EWJ 60 April 2025 web - Journal - Page 53
original TBI. This is particularly relevant in mild TBI
cases, where initial medical documentation may not
fully capture potential long-term impacts.
particularly during key transition periods (starting
school, entering adolescence, transitioning to secondary education, entering adulthood).
2. Capacity and Decision-Making
Brain injuries may impair an individual's ability to
make decisions, raising questions of capacity and
guardianship. For children with TBI, these issues may
become particularly apparent during transitions to
adulthood, when executive function demands increase significantly. Legal professionals should be attuned to how injury-related cognitive changes might
affect a client's capacity as they mature.
Where the entire family has been affected due to the
road traffic accident, I have argued that there needs to
be a better understanding of the bi-directional impact
of the trauma on the parenting by the parent were the
parent and the subject child to be involved together
in the accident.
Conclusion: An Optimistic Approach to Complex
Cases
While this evolving understanding presents challenges, it also creates opportunities for improved outcomes. By recognizing the potential long-term
implications of childhood TBI and implementing appropriate monitoring protocols, we can significantly
enhance trajectories for affected children.
3. Assessment Complexities
The role of the child and adolescent psychiatrist as a
medicolegal expert in TBI cases is challenging and
complex. Any assessment must integrate:
l Pre-injury functioning and developmental history
l Acute injury characteristics
l Post-injury development and change, if any
l Behavioral observations as reported across settings
(it is often imperative to ask for information from
school and, if required, other settings that the child
has been attending
Legal professionals play a crucial role in ensuring
these children receive comprehensive support
throughout their development. With proper assessment, monitoring, and timely intervention, many children with TBI can achieve favorable outcomes despite
initial challenges.
Based on professional experience, treatment of
ADHD like presentation is relatively straightforward
and can be rewarding for all concerned.
The Imperative for Long-Term Monitoring
Given the evidence that childhood TBI effects can
emerge or worsen over time, long-term monitoring
becomes essential to both clinical care and medicolegal considerations. A proactive monitoring approach
should include regular developmental assessments,
[reference for the graphic - https://www.mdpi.com/16489144/60/3/380 (open access)]
Dr Linda Monaci
Consultant Clinical Neuropsychologist
Medico-legal assessments for suspected or known brain injury and/or
brain dysfunction in Personal Injury and Medical Negligence claims
• Acquired brain injury
• Cognitive dysfunction
• Stroke
• Epilepsy
• Mental capacity assessments
• Post-concussion syndrome
• Anoxia
• Dementia
• Neuropsychiatric conditions
• Alcohol and drug abuse
Medico-legal services:
Instructions from Claimants, Defendants and as a Single Joint Expert. Assessments can also be carried out in Italian.
Dr Monaci has a good knowledge of Swedish and Spanish and has experience of working through interpreters.
Dr Monaci has completed the Cardiff University Bond Solon Expert Witness Certificates.
Dr Monaci receives approximately 60% instructions from Claimants and 40% from Defendants. In April 2024, Dr Monaci counted each new
instruction received in the previous 12 months and found the percentages were as follows: 58% Claimant / 37% Defendant / 5% Jointly
instructed.
Clinical services:
Neurorehabilitation services in Surrey.
Main consulting rooms (nationwide locations):
Consultations for medico-legal services are available in London, Guildford, Horsham, Leatherhead and Southampton.
Assessments in care homes and in individuals' home may also be possible when based on clinical needs.
Clinical services are available in Surrey. Available for travel throughout the UK and abroad.
Correspondence address:
Email: linda@monaciconsultancy.com
www.monaciconsultancy.com
EXPERT WITNESS JOURNAL
51
APRIL 2025
