Brain Damage in Teenagers is Not Lessened because it is Hard to Distinguish

Brain damage in teenagers is more complicated than in adults as adolescence creates unique challenges and vulnerabilities for long term problems.

Many adults fail to appreciate the many unique challenges faced by teenagers. The teenage years are a time of huge social and sexual development in a world which is suddenly demanding more of them. Judgment has not completely developed and risk taking behaviors are viewed much more casually than an adult might view them. Our kids are facing career and education choices after they leave high school and in current times, these choices are adding pressures in an increasing manner with each passing year. Look good, fit in, excel–it truly is a time of super stressors while trying to transition from childhood to adulthood.

A greater tendency towards risk taking behaviors and an immature development of judgment can lead to dire consequences which can basically derail a teen if these behaviors result in brain damage. Especially when looking at the delicate balance a high performing teen may be keeping up with in often too busy schedules. With entrance exams and scholarships looming, a brain injury can be just the impetus to throw a promising teen off track.

Brain Damage in Teenagers is Complicated by Puberty

With the onset of puberty, brain injuries sustained in childhood may resurface as different areas of the brain mature and the damage which has remained mostly unnoticed suddenly becomes critical for successful functioning.

Children and teens are more susceptible to headaches following a concussion and it is not unusual for headaches to continue for up to a year following a concussion. And there is good evidence to support that the emergence of migraines after puberty, especially in girls, could likely be linked to a former injury in childhood. This appearance of migraines would be correctly diagnosed as post-traumatic migraine even though the incidence of concussion may not immediately precede the onset of migraine symptoms. And while we may write off headaches as a mild symptom of little concern, we must consider the fine line our teens are balancing on to take the steps they need for success during the short period of time we label adolescence.

University of Washing Research on Brain Damage in Teenagers

Researchers at the University of Washington in Seattle did a study of 512 children with brain injuries and discovered that children who had suffered a mild traumatic brain injury suffered from headaches and that the headaches were more severe in nature. Nearly half of the children suffered from headaches at least 3 months following their injury. And although most of these headaches resolved after a year, we are dismissing that the year is one quarter of the time spent in high school and that can drastically impact scholastic, sport, and other specialized performances.

Even Short Term Problems can Cause Life Disruptions

A year is a long time in the mind of a teenager and some conditions can impact them in terms of self-image as well. If reading gives one a headache for a year, then they are likely to presume that reading gives them headaches. You can quickly see where that perception might impact a young person’s performance in college.

Hormonal Damage in Teens

Traumatic brain injury in childhood may also impact the way hormones are produced and regulated once puberty hits. Hormones control our sex drive, how we reach puberty,  and our growth. In addition they impact the way we gain weight, and our feelings of thirst and hunger. Hormones impact our energy levels which amplifies certain aspects involved with the way the body gains weight or deciphers our need for food.

Brain damage in teenagers can be complicated by pituitary damage, which magnifies hormonal changes. Shown here is an empty sella, where the pituitary gland is expected to be.

These factors are related to the pituitary function and malfunctions are referred to as hypopituitarism. This can present in different ways. Growth may be stunted and a young person may not achieve puberty at the expected time. Menstrual cycles may be delayed to interrupted. There might be a lack of libido or sex drive which can result in psychological issues, especially depression.

 

On the other end children may reach puberty much earlier than expected.  This is called precocious puberty. Children may develop physically before their peers. This can be impactful in a child wanting to fit in with their peers but developing the physical signs of puberty long before their peers do.

Another problem with brain damage in teenagers is its impact on inhibitions. Disinhibition, the term for a loss of inhibitions, may present in multiple ways. It can be of a sexual nature in which a young person may say inappropriate things, have difficulty discerning when the appropriate time and place is to discuss things of a sexual nature, have difficulty following social norms and may even exhibit a lack of  concern for others’ personal sense of space through touch or merely standing too close to others. This type of disinhibition tends to make people uncomfortable and can greatly impact the child suffering from this as it is impossible to judge one’s own behavior when hormones are involved with regulating these behaviors. Insight is very difficult and confusing.

Symptoms Can Impact Young Adulthood

It is widely accepted that adolescence really extends to the age of 25, when the brain reaches full development. Brain injury during adolescence can impact the executive functioning of the brain. This is your ability to plan, organize and defer gratification. This effects one’s ability to make good decisions. Young people in this age range are capable of logical thinking but are not entirely developed when it comes to executive functioning and thus not capable of the exhibiting that same degree of logic in the decision making process. Thus, damage to the executive functioning of the brain can place young people at a far greater risk for poor decision making during this developmental phase.

Brain injury can affect the way executive functioning develops. As a consequence it can also adversely affect the way a young person might view their self and have very dire consequences. This is exacerbated by the teen’s knowledge that something is wrong but unlike a physical disability, it is invisible to those around them and therefore not addressed. This entire process is occurring during the critical time when a young person is discovering their identity and how they fit into society while setting the foundation for their success as an adult.

When looking specifically at teens in the 16-17 year old range brain damage in teenagers becomes particularly problematic. They have just come through puberty and navigated the changes from childhood to adolescence. They have established a basis for who they are in the world. Then we introduce a brain injury and shatter what is already a somewhat fragile sense of identity. It can upset the social structure they have built with family and friends as they begin to see different responses from those around them to this changed person they have become due to a traumatic brain injury. Disinhibitions may create social tensions in what were comfortable social circles prior to a brain injury. This tension can lead to an increased isolation and depression.

The impact of brain damage during adolescences is never more tragic than when it leads to suicide.

For our Pop Warner litigation over brain damage and football, click here.

Some individuals are going to feel the impact in other ways. The straight A student who has never had to work hard for grades is suddenly facing difficulty with comprehension and memory. This involves not only an emotional acceptance of the changes but learning a whole new set of behaviors and expectations. Similarly, the gifted athlete may experience a greater impact when what was automatic, suddenly becomes a hurdle which they must struggle over.

Often in these cases it is the parents themselves who struggle with the personality changes in their child injured during adolescence. They know their child prior to injury and the changes can be written off by lumping the changes into the onset of adolescence. Unlike children who advance into adolescence with a familiar and visible disability, children who suffer a brain injury and the subsequent changes in personality can be become alienated from both social systems and educational systems. All the dreams and aspirations of both the child and the parents may be threatened. The outcome may be that the child simply gives up because they are not living up to prior expectations and no one is really seeing what is going on in the child’s brain.

How do we then avoid losing promising teens to depression and despair due to brain injury and help them to achieve their goals? First, by a better  understanding that outward appearances have no correlation to what a teen might be going through due to a traumatic brain injury. Returning to school should be faced with a transition plan which offers coping and compensatory strategies for the teen.  Proper identification and assessment of the specific challenges each individual may face is also essential. We have to address four different areas; physical , emotional, social and behavioral functioning.

Focus and concentration may be more difficult in a busy classroom making it difficult to retain the information presented. The struggle to focus and concentrate can result in frustration and fatigue. To counteract this we might seat this student closer to the teacher and provide learning aids which minimize the demands of the classroom setting including written materials to study in a quieter environment. We might allow for frequent breaks to allow information to be processed. Schedules, reminders, organizers–there are many tools which can aid a student who has suffered a traumatic brain injury.

Behavioral problems may present and are often triggered by too much stimulation and a lack of predictability, structure or organization. This leads to fatigue and frustration which may grow throughout the day. Add to this the negative response from teachers and other students and we have a situation where behavioral issues get out of control. Ron Savage, EdD, classifies adolescent brain injury as a “developing disability over time” (Savage, 2012). As such, students with traumatic brain injury need to be re-evaluated regularly to ensure the success in navigating the education system.

Because adolescent brain injury can lead to a greater incidence of high risk behaviors, the communication lines at home need to be kept open. Parents need to educate themselves as to how to better assist their child and above all to understand that what is happening to their child is not necessarily intentional or under the child’s control. It is more likely that the child is confused and even unaware pf the changes which have occurred and why everyone is suddenly reacting differently.

It is also highly recommended among professionals that teens have a support group with other teens going through what is happening to them if at all possible. Teens communicate with each other differently than they do with adults and working through the issues with other teens is extremely helpful.

Whether a child is facing disrupted hormonal changes when reaching puberty after suffering a brain injury in childhood or has had their adolescence interrupted by a brain injury, the result Is often the same. A child can be lost in their journey to establish their identity and fail to build the supports to guarantee a successful adulthood. They may fail in the education system and lose social supports so essential to development. This does not seem to be lessened by the time period in which they are affected. Whether it be for a year or a present and permanent change, their self-image can be permanently altered in those periods of time. Their expectations of themselves may fail and their dreams can get lost.

I often hear people complaining about “that generation” but I empathize with the utterly terrifying pressures teenagers face today.  They not only are facing family expectations and peer pressure; they have overwhelming educational expectations and so many activities they are expected to excel at. And then they have the added pressures of media and social media to ensure themselves against. But unlike past generations we do have a greater understanding of brain injury and its impact on the adolescent brain as well as more resources to ensure the success of those impacted.

Whether a brain injury occurs due to carbon monoxide poisoning, a sport injury or an auto accident, it has a unique impact on different individuals. We often see the impact on children explained, and we see the special circumstances for the elderly. The most sensitive function of the human mind to brain damage is behavior.  Yet with the adolescent brain, it is hard to identify such changes without comprehensive and enlightened diagnosis as behavior and problems are so often attributed to “just being a teenager”. And individuals get lost in a system which is slow to recognize and validate the long term symptoms of brain injury. In those cases we see bright lights dimmed who just needed to be acknowledged and supported to achieve their places in society.

As I quoted above, brain injury is a “developing disability” that with diligence can be managed if the individual is set up with a transition plan and a plan for routine assessment for the long term.

This blog was written by Rebecca Martin

 

 

 

 

 

 

 

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