While the examples given in this section include plans for responding to changes in behaviors, success is not always that easy. Very often, the process of modifying problem behavior requires considerable time and patience. It involves trying several strategies, consulting with experts, having discussions with teachers, and learning about what works and doesn't work for your child. There are several things to consider as you go through this process.
Neuropsychologists are psychologists with special training in the relationship between the brain and behavior. They can help you and your child understand how the brain injury is affecting behavior. They can give practical suggestions and strategies for controlling, changing, and managing behaviors. They can also test your child's intelligence and, most importantly, examine how your child learns. As your child gets older, his brain will be challenged to do more complicated tasks for learning. The neuropsychologist can help your child meet these new challenges by working with educators to design effective teaching strategies, by teaching you how to help your child at home, and by teaching your child how to build on strengths and adapt to weaknesses.
TIP: For more information about choosing and working with a neuropsychologist, see "Neuropsychological Evaluation" in the chapter titled "Child's Educational Needs".
Many of the behaviors already described in this section can be affected by medications. Some medications can help control or improve specific behaviors related to the brain injury; others may aggravate or worsen some behaviors. For example, some medications have side effects that may make your child more drowsy, less attentive, or more irritable. Some medications may help calm or increase certain behaviors, such as restlessness or agitation. Because of your child's brain injury, it is very important to discuss any medications with your child's doctor or a specialist in brain injury. Your child may be referred to a neurologist, psychiatrist, or physiatrist who has experience with brain injury in children.
If your child is attending school, then medications need to be discussed with the school nurse, and a specific plan must be developed for administering medications while your child is in school. For more information about handling medications at school, see "What Information Will the School Need?" in the chapter titled "Child's Educational Needs".
Change is often difficult for the child who has had a brain injury, particularly a severe injury. Yet the life of any child at home and in school is constantly changing. How your child reacts to changes will also evolve over time. Some transitions may become easier, while others may become more difficult. Some changes will be major; others will be minor.
Because structure and consistency are so important for a child with a brain injury, any transition or change can affect the behaviors already described. Changes in the bus route, the arrival of a new teacher, moving to a new town, joining a new play group, switching after-school programs, responding to school cancellations and fire drills, and changes to assigned chores at home—any of these can require special planning. By planning ahead and helping your child prepare in advance for changes, you can smooth these transitions.
There are some predictable changes or transitions that are commonly difficult for children with brain injuries. They include changing teachers, grades, and schools. Changes are also related to growing up. Entering school is a big step for a young child. Middle school is a major change from elementary school. Adolescence is known for dramatic changes that are physical as well as emotional, social, and academic. The increased pressures, responsibilities, and changes in the life of an adolescent are typically more challenging for the child with a brain injury. Likewise, moving from adolescence to adulthood is an exciting but stressful time. The changes associated with graduating from high school, moving away from home, finding a job, going to college, and becoming more independent can all pose special challenges to the young adult with a brain injury.
By looking at change as an ongoing process, you can plan ahead. Learn which strategies and supports help your child make the smooth transitions, and then use them again and again. Even mistakes or bad experiences can be used for better planning next time. Preparation and planning with your child, family, the school, friends, and anyone else who will be involved are essential for making a transition successful.