In recent years, there has been a significant increase in both acquired and congenital brain injuries (head injuries, stroke, brain tumors, infectious diseases and cerebral palsy) and neurodevelopmental disorders (genetic disorders, autism spectrum disorders and learning disorders) in children. These disorders produce physical, cognitive, behavioral, emotional and social injuries, with repercussions on the child, his or her family, social environment and school performance, so intervention programs must integrate all three areas.
Thanks to advances in medicine, the application of new technologies and current treatments, many of these children survive the brain sequelae. All this has generated a growing concern about brain damage in children, given the impact of the sequelae on their development and their ability to adapt socially. Moreover, brain damage in children represents an interruption in the course of their normal development, unlike in the adult population, whose developmental stages have already been reached.
Today, brain damage in children is known as the “silent epidemic” because, at first, many children show no observable cognitive deficit and it takes two or three years for the problems associated with brain damage to become evident. After this time, the physical lesions have apparently been corrected, but cognitive, psychological and psychiatric problems remain. Generally, once the acute phase of treatment is over, the child usually enters the school environment, where his or her cognitive difficulties are often underestimated. Therefore, many neuropsychological alterations resulting from brain damage are only noticed later in development, when poor performance at school raises suspicions that something is going on. Family functioning, socioeconomic status, access to rehabilitation services, and response to disability will play an important role in recovery from brain injury.
Among the consequences of brain injury, neuropsychological disturbances encompass cognitive, behavioral and emotional aspects. These children may present problems of: attention difficulties and reduced speed of information processing, memory disturbances and difficulties in making new learning, language and speech disturbances, executive function disturbances and behavioral and emotional disturbances.
Child neuropsychological rehabilitation should include the child, the family and the school.
Before designing a child neuropsychological rehabilitation program, a complete neuropsychological assessment that evaluates the child’s cognitive, emotional and behavioral functioning is essential. This information will establish the diagnosis, the type of intervention needed and guide the treatment throughout the process. The goals of child neuropsychological rehabilitation are to aid recovery and work with the brain-damaged child and his or her family to compensate, restore or replace the cognitive deficit, as well as to understand and treat cognitive, behavioral, emotional and social problems to find out how this deficit influences his or her environment.
Child neuropsychological rehabilitation should include the child, the family and the school. The school should be integrated into the intervention model, as it is a complex environment that requires academic, social and behavioral skills. The goal of neuropsychological rehabilitation is not only the recovery of higher mental functions, but mainly to offer assistance in the search for an improvement in the child’s quality of life after brain injury. This includes family, school, friends, community and leisure activities. The child should be helped to develop coping strategies and ways to participate in his or her community so that he or she can live the best quality of life possible. Children with brain damage should have long-term neuropsychological intervention, especially in periods of academic transition (preschool, elementary, high school). It is very important to work together with the rehabilitation team, the family and the school. The introduction in rehabilitation of a behavior modification program in children with behavioral problems derived from the brain injury allows us, on the one hand, to teach, establish or increase desirable behaviors adapted to the environment and, in parallel, to reduce, restrict or eliminate disruptive behaviors that interfere significantly in the child’s daily life activities. One of the current challenges of child neuropsychological rehabilitation is the development of tools that focus on addressing cognitive problems that may arise throughout the child’s development and that facilitate the generalization of the contents of cognitive rehabilitation sessions in daily life activities.
Intervention at school
A very important aspect in child neuropsychological rehabilitation is intervention through educational programs aimed at the family and school. They help to understand the problems presented by the children. It is very important to give written information and guidelines to parents and teachers, as they will help them to understand the cognitive and behavioral alterations and, thus, they will be able to make a correct intervention. The acquisition of new learning skills after brain damage can be complicated. Interventions in educational programs are aimed at accelerating these processes and it is appropriate to carry out school reinforcement, individually or in small groups, so that these children can progress more rapidly. Schools, specifically teachers, should maintain regular contact with the child’s neuropsychologist and receive explicit intervention guidelines, with the aim of enhancing the learning processes according to the characteristics of each child. School reinforcement, either individually or in small groups, will facilitate the consolidation of the concepts addressed in the classroom, thus ensuring that they have been acquired. Curricular adaptations, from the first moment the child returns to school, will help him/her to normalize the hospital-home-school transition situation, and may function as an important aid in his/her motivation to continue neuropsychological treatment and to achieve short, medium and long term goals. This educational process should continue throughout the child’s school life and should go through different stages in education, as new problems and difficulties may appear throughout school life.
In summary, neuropsychological rehabilitation has to be carried out not only in the short and medium term, but also in the long term. Specialists should be consultants to teachers, parents and significant others, and should aim to “organize the routines of school life, as well as other activities of daily living”. Each program should allow for follow-up with children so that new intervention strategies are targeted to meet the new demands of the child’s environment throughout the child’s development.