Emotional Issues Associated with BI
Life Changes After Brain Injury
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The impact of brain injury changes across the lifespan. This is due in part, to the variety of developmental stages and associated life changes that the person with brain injury goes through, though sometimes in different ways than their similar aged peers. The challenges that brain injury imposes on these developmental changes can be difficult.
During the childhood years, the main developmental milestone is that of early elementary education. Here the child’s tasks are focused around the classroom and the beginnings of establishing peer relationships. Due to brain injury, the child may require additional tutoring and special education classes. Some may be held back for a grade due to learning difficulties imposed by the brain injury itself. If there are physical problems or speech difficulties associated with the brain injury, the child with brain injury may experience feelings of embarrassment or self-consciousness. It is important for the parent in these situations to provide support, encouragement, and freely talk about these concerns with the child. Sometimes it can be helpful to include the child’s teacher in these discussions to assist in supporting the child in the classroom.
The adolescent years are marked by significant physical, hormonal, and behavioral changes. The adolescent with brain injury may experience accentuated changes. Brain injury may result in an enhancement in these behavioral changes, sometimes over and beyond what that youth’s peer may exhibit. A significant milestone that is achieved in most adolescents is an increased desire for independence from the parents. Although this is a normal part of growing up, the youth with brain injury may be placed in a dilemma: the same desires for independence are balanced against supervision for safety and judgment issues due to cognitive impairments due to brain injury. Parents in these situations may need to be clear on guidelines for behavior, socialization, communicate regularly, and provide a safety net for youth.
Most lifespan theories of development break down the adult years into several stages. These include young adult, middle adulthood, and older adulthood periods. Each are associated with specific developmental milestones. In young adulthood, transition into the world of college or the world of work is first encountered. The person with brain injury may require on going assistance through disabled student services in the college setting as an academic support system. Depending upon the severity of cognitive impairments, a supported employment approach to bridge the school-to-work transition may be of assistance. Likewise, independent living skills may need to be worked on to assure a smooth transition. During middle adulthood, difficult transitions can occur when changing jobs, or moving to a new location. Developing a clearly laid out plan for making moves, and for switching job settings may need to be attended to prior to such transitions. In older adulthood, a developmental milestone is that of examining issues of meaning, reflecting back upon one’s life and accomplishments, and considering life after work. For those with brain injury, these transitions can be especially difficult because of reduced ability to think flexibly and creatively. Throughout any of these life changes, an early sign of difficulty in making transitions can be increased problems with mood, interpersonal conflict, or social withdrawal. Counseling can sometimes ease the distress that may be associated with transitions throughout the lifespan to assist with coping skills and problem solving.
Jay Uomoto, Ph.D. is a Professor in the Department of Graduate Psychology at Seattle Pacific University and teaches neuroscience, personality and rehabilitation psychology courses in the Ph.D. Clinical Psychology Program. His research emphasizes the neuropsychology and multicultural aspects of traumatic brain injury, long-term care patterns in older Japanese Americans, as well as studies in interpersonal changes after brain injury. Dr. Uomoto is certified in Health Care Ethics. He also has a private practice in neuropsychology and rehabilitation psychology.