It seems like head injury awareness is everywhere these days. From veteran hospitals and construction sites to cheer practice and Pee-Wee hockey games, it appears that people are beginning to understand just how serious a head injury can be. One of the more important aspects of that awareness is the realization that with these types of injuries, many of the associated risks may not become apparent until long after the swelling has subsided and bruises have healed, or there may be no bruises at all. Memory loss, brain damage and difficulties with school have all been seen in children who suffered a blow to the head, and sometimes these conditions don’t manifest for months or years after the accident. Now, according to a new study published in the journal Pediatrics, there could be yet another risky, long-term side effect for children with brain injury: An increased risk for violent behavior.
The study, which followed 850 high school students for five years, showed that of the 88 study participants who had suffered head injury, 43 percent of them were involved in some form of violence in the year following their injury. That’s almost a 10 percent increase in violent activity when compared to study participants who had never suffered a head injury. These numbers may seem staggering to some, but come as no real surprise to the medical community.
“Given what we know about brain injuries’ ability to affect behavior, these results are far from shocking. Depending on the nature of the injury, it’s not unusual for a patient’s judgment of what is and what isn’t acceptable behavior to change after significant brain trauma,” says Mark Proctor, MD, of Children’s Hospital Boston’s department of Neurosurgery. “It’s a little bit like what happens when some people drink. Their inhibitions and normal judgment change, sometimes fairly significantly.”
A change in a patient’s mood or judgment following a head injury is known as disinhibition, where the person suddenly displays a lack of restraint, or regard for social norms not previously shown in their behavior. It’s not fully understood how blows to the skull result in disinhibition, but it is a fairly regular occurrence after serious brain injury, and can be seen in less severe cases as well.
“There are many cases where a child has suffered a head injury and then acted differently afterwards,” Proctor says. “Often the parents believe their child’s brain trauma was the trigger.”
To treat potential cases of disinhinbition, as well as other affects of head injury, patients at Children’s Hospital Boston’s Brian Injury Center are cared for by experts from many services, including Neurology, Neurosurgery, Trauma Program, Sports Medicine and Neuropsychology. Once admitted to the program, the multifaceted care team screens the patient for potential future concerns like academic difficulties or problems reintegrating to their normal life. By establishing concerns early and keeping up with the long term-care of each patient, the team at the Brain Injury Center is often able to offer treatment options before problems occur, instead of addressing them after the fact.
“Depending on the nature of the injury, it’s not unusual for a patient’s judgment of what is and what isn’t acceptable behavior to change after significant brain trauma.”
It’s a preemptive strategy, which is one of the cornerstones of Children’s Brain Injury Center’s mission. In addition to furthering the treatment of children with brain injury, the Brain Injury Center is dedicated to educating the next generation of health care practitioners and increasing awareness in the community through continued training and outreach programs. “People are finally beginning to recognize that kids with brain injury are more likely to have future problems in school, and possible social problems, as they recover,” Proctor says. “The more aware of that fact people are, the more likely they will be help identify these problems before they become too much of an issue.”