Guest writer: Caroline Klage, Partner heads up the Child Brain Injury team at Bolt Burdon Kemp and is also a SEN (Special Educational Needs) advisor. She is passionate about helping her clients to flourish and enjoy life. Caroline assists the parents of her brain injured clients to secure EHC (Education and Health Care) Plans for their children, ensuring they receive the support they need to fulfil their potential at school, both socially and academically.

Please understand me!
Year on year, the Child Brain Injury Trust continues to provide excellent and essential support to growing numbers of children with acquired brain injury and their families. It will be an enormous pleasure and privilege for Bolt Burdon Kemp to host the Child Brain Injury Trust’s annual art exhibition on 12th May 2016 for the third year running. This year, the theme of the art work will be the very real difficulties children with acquired brain injury face in socialising.

The “invisible” injury
The problem with an acquired brain injury is that it can, to most people appear invisible. A child with a brain injury can look like a neuro-typical child. Consequently, behaviour resulting from a brain injury is often wrongly and unfairly interpreted as naughty, rude, odd, weird and/or inappropriate behaviour by teachers, family and friends. Even worse, it may be treated and/or punished as such, causing the brain-injured child to feel confused and isolated when what they most need is understanding and reassurance.

To compound the challenges a brain-injured child faces, they will often have an overwhelming desire to fit in with peers and avoid being perceived as different. This can be especially strong in the teenage years, when the image and persona a teenager projects becomes incredibly important to them. A brain-injured child may feel immense frustration when the difficulties they face conspire to form a barrier to them fitting in, adding to the hidden difficulties they already experience as a result of their brain injury.

Features of acquired brain injury
It is vital that everyone involved with a child with an acquired brain injury (ie school, family and friends) is aware of the following features of acquired brain injury and how these can present difficulties for the brain-injured child:

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  • Problems with memory
  • Intolerance to noise
  • Sensory sensitivities i.e. to light, smells and tastes
  • Disinhibition
  • Impulsivity
  • Vulnerability to becoming overwhelmed
  • Anxiety, caused by all of the above which could manifest itself in challenging, irritable and/or inappropriate behaviour
  • Difficulties with: processing information, including difficulties following and participating in conversations, learning new things, coping with changes of routine or the unexpected, empathy i.e. seeing things from someone else’s viewpoint, organising and planning, coordination, gross and fine motor skills
  • Fatigue – coping with all of the above can be incredibly tiring.
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      How these features impact on socialising
      The above features will all impact negatively on a child’s ability to socialise, both in isolation and also in combination with one another. Therefore awareness of these issues is key to creating an environment in which the brain-injured child can be understood and supported.

      A survey carried out by the Child Brain Injury Trust suggests that children who have suffered a brain injury will be out of school for between 4 to 12 months on average. Many then return to mainstream school. Any child would find it hard to return to school after such a long period of absence, but imagine how difficult it must be for the brain-injured child who has to grapple with the difficulties listed above and also, in many cases, a lack of understanding of these issues on the part of the people surrounding them, most notably their friends.

      Friendships will feel completely different. Old friends may have moved into new friendship groups. The brain-injured child may find it difficult to re-integrate into their old friendship group and to form new friendships. Information processing difficulties and difficulties with memory will make it hard for brain-injured children to follow and participate in conversations, particularly in larger groups. The brain-injured child may also find it harder to engage in the “give and take” of conversation.

      Disinhibition may mean that if a child is irritated by a peer, they may openly express this, causing offence and upset in the absence of any understanding on the part of the peer that this is a feature of brain injury. Desperate to fit in and not wanting to be different, it will be very difficult for most brain-injured children to explain to their peers that their behaviour is the result of their brain injury, particularly when they may not realise this yet or are having difficulties coming to terms with this.

      The ability of the brain-injured child to participate in school life and in the extra-curricular activities they enjoyed before their brain injury may well be far reduced. From a physical point of view, they may fatigue easily. Challenges they face with coordination may impact on their ability to compete at the same level as peers in sport or music. Both sport and music are sociable activities that give rise to bonding opportunities and help boost self-esteem. However, they can prove difficult for the brain-injured child to access if the challenges they face are not properly taken into account. This may lead to them giving up these activities and losing out on the social benefits they provide.

      Brain-injured children may feel self-conscious and may be perceived as “weird” or “odd” as they struggle to cope with environmental challenges e.g. the harsh sound of a school bell, the hustle and bustle of going into school at the start of the day and leaving at the end of the day and the difficulties they face in trying to organise what they need for each lesson coupled with having to get to each lesson on time. These features are likely to distinguish and then isolate brain-injured children from their peers who may not understand these features are due to a brain injury. Without encouraging understanding through education about acquired brain injury, some children may not wish to mix or be seen to be mixing with a child who is perceived to be “different”.

      The way forward – education and awareness
      It is crucial that teachers as well as the brain-injured child’s peers are educated about the effects of brain injury so that they are able to provide support when it is required, in particular by educating the child’s peers in how to understand and support their brain-injured friend. The child’s peers should be educated as to what to expect so that they can better understand why their brain-injured friend might behave in a certain way. Teachers should also be taught to be able to identify particular behaviours so that when they arise, they can discreetly intervene to provide the necessary explanations to peers and reassurance to the brain-injured child, thereby diffusing tensions and anxieties. They should also ensure that activities and lessons are appropriately differentiated so that they can be accessed by the brain-injured child. All of this work can be difficult for a school to manage within its existing budgets. Often, it is helpful to apply for an Education and Health Care Plan. This can help schools access additional funding to enable them to better meet the needs of the brain-injured child, for example, by funding one to one support and specialist training.

      A survey undertaken by the Child Brain Injury Trust suggests that many children feel socialising would be easier if people had a better understanding of the effects and implications of acquired brain injury. The Child Brain Injury Trust is to be applauded for its fantastic awareness raising work in this regard.

      In the last year, its Team:
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      • delivered awareness sessions to 53 schools
      • visited 230 families at home
      • received 316 calls on their helpline
      • had 688 viewings of their webinars
      • welcomed 24,989 viewers to their website.
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          As child brain injury specialists, we at Bolt Burdon Kemp see the difficulties our clients face on a daily basis and how understanding of acquired brain injury can make a massive difference to a child’s quality of life. This is why we must support this excellent and essential work and enable the Child Brain Injury Trust to reach more children as well as their families, schools and friends.

          All views in this featured blog are those of the author. The Child Brain Injury Trust would like to take this opportunity to thank Bolt Burdon Kemp for sponsoring their annual Action for Brain Injury Week campaign in England, Wales and Northern Ireland.
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