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Adolescents with Traumatic Brain Injury
Ronald C. Savage, Ed.D.
Adolescence is a time of growth, freedom, adjustment, and, unfortunately, injury. During adolescence the rate of traumatic brain injury increases dramatically, with the number of severe injuries sustained between ages 15 and 19 equal to all the previous 14 years combined. Most traumatic brain injuries during adolescence are related to motor vehicle accidents. This is the time when adolescents are beginning to get their driver's licenses and are spending much of their time "on the move." Experimenting with alcohol and drugs combined with driving increases the possibility of serious accidents during adolescence. It is no longer uncommon for adolescents to have had a friend killed or injured in a motor vehicle accident. More frightening is the fact that in our major cities, gun shot wounds are fast becoming the leading cause of death and injury to adolescents.
Neurologically, the brain appears to be going through a major, and perhaps its last, reorganization. It has been known for many years that the frontal area of the brain is myelinated during adolescence. However, recent research has indicated that neurological changes may be more widespread. The increased number of nerve connections (or synapses) that characterized the earlier stages of child development are reduced by as much as half in adolescence. This appears to be the end of the "supercharged" childhood brain and the beginning of the efficient, stabilized adult brain. Both the changes in the frontal lobes (or the "executive" part of the brain) and the more efficient connections are likely to be related to the emerging ability to sustain logical thought in solving abstract and complex problems.
Adolescents are confronted with rapid physiological changes, including sexual maturation. They are in the process of getting ready to become adults, but are not yet expected to grapple with the demands of adulthood. Along with the development of conceptual thought comes the ability to struggle with issues of self identity and intimacy. Most adolescents confront the developmental tasks of this period with energy, and with a burgeoning sense of independence, selfsufficiency, and selfconfidence. However, they are also more aware of the fragility of life and the reality of death.
Traumatic brain injury can alter the adolescent's sense of physical attractiveness, perception of vulnerability, selfconfidence, social appropriateness, and cognitive capacities. Previously mastered academic skills appear to be more resistant to injury effects and intellectual problems may be less pronounced than in children. However, the effect of traumatic brain injury on developing executive functions and the evolving "sense of self" has rarely been directly studied in adolescence.
Adolescents may resent the perception of being different subsequent to their injuries and may become quite resistant to the need to alter any part of their lives, despite the injuryrelated necessity. Any loss of school time, family disruption, and/or changing peer relationships will have a significant impact on the adolescent's life. Their struggles with "who" they are now, how to adjust all their dreams and goals, and how they see themselves fitting into their home and community can create a multitude of problems. Anger, depression, suicidal thoughts, inappropriate behaviors, substance abuse are not uncommon following a traumatic brain injury. Their personal lives and the lives of their families and friends have been drastically altered.
Unfortunately, without comprehensive services and long term followup and support, the life of an adolescent with a traumatic brain injury only worsens as they grow into adulthood. Adolescents need age specific medical and rehabilitation services, educational programs based on their strengths and needs, and transition services to help them become as functional and independent as possible in the community. Without such services and coordinated efforts among services, the adolescent's life will only become more difficult over time.
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