NR Times reports on progress in unpicking the relationship between childhood TBI and struggles in education and the workplace.
The impact of childhood traumatic brain injuries on school years and working life is well documented; with behavioural, planning and learning challenges among many factors which can adversely affect young people.
Often these experiences happen years after their injury, as brains develop and educational life requires ever-more independence.
A spokesperson for the American Academy of Pediatrics explains to NR Times: “Mild traumatic brain injury can have an effect on how the brain functions.
“If the brain isn’t functioning normal, students can struggle with learning new information, recalling information, focusing and concentrating to their normal abilities.
“Communication is key in all mild TBI patients as most of the symptoms are not outwardly visible.
“Since you can’t see their struggles it is important for kids and the parents to be able to communicate with the school staff and teachers as to how their symptoms are specifically causing them struggles in school.”
But evidence linking TBI and specific negative outcomes, such as exclusion, absenteeism and unemployment, is lacking.
Glasgow University researchers this week announced their progress in addressing this, via fresh analysis of historic data.
Their findings, although inconclusive, may be a small step towards a greater understanding of interventions that might avoid such outcomes.
They carried out a retrospective study of the health and education administrative records of 766,244 children born in Scotland aged four to 18 and who attended school between 2009 and 2013.
Outcomes measured included special educational need (SEN), examination attainment, school absence and exclusion, and unemployment.
Children previously admitted to hospital for TBI were found to be more likely to have absences or exclusions from school.
They were more likely to have a record of SEN due to learning disability, learning difficulty, sensory, physical or motor impairment, communication problems, physical health problems, or social, emotional or behavioural difficulties, and they were more likely to have low attainment in examinations.
It has previously been reported that 39 per cent of children were enrolled in special education 1 year following hospitalisation for TBI and that 50 per cent to 79 per cent had either failed a grade or been placed in special education two or more years after TBI.
Previous studies have suggested that the risk of SEN was greater among children who had severe TBI, which is consistent with this latest study that notes stronger associations with adverse outcomes when hospital admissions for concussion are excluded.
The mean length of follow up from first head injury varied by outcome measure; 9.44 years for assessment of SEN and 9.53, 12.70, and 13.74 years for absenteeism and exclusion, attainment, and unemployment, respectively.
Of the 766,244 children in the cohort, 4,788 (0.6 per cent) had a history of hospitalisation for TBI. The mean age at first head injury admission was 3.73 years (median = 1.77 years).
The average age on leaving school was 17.14 (median = 17.37) years among children with a TBI and 17.19 (median = 17.43) among peers.
Among children previously admitted for a TBI, 336 (12.2 per cent) left school before age 16 years compared with 21,941 (10.2 per cent) of those not admitted for TBI.
There was no significant association with unemployment 6 months after leaving school.
Excluding hospitalisations coded as concussion strengthened the associations noted in the study.
“For TBI occurring before school age, it was impossible to be certain that SEN had not predated the TBI. Therefore, potential reverse causation was a limitation for this outcome,” the study says.
Researchers said: “Our findings help to address the paucity of evidence on the association between childhood TBI and absenteeism and exclusion.
“Behavioural problems are well-recognised sequelae of childhood TBI, and a single UK study of 525 children admitted to hospital for TBI reported a dose-relationship between injury severity and parent-reported school absences and exclusions over 3-year follow-up.
“Sociodemographic and maternity factors play an important role in predicting behavioural problems independent of childhood TBI.
“Indeed, previous studies have reported associations between maternity factors and educational outcomes including SEN. Our study demonstrated that the observed associations between hospitalisation for TBI and later educational outcomes remained even after adjusting for maternity and sociodemographic factors.
“Current evidence does not suggest that mild TBI in childhood results in significant or lasting reductions in school performance, but children with a moderate or severe TBI achieve significantly lower scores in the reading, mathematical, and language domains of achievement tests.
“There is consistent evidence that deficits in academic achievement persist beyond the first-year post injury, and that, two years after severe TBI, children are 18-fold more likely to have an unfavourable academic performance than their peers.
“Severe TBI in childhood is also associated with poorer academic performance in adulthood, compared with moderate or mild TBI or orthopaedic injuries. Studies on the association between childhood TBI and employment are few in number and have reported inconsistent findings, but 2 studies have demonstrated a significant association between history of childhood TBI and receipt of government benefits.”
Aiming to add more research evidence to childhood brain injury and school life, meanwhile, is a joint project between Swansea University, the Child Brain Injury Trust charity and the National ABI Education and Learning Syndicate (N–ABLES).
It plans to launch a UK-wide survey to understand educators’ perceptions and understanding of childhood acquired brain injury (ABI).
Open to anyone aged over 18 years and working in an educational role, the survey aims to gather information around the challenges children face in their learning following an acquired brain injury.
UKABIF executive director Chloe Hayward said: “This is the first nationwide survey of schools to have focused on acquired brain injury.
“The scale of this survey will provide us with a better understanding of how childhood brain injury can affect a child’s experience of education.
“I would encourage anyone working in the educational sphere to add their voice by completing the survey.”
The survey is accessible here and NR Times hopes to report on the findings once published.
While many schools are geared up to best support TBI survivors, others are not able to give the condition the attention it needs, sometimes through fear of making a mistake, says the American Academy of Pediatrics.
“Schools may feel they don’t know how to handle a child who has sustained a mild TBI, however they do support students with many other challenges of learning, even a student who just may struggle academically without any specific medical diagnosis.
“Often it just may be making schools aware of this and then it becomes a lot easier to conceptualise supporting the student with a mild traumatic brain injury while they are recovering.”
“[Schools] can support kids in a similar way to many other conditions that they already address with kids who have other challenges with learning such as attention deficit disorder, various learning disabilities, and anxiety.
“Kids may need extra time to complete tasks, may need a temporary reduction in their workload, may benefit from breaks throughout the day when symptoms flare, and may need to be in a more distraction free area of the classroom.
“Ideally schools should work with the child to help support them with what specific challenges they are dealing with individually.”
