EWJ June 61 2025 web - Flipbook - Page 59
Long-Term Impact of Childhood
Traumatic Brain Injury: Some
Medicolegal Considerations
by Girish Vaidya
Consultant Child and Adolescent Psychiatrist, Medicolegal Expert Witness,
Healthcare Analytics.
Recent research on childhood traumatic brain injury
(TBI) has revealed significant implications for medicolegal practice, particularly for cases involving road
traffic accidents. This evolving understanding offers
critical insights for legal professionals who instruct
psychiatric experts in TBI assessments.
approximately 20,000 traumatic brain injury cases
annually in the UK, with around 5,000 being moderate to severe. The relationship between brain injury
and mental health is especially complex, as both are
linked to dysfunctions in the neurological pathways of
the brain.
The Chronic Nature of Childhood TBI
Traumatic brain injuries are a leading cause of
morbidity and mortality in children. While most children with mild TBI (mTBI) appear to recover from
initial symptoms, emerging research demonstrates
that TBI effects can persist throughout childhood and
span into adulthood. Even mild TBI can have significant long-term consequences for a substantial subgroup of children, representing a major public health
issue that deserves attention in a medicolegal context.
Critical Developmental Considerations
What makes childhood TBI uniquely challenging is
its interaction with ongoing brain development. The
paediatric brain continues to develop past late adolescence, with sensory systems and the frontal lobes still
maturing into early adulthood. This developmental
context creates a scenario where:
The traditional view of TBI as a discrete event with a
predictable recovery trajectory is increasingly being
replaced by a more nuanced understanding. Current
evidence supports approaching childhood TBI as a
chronic health condition requiring ongoing monitoring and proactive intervention.
l Injuries occurring during critical developmental
windows (before age 5 or during adolescence) can result in long-standing changes in neuroplasticity and
potential loss of developmental potential
l Some children may not present with immediate
effects but experience challenges later as academic
and social demands increase
l The full sequelae of paediatric TBI can emerge
and/or persist well into adulthood, supporting the
perspective that TBI in children is a chronic disease
process rather than a one-time event
Key Research Findings with Medicolegal Relevance
Longitudinal studies provide compelling evidence
that challenges conventional assumptions about
childhood TBI recovery:
l Comparison of adults who experienced childhood
TBI with unaffected siblings demonstrated lower educational attainment, more psychiatric conditions,
and increased disability - even for individuals who experienced mild TBI
l Research from a birth cohort found that children
hospitalized for mTBI showed increased inattention/hyperactivity and conduct problems through
ages 7-13
l Even after controlling for confounding factors,
children with mTBI demonstrated increased rates
of psychiatric disorders between ages 14-16, including symptoms consistent with ADHD, Conduct Disorder, and Substance Abuse
Figure 1. (above) A summary of key points discussed
in the current narrative review.
l By early adulthood (ages 21-25), these individuals
showed higher likelihood of being arrested and involved in property and violent offenses compared to
non-injured peers
Medicolegal Implications for Legal Practitioners
1. Causation and Attribution Challenges
The temporal gap between injury and symptom
emergence creates significant challenges in establishing causation. Effects that appear years after an injury
may be incorrectly attributed to other factors when
they actually represent delayed consequences of the
These findings are particularly relevant for
road traffic accident cases, as RTAs contribute to
EXPERT WITNESS JOURNAL
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JUNE 2025
