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. 2004 Feb;89(2):136–142. doi: 10.1136/adc.2002.025577

Return to school after brain injury

C Hawley 1, A Ward 1, A Magnay 1, W Mychalkiw 1
PMCID: PMC1719800  PMID: 14736628

Abstract

Aims: To examine return to school and classroom performance following traumatic brain injury (TBI).

Methods: This cross-sectional study set in the community comprised a group of 67 school-age children with TBI (35 mild, 13 moderate, 19 severe) and 14 uninjured matched controls. Parents and children were interviewed and children assessed at a mean of 2 years post injury. Teachers reported on academic performance and educational needs. The main measures used were classroom performance, the Children's Memory Scale (CMS), the Wechsler Intelligence Scale for Children–third edition UK (WISC-III) and the Weschler Objective Reading Dimensions (WORD).

Results: One third of teachers were unaware of the TBI. On return to school, special arrangements were made for 18 children (27%). Special educational needs were identified for 16 (24%), but only six children (9%) received specialist help. Two thirds of children with TBI had difficulties with school work, half had attention/concentration problems and 26 (39%) had memory problems. Compared to other pupils in the class, one third of children with TBI were performing below average. On the CMS, one third of the severe group were impaired/borderline for immediate and delayed recall of verbal material, and over one quarter were impaired/borderline for general memory. Children in the severe group had a mean full-scale IQ significantly lower than controls. Half the TBI group had a reading age ⩾1 year below their chronological age, one third were reading ⩾2 years below their chronological age.

Conclusions: Schools rely on parents to inform them about a TBI, and rarely receive information on possible long-term sequelae. At hospital discharge, health professionals should provide schools with information about TBI and possible long-term impairments, so that children returning to school receive appropriate support.

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Selected References

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  1. Anderson V. A., Morse S. A., Klug G., Catroppa C., Haritou F., Rosenfeld J., Pentland L. Predicting recovery from head injury in young children: a prospective analysis. J Int Neuropsychol Soc. 1997 Nov;3(6):568–580. [PubMed] [Google Scholar]
  2. Bevington J., Wishart J. G. The influence of classroom peers on cognitive performance in children with behavioural problems. Br J Educ Psychol. 1999 Mar;69(Pt 1):19–32. doi: 10.1348/000709999157545. [DOI] [PubMed] [Google Scholar]
  3. Catroppa Cathy, Anderson Vicki. Recovery in memory function in the first year following TBI in children. Brain Inj. 2002 May;16(5):369–384. doi: 10.1080/02699050110104444. [DOI] [PubMed] [Google Scholar]
  4. Chadwick O., Rutter M., Shaffer D., Shrout P. E. A prospective study of children with head injuries: IV. Specific cognitive deficits. J Clin Neuropsychol. 1981 Jul;3(2):101–120. doi: 10.1080/01688638108403117. [DOI] [PubMed] [Google Scholar]
  5. Crouchman M., Rossiter L., Colaco T., Forsyth R. A practical outcome scale for paediatric head injury. Arch Dis Child. 2001 Feb;84(2):120–124. doi: 10.1136/adc.84.2.120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Donders J. Memory functioning after traumatic brain injury in children. Brain Inj. 1993 Sep-Oct;7(5):431–437. doi: 10.3109/02699059309029686. [DOI] [PubMed] [Google Scholar]
  7. Ewing-Cobbs L., Miner M. E., Fletcher J. M., Levin H. S. Intellectual, motor, and language sequelae following closed head injury in infants and preschoolers. J Pediatr Psychol. 1989 Dec;14(4):531–547. doi: 10.1093/jpepsy/14.4.531. [DOI] [PubMed] [Google Scholar]
  8. Ewing-Cobbs L., Thompson N. M., Miner M. E., Fletcher J. M. Gunshot wounds to the brain in children and adolescents: age and neurobehavioral development. Neurosurgery. 1994 Aug;35(2):225–233. doi: 10.1227/00006123-199408000-00007. [DOI] [PubMed] [Google Scholar]
  9. Guyer B., Ellers B. Childhood injuries in the United States. Mortality, Morbidity, and cost. Am J Dis Child. 1990 Jun;144(6):649–652. doi: 10.1001/archpedi.1990.02150300047016. [DOI] [PubMed] [Google Scholar]
  10. Hawley Carol A., Ward Anthony B., Magnay Andrew R., Long Julie. Children's brain injury: a postal follow-up of 525 children from one health region in the UK. Brain Inj. 2002 Nov;16(11):969–985. doi: 10.1080/02699050210147239. [DOI] [PubMed] [Google Scholar]
  11. Klonoff H., Clark C., Klonoff P. S. Long-term outcome of head injuries: a 23 year follow up study of children with head injuries. J Neurol Neurosurg Psychiatry. 1993 Apr;56(4):410–415. doi: 10.1136/jnnp.56.4.410. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kraus J. F., Rock A., Hemyari P. Brain injuries among infants, children, adolescents, and young adults. Am J Dis Child. 1990 Jun;144(6):684–691. doi: 10.1001/archpedi.1990.02150300082022. [DOI] [PubMed] [Google Scholar]
  13. Levin H. S., Eisenberg H. M. Neuropsychological outcome of closed head injury in children and adolescents. Childs Brain. 1979;5(3):281–292. doi: 10.1159/000119825. [DOI] [PubMed] [Google Scholar]
  14. Levin H. S., Eisenberg H. M., Wigg N. R., Kobayashi K. Memory and intellectual ability after head injury in children and adolescents. Neurosurgery. 1982 Nov;11(5):668–673. doi: 10.1227/00006123-198211000-00009. [DOI] [PubMed] [Google Scholar]
  15. Middleton J. A. Practitioner review: psychological sequelae of head injury in children and adolescents. J Child Psychol Psychiatry. 2001 Feb;42(2):165–180. [PubMed] [Google Scholar]
  16. Nelson J. E., Kelly T. P. Long-term outcome of learning and memory in children following severe closed head injury. Pediatr Rehabil. 2002 Jan-Mar;5(1):37–41. doi: 10.1080/1363849021000007088. [DOI] [PubMed] [Google Scholar]
  17. Parmelee D. X. Neuropsychiatric sequellae of traumatic brain injury in children and adolescents. Psychiatr Med. 1989;7(1):11–16. [PubMed] [Google Scholar]
  18. Pfeffer J., Martin R. P. Comparison of mothers' and fathers' temperament ratings of referred and nonreferred preschool children. J Clin Psychol. 1983 Nov;39(6):1013–1020. doi: 10.1002/1097-4679(198311)39:6<1013::aid-jclp2270390634>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  19. Scott-Jupp R., Marlow N., Seddon N., Rosenbloom L. Rehabilitation and outcome after severe head injury. Arch Dis Child. 1992 Feb;67(2):222–226. doi: 10.1136/adc.67.2.222. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Shaffer D., Bijur P., Chadwick O. F., Rutter M. L. Head injury and later reading disability. J Am Acad Child Psychiatry. 1980 Autumn;19(4):592–610. doi: 10.1016/s0002-7138(09)60964-x. [DOI] [PubMed] [Google Scholar]
  21. Slomine Beth S., Gerring Joan P., Grados Marco A., Vasa Roma, Brady Kathleen D., Christensen James R., Denckla Martha Bridge. Performance on measures of executive function following pediatric traumatic brain injury. Brain Inj. 2002 Sep;16(9):759–772. doi: 10.1080/02699050210127286. [DOI] [PubMed] [Google Scholar]
  22. Taylor H. G., Alden J. Age-related differences in outcomes following childhood brain insults: an introduction and overview. J Int Neuropsychol Soc. 1997 Nov;3(6):555–567. [PubMed] [Google Scholar]
  23. Teasdale G., Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81–84. doi: 10.1016/s0140-6736(74)91639-0. [DOI] [PubMed] [Google Scholar]

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