Hi, my name is Dr Andrea Pickering, Consultant Clinical Psychologist at Recolo.

One of the commonest problems reported by young people and their families following a brain injury is fatigue. It is divided into two main types: cognitive (mental tasks) and physical fatigue.

The nature of a brain injury means that connections within the brain have been disrupted, causing thinking tasks and physical activities to be more effortful and a challenge. Often the young person’s behaviour or emotional state is the first sign of fatigue because they feel overwhelmed.

Help! My child is not able to concentrate and it’s affecting their learning.

Following a brain injury, young people often describe experiencing headaches, brain-fog and losing concentration as signs of cognitive fatigue. Younger children can find it hard to recognise this and may need adults to support them. The key to managing cognitive fatigue is a combination of Adjustment and Creativity. This may involve adjusting tasks to better fit your child’s abilities as well as pacing the flow of demands throughout the day by scheduling regular breaks with restful activities, such as taking a walk or listening to music.

Learning tasks can be created into an engaging game that not only rewards your child for effort, but also persistence. Be creative by shifting between alternating response systems to overcome low level fatigue in a task, for example listening, speaking, acting out, playing music, drawing and writing. Using technological shortcuts will also help reduce the demands on your child’s cognitive resources, for example IT educational programs that scaffold reading and writing to alleviate the pressure and improve progress, for example Clicker (Primary Education), Docs Plus (Secondary Education)

My child is so fretful and tired by the end of the day, what can I do?

It can be difficult for a young person to recognise physical fatigue (e.g. muscle tiredness, painful and effortful movement). They often do not know how to regulate physical activity to conserve energy.   Foundations of good quality sleep, nutritious food rich in protein for fuel and water to hydrate are important to regulating physical fatigue. A tool to help them identify, communicate and plan a response to regulate their fatigue is useful.

Zones of Regulation often used for emotional regulation can be adapted to provide a colour code prompt to help your child to recognise changes in their fatigue level and a coping strategy.

  • Green means that all is good, they are feeling fine and they can keep going.
  • Yellow is when they are starting to feel irritable, annoyed and they need to slow down.
  • Blue is when they are feeling very tired and they do not have the energy to continue, so they need to rest.
  • Red is when they have burned themselves out, feeling overtired and upset. They then need to initially Stop and then rest.

By using these zones, your child is able to regulate their fatigue to remain in Green and Yellow zones and avoid the unpleasant Blue and Red zones.




Recolo provides holistic, home and school-based neuropsychological rehabilitation. We are a child and family-centred service, putting your quality of life, well-being and participation at the heart. We aim to make a meaningful difference to the lives of children and their families living with a brain injury. See our website recolo.co.uk or contact lois.shafikhooper@recolo.co.uk, COO.