Brain injury in children and adolescents

the school have grown in significance. There may be no outward sign that the child has received major trauma to the brain and problems initially may be considered to have arisen from the psychological trauma of the injury or illness, time in hospital and consequently away from home and school, part of the general recovery process following injury or illness, or a change in the parents’ or school’s handling of the child. Each of these could indeed partly explain the perceived change in the child, but there may be specific difficulties arising from damage to the brain (Goodman, 1994). Children who receive radiotherapy for leukaemia can show a slowly emerging pattern of deficits (Anderson et al, 1994). As the main aim of this paper is to describe how clinicians in child and adolescent mental health can help these children and their families, the specific problems arising from acquired brain injury will be described only briefly and the reader is referred to more extensive sources on head injury (Broman & Michel, 1995), treatment effects of leukaemia (Anderson et al, 1994) and brain tumours (Dennis et al, 1991). However, before any interventions can be considered, an assessment of the full complexity of difficulties including the injury variables (cause, severity and type of injury) and child variables (premorbid functioning and behaviour and age and developmental level; see Middleton (2001) for a fuller discussion) is needed.