Traumatic brain injury (TBI) is a common cause of disrupted development among children and disproportionately affects children aged five and younger. Severe TBI can have chronic adverse effects on children’s’ cognitive development, communication, and social abilities. Due to various anatomical differences, including larger head size and poorer neck musculature, children are more susceptible to TBI than adults, especially at younger ages. Additionally, the nature of injury differs for children depending on their age: children under five are likely to sustain TBIs from falls in the home, while children over five years of age are more likely to be injured outside of the home during sports, traffic, or pedestrian accidents.
A particular area of interest for childhood TBI is the development of the frontal lobe, which reaches maturation during adulthood. The frontal lobe is responsible for the metacognitive aspect of thinking, including one’s perception of self-awareness, among other social and behavioral functions. Consequently, damage to this area of the brain can significantly disrupt children’s success in school, social life, communication, recreation, and other important aspects of daily living. During TBI recovery, children’s self-awareness of their disabilities plays a large role in how motivated they are to engage with rehabilitation. Younger age at injury and more severe injuries are associated with poor self-awareness, and also tend to have poor rehabilitation outcomes following TBI.
Current clinical practice for childhood TBI relies primarily on adult-based research, overlooking important milestones in childhood development. In addition to standard functional assessments for individuals with TBI, clinicians may consider adding an extra self-awareness component for evaluating children with TBI through self-report questionnaires. Incorporating self-awareness into children’s’ rehabilitation plans may be beneficial for motivation, functional recovery, and overall cognition following TBI.
Taking action to support the recovery and strengthening of self-awareness is a joint effort between clinicians, schools, and families. Psychology researchers have created a developmental framework of self-awareness in children with TBI, consisting of three major steps toward recovery. Individuals supporting children with TBI may find this model useful for guiding recovery through the context of self-awareness.
Developing a guide for self-awareness in children with TBI:
- Self-awareness knowledge. Throughout childhood, children develop cognitive skills and their senses of self, both of which can be hindered by TBI. In addition to linguistic challenges, researchers found that children with TBI had more difficulty answering open-ended interview questions related to self-awareness than children of the same age without TBI. Helping children intuitively understand their newly acquired difficulties and encouraging them to articulate their challenges is critical for self-awareness and cognitive development.
- Self-awareness in context. Children largely rely on external feedback from adults to learn how tasks should be performed, and their ability to self-monitor tasks matures during adolescence. Performance-based research found that many children with TBI recognize their functional difficulties during a task but fail to apply compensatory strategies to complete the task. Fostering self-reflection and independence through compensatory strategies is an important step in overcoming the functional barriers of TBI in children.
- Self-awareness for the future. As children mature in their general and TBI-related self-awareness, it is important to continually support their ongoing development through future planning. Planning and organizational skills typically begin developing in children around eight or nine years old, and memory difficulties acquired from TBI may create challenges for developing this domain of self-awareness in children with TBI. It is therefore crucial for adults to support children in this stage, as newly acquired functional limitations accompanying TBI require thorough planning for how young individuals can accommodate their specific needs.
References:
Lorna Wales. Conceptual framework of the recovery of self-awareness following a severe traumatic brain injury in childhood. Brain Injury. (December 2022).
Wales L, Sidebotham P, Hawley C. Self-awareness following a traumatic brain injury in childhood: a developmental perspective. Brain Injury. (January 2019).
Anderson V, Godfrey C, Rosenfeld J, et al. Predictors of cognitive function and recovery 10 years after traumatic brain injury in young children. Pediatrics. (February 2012).