Learning can be defined as the result of the interaction between the central nervous system and the environment. A complex interaction between different neurobiological and genetic components, together with the modulating effect of the environment on brain development, determines the child’s cognitive capacity, on which his or her learning abilities and difficulties will ultimately depend.
Most children with school failure due to learning disorders or acquired brain damage present problems in the development of executive functions: ability to maintain attention, plan, organize time, regulate one’s emotions and control thoughts, with the aim of executing one’s own behavior effectively and efficiently.
This executive dysfunction hinders the proper adaptation of children and adolescents to the constant changes in their environment, especially in the school environment, where these skills are essential to integrate new and more complex learning.
In this sense, last April 20, the XXIX Technical Conference of the Institut Guttmann was held, in which the application of neuropsychology at school was discussed. Very interesting conclusions were drawn, among which we highlight those of the neuropsychologist, Dr. Antonia Enseñat.
Dr. Enseñat focused on describing the difficulties in the executive functions presented by children who have suffered acquired brain damage, and on explaining the neuropsychological rehabilitation program carried out at the Guttmann Institute.
Executive functions begin to develop in the first year of life and continue into late adolescence and early young adulthood. Therefore, the sequelae of brain injury will depend on the stage of development the child is in at the time the damage occurs. Damage to the child’s brain may alter future skill acquisition, and behavioral disturbances may not appear until later in life. The younger the child is when the injury occurs, the more severe the functional impairment.
Many children with early brain injuries do not show noticeable cognitive deficits in the early stages; it is when the frontal lobe evolves that these deficits appear. It has been observed that frontal brain damage during early childhood, although it does not cause evident deficits in executive functioning after the damage (since these functions have not yet developed), does have long-term repercussions. Thus, although frontal functioning is not clearly observable in the first stage of development, its lesion generates difficulties in acquiring the necessary prerequisites for full executive functioning at later stages of development, and clearly in the acquisition of school learning.
Dysfunction of the executive functions makes it very difficult for children and adolescents to adapt adequately to the constant changes in their environment, especially in the school and academic environment, where these capacities are necessary to carry out and integrate new and complex learning. Among the different consequences of acquired brain damage, neuropsychological alterations are highly disabling. They have an impact on the child, his family, social environment and school performance.
The main neuropsychological deficits after suffering brain damage are:
- Cognitive alterations.
- Attention impairment.
- Reduction of information processing speed.
- Memory impairment and low capacity to learn new things.
- Visuoperceptive dysfunction.
- Executive dysfunction (planning and organization difficulties, cognitive inflexibility, poor working memory, poor problem solving).
- Emotional and behavioral disturbances
- Irritability.
- Impulsivity.
- Low frustration tolerance.
- Apathy.
- Alterations in social cognition
- Loss of social skills.
- Poor emotional perception.
- Poor empathy.
Prior to designing a child neuropsychological rehabilitation program, a neuropsychological evaluation is essential. The child neuropsychological evaluation differs from an adult psychological evaluation not only because of the type of tests used, but also because of the interpretation of the results in terms of knowledge of the structure and function of the developing brain.
The objective of this evaluation is to identify, describe and quantify the cognitive, emotional, behavioral and social alterations caused by the different brain lesions, as well as to know the preserved abilities. This information will help us to make a good diagnosis, establish treatment goals and guide the neuropsychological rehabilitation program.
The neuropsychological rehabilitation process encompasses any intervention strategy aimed at enabling children who have suffered an injury and their families to reduce neuropsychological alterations, manage these difficulties and reduce their impact on daily life.
Child neuropsychological rehabilitation is part of a multidisciplinary model involving different professionals. In child neuropsychological rehabilitation, different interventions should be combined and used simultaneously depending on the stage of recovery of the brain-damaged child.
The neuropsychological rehabilitation program consists of the following points:
- Cognitive rehabilitation.
- Functional adaptation.
- Environmental modification.
- Behavioral and emotional interventions.
- Family intervention.
- School intervention.
In the early stages of neuropsychological treatment, it is essential to work with families on the process of adaptation to the child’s difficulties. A good adaptation is an essential step for the success of rehabilitation. In the early stages parents are focused on the physical aspects of physical recovery, when it is the cognitive recovery that is the most important aspect of successful rehabilitation.
On reintegration into school, children may encounter difficulties whose cause is not correctly diagnosed, with the risk that they may be dealt with incorrectly. School represents a highly stressful series of situations, involving new learning and multiple demands, such as paying attention, remembering information and exercising self-control.
A very important part of neuropsychological rehabilitation is school intervention. Schools, specifically teachers, should maintain regular contact with the child’s neuropsychologist to receive explicit intervention guidelines with the aim of enhancing learning processes according to the characteristics of each child.
Children with brain damage should receive long-term intervention, especially in periods of academic transition (preschool, primary, secondary). It is very important to work together with the rehabilitation team, the family and the school.