EWJ June 61 2025 web - Flipbook - Page 86
The Complex Relationship
Between Neurodevelopmental
Disorders and Paediatric Brain Injury
by Associate Solicitor, Oliver Shaw
Brain injuries in children, even subtle ones, can profoundly affect cognitive, emotional and
social functioning. These areas of function are also often impacted by neurodevelopmental
disorders (NDD) such as Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism
Spectrum Disorder (ASD). A diagnosis of an NDD or brain injury can have a profound effect
on a child’s future.
Challenges arise when a child suffers a head injury,
initial medical investigations do not identify obvious
damage to the brain, but the child’s behaviour significantly changes. Untangling which symptoms may
stem from a subtle brain injury, a psychological injury
or a potentially undiagnosed pre-existing condition,
such as a neurodevelopmental disorder is complex.
problems, impulsivity and poor emotional control)
might then manifest in the child’s behaviour. The
child might become disinhibited, displaying behaviour
inappropriate for the circumstances or have angry
outbursts. They might struggle with planning or
switching between activities, and instead get “stuck”
on one idea or action. This type of injury can also
make it harder for a child to empathise and understand others’ feelings, leading to awkward or challenging interactions. Each brain injury is different,
because each child is different and the effects of a
brain injury are unique.
In personal injury claims, parents and carers, as well
as the solicitors who support them, must prove it likely
that the accident caused at least some of the problems
suffered by the child before compensation can be
awarded.
Because many of these issues mirror the characteristics seen in ADHD and, to some extent, ASD, this is
where challenges can arise when bringing a personal
injury claim.
Brain injuries, particularly frontal lobe injuries, and
the relationship with ADHD and ASD is a complicating factor. However, there are common themes that
affect those seeking compensation for such injuries in
England and Wales, which are explored below.
The overlap between brain injury and
neurodevelopmental disorders
There is a striking similarity between the effects of a
frontal brain injury and the symptoms of certain neurodevelopmental disorders. The nature of ADHD is
that it involves impaired attention, hyperactivity, and
impulsivity which, as noted, are also common problems after child brain injury. Research supports this
overlap: one American based study found that diagnoses of “secondary ADHD” (attention-deficit type
symptoms arising after a brain injury) are three times
more common in children with head trauma than in
their uninjured peers (Study, The effect of pediatric
traumatic brain injury on behavioral outcomes: a systematic review - LI - 2013 - Developmental Medicine
& Child Neurology - Wiley Online Library).
Understanding frontal lobe brain injury in children
The frontal lobes are referred to as the brain’s
“executive centre”. This is because they play a dominant role in behaviour, personality and decision making. Located behind the forehead – the frontal lobes
are where the brain conducts problem-solving, planning, impulse control, judgement and attention. The
frontal lobes also contribute to emotional regulation
and motivation, which when combined with the other
functions creates behaviour. In a developing child the
frontal lobe, and therefore that child’s behaviour and
comprehension, are still maturing. Meaning that
damage to this area can disrupt development, and
significantly alter a child’s trajectory in life.
When a child suffers a frontal lobe injury, such as in a
fall or road accident, parents and carers, or teachers,
might notice changes in behaviour and abilities, but
these changes may not always appear immediately.
Difficulties can emerge later. Whilst damage will still
be present from an injury, problems might only become evident as the child faces increasingly complex
cognitive and social demands, typically as they get
older and advance in school.
Autism Spectrum Disorder (ASD) also shares some
similarities with brain injury (Headway – Brain Injury
& Autism, https://www.headway.org.uk/news-andcampaigns/news/2024/brain-injury-and-autism/). By
definition, autism affects social communication, behaviour, and sensory processing. However, it is important to distinguish that a traumatic brain injury
cannot itself “cause” a child to become autistic; autism
is a lifelong developmental condition rooted in genetic
and early brain development. The complexity arises
in a personal injury claim because a brain injury might
cause a child to present with traits similar to those with
ASD.
Common difficulties experienced by children who
have suffered brain injuries, such as those already
outlined (difficulty paying attention, memory
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