Psychiatric Consequences of Traumatic Brain Injury in Children and Adolescents

Abstract

Traumatic brain injury (TBI) is one of the most important causes of mortality and morbidity of children and adolescents worldwide.

The psychiatric, psychological, and cognitive consequences of brain injury can be emotional, e.g., post-traumatic stress disorder or anxiety; neuropsychiatric, e.g., ADHD, decrease of IQ; and symptoms such as social difficulties and processing skills deficit which do not fit into a diagnostic category but are very impairing. Co-morbidity is usual.

Because of brain maturation, the consequences of TBI evolve as the child grows. In some instances, brain plasticity may help to regain skills or compensate; but, very importantly, in many instances the totality of the consequences of TBI may not be apparent until the child is older. It may then become clear that the young person has not developed a particular skill to the level expected in the general population (e.g., the young person’s social skills may not be as sophisticated as those of other young people).

The severity of brain injury is one of the predictors of outcome, but other factors such as pre-injury aspects (child’s function, psychiatric and cognitive abilities, and family function) and post-injury factors (family, environment) are also significant influences.

Traumatic brain injury is often referred to as a “hidden” disability, because some of the effects appear small but they may have a great effect on function. Psychiatrists and psychologists should undertake a careful assessment and, in many instances, assessments should be repeated periodically until the young person has reached full brain maturation.