Laxmi Patel, Partner and Head of Education at Boyes Turner takes a look at how a brain injury can affect your child’s education.
The effects of a brain injury are not always clear for all to see. The physical effects of an injury are often more evident and are sometimes, therefore, more straightforward to provide support for. But the ‘invisible’ cognitive effects may not be as obvious and may be difficult to identify. Parents will often sense that something is different but are unable to describe the change or convince others that behavioural changes are due to the brain injury.
These are some of the difficulties that parents describe in their child after a brain injury:
- Difficulty in maintaining attention to tasks, difficulty multi-tasking and reduced motivation to start tasks. Also, reduced executive functioning which can affect planning, problem solving, reasoning, decision-making and self-monitoring. For example, children may lose their train of thought and go off at a tangent or be very rigid in their thinking.
- Reduced ability to process information.
- Problems with short term and working memory, making it difficult to follow instructions.
- Language difficulties – expressive and receptive including finding it difficult to follow a discussion, turn-taking or follow rules.
- Specific learning difficulties with reading, writing or spelling.
- Visual-perceptual skills – difficulty making sense of visual information which can impact many areas of development e.g. independence skills.
- Difficulties with fine and gross motor skills, muscle weakness and coordination difficulties.
- Reduced empathy – affecting socialisation and confidence.
- Emotional effects such as mood swings and frustration.
- Lack of energy.
A brain injury can impact the areas listed below but it is important to understand that these changes may co-exist alongside other changes in physical, cognition, emotional and behaviour.
Physical changes – this includes problems with mobility and accessing the school environment and community. It requires the consideration of delivery of therapies throughout the day, accessibility of the whole schools, specialist equipment such as a wheelchair or walker and perhaps the support of a learning support worker to ensure the child can navigate the school environment safely. Weak or stiff limbs will affect the child’s ability to take part in practical subjects and affect their independence skills. The child may have weakness on one side which means that support is needed with personal care and getting changed. Muscle weaknesses may affect continence and ataxia may cause uncontrolled movement affecting fine motor skills such as handwriting and difficulty carrying out basic tasks such as dressing, feeding and carrying school books/bag. The child may appear clumsy and may impact their self-esteem.
Communication – communication problems are common after a brain injury and can be difficult to identify. Many people will experience more than one type of communication problem depending on the areas of the brain affected and the severity of the injury.
Some of the changes are related to the understanding of language and expressing thoughts through language and can include difficulties with reading and writing. Another type of communication difficulty is an impairment of the physical ability to speak, usually called dysarthria and/or dyspraxia of speech. There can also be cognition related difficulties such as memory impairment, attention difficulties, poor social skills and fatigue.
Overall signs to look out for include difficulties with perception, spelling, memory, planning and organising thought, low confidence and difficulties with social skills.
Executive functioning skills can also be affected by a brain injury and are not always easily understood. Executive functioning difficulties are weaknesses in skills that are key to learning, for example, setting goals, planning work/steps to be taken and getting things done. Broken down, the skills required for these tasks includes paying attention, organising, planning and prioritising, starting tasks and staying focused on them to completion and regulating emotions. The signs of problems with executive functioning are often similar to ADHD and can include forgetting what has just been said, having problems following tasks or a sequence of steps, panic setting in when rules or routines change, having trouble switching from one task to another, getting overly emotional and fixating on things, difficulty organising thoughts, losing belongings and not being able to manage their time.
Of course, children develop executive functioning skills over time. It would be normal for a pre-schooler to have difficulty managing their emotions, for child at Key Stage 1 to get easily distracted and for a teenager to forget to complete homework occasionally but you may notice a more pronounced change following a brain injury.
Emotional effects can perhaps be the most difficult to deal with, often, because they are more difficult to see than the more obvious problems affecting speech and physical issues. Some families will see personality changes, mood swings, depression, anxiety and frustration or anger. It is important to put support in place to address these issues early on.
Many difficulties from the list above would not always be obvious to the bystander. Hidden disabilities can be difficult for others to understand and there is a risk that your child is mistakenly labelled ‘naughty’ or ‘attention-seeking’ and parents could be thought of as over-protective or over-indulgent. Brain injury can affect the child’s personality, their friendships, self-esteem and their ability to do things for themselves. It can result in over dependence and emotional outbursts.
Symptoms can also fluctuate after a brain injury, meaning that your child’s difficulties can change over time, often coupled with the usual growth spurts and problems with puberty. Each stage can come with its own unique set of challenges. Often, the difficulties do not become apparent until later.
Invariably, all these difficulties can affect your child’s self-confidence and emotional stability and it is important that your child is well supported when they return to school. Schools may believe they are putting adequate support in place but problems can sometimes surface a couple of terms in.
When children with a brain injury return to school, their needs are often very different than before the injury but may not always be obvious. Your child may have been out of school for some time and may remember how they were before the brain injury, which can bring on many emotional and social changes. Your child’s friends and teachers may also recall what your child was like before the injury, and may have trouble adjusting to the changes.
It is important to start discussions with the school early on and plan a gradual return to school with adequate support in place. This may mean the school putting in support from their own resources, or seeking external help. It may also mean requesting a statutory assessment leading to a statutory Plan that sets down your home Local Authority’s duty to provide support set out in the Plan. This can include input from educational professionals, therapists, specialist equipment and training and teaching assistant support. As it can take up to six months to put a Plan in place, it is important to start the process early.
Note that the statutory Plan in England is the Education, Health and Care Plan, ‘EHCP’. In Wales it is currently a Statement of Special Educational Needs but changes triggered by SEND law will replace Statements with Individual Development Plans, IDPs, from September 2021, subject to subordinate legislation in place by the end of 2020.
May 2020
Laxmi Patel
Partner and Head of Education
Boyes Turner LLP
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