems with attention, memory, impulse control, etc. This knowledge must be examined to determine how it can be applied and modified, if necessary, for students with brain injury. This approach builds on the strengths and skills of educators (Glang & Lash, 2004).

Build capacity of educational systems

Ongoing training and brain injury consulting teams are effective models for increasing the identification of students with brain injury and for providing educators with new strategies and skills (Glang & Lash, 2004).

Support parents as educational advocates

A child’s return to school after a brain injury introduces parents to an unfamiliar and confusing educational system involving special education and 504 plans. Training programs for parents of children with special needs have demonstrated that families can become effective advocates support, training and guidance. Parents of children with brain injury need comparable programs as well as mentors through other families (Glang & Lash, 2004).


Bond Chapman, S. (2006). Neurocognitive Stall: A paradox in long term recovery from pediatric brain injury. Brain Injury/professional 3(4), 10-13.

Glang, A & Lash, M. (2006). A Holistic Approach for Improving Educational Outcomes of Students with TBI: Promising practices and new directions for research. Brain Injury/professional 3(4), 16-18.

Recommended reading

This Fact Sheet is based on a special issue of Pediatrics and TBI of the Brain Injury/Professional (vol. 3, issue 4) 2006.

Brain Injury/Professional is the largest professional circulation publication on the subject of brain injury and is the official publication of the North American Brain Injury Society (NABIS). Brain Injury Professional is published jointly by NABIS and HDI Publishers. Members of NABIS receive a subscription as a benefit of NABIS. Visit to become a member.

Lash and Associates Publishing/Training, Inc. has a full line of manuals on educating students with brain injury in school.

Featured Authors and Organization: Lash & Associates Publishing/Training Inc.

We thank Lash & Associates Publishing/Training, Inc. for allowing PediaStaff to reprint their article.

Lash & Associates Publishing/Training, Inc. publishes practical, informative, and affordable materials on traumatic brain injury in children, youths, adults and veterans. Their audience includes families, persons with brain injuries, health care professionals, rehabilitation specialists, educators and community staff. In addition to an impressive library of written offerings, Lash & Associates offers CEU Online Training in the area of traumatic/acquired brain injury for professionals including therapists.

Marilyn Lash M.S.W., uses her social work experience and research in pediatric rehabilitation to develop sensitive and practical guides for families, educators, and professionals. Marilyn’s specialty is helping families cope with the emotional impact of brain injury and developing strategies for negotiating the complex service system. Now Director and Senior Editor of Lash & Associates Publishing/Training Inc., she focuses on developing user friendly publications for families, educators, and clinicians.

Please support our contributing authors and organizations and visit the Lash & Associates website.

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