Parent's Guide: Balancing risk & independence for children with a brain injury
Growing up involves taking risks -
this is normal as young people 'test the waters' and move towards
independence and adulthood.
Risks are of many types. Some are social - for example, inviting
someone on a date for the first time; and some are emotional, such
as talking about fears. The risks that most concern parents are
usually those that might cause physical harm. Sometimes young
people do dangerous things deliberately; sometimes they just don't
see the risks.
One of the important things parents do is to help young people
learn to manage and judge risk. As parents, you need to judge what
risks are acceptable and make sure your young person has the
necessary skills to avoid danger. Parents who encourage
independence and allow a manageable element of risk are showing
optimism and confidence in their child.
Decisions about risk crop up all the time - your child wants to
go to the milk bar alone, go to a party where you don't know the
parents, or cook something on the gas. Ask yourself:
- Does he/she have the necessary skills?
- Can I trust him/her to follow the rules?
- What are the likely risks, including risks to others?
- Are there dangers outside his or her control?
- What would make it safe?
It may be tempting to put physical safety above all else, but
saying 'no' too often can have a cost. Kids lose confidence, or
rebel, or simply miss out.
Brain injury, risk & your child
The pitfalls and dilemmas faced by all parents can be magnified
when the young person has a brain injury. The young person may be
less capable of anticipating danger, judging risk, or showing
self-control. It may be harder to learn the skills needed to be
safely independent. These might be physical skills, and/or skills
related to behaviour, judgement, memory and perception.
Impulsive behaviour can place the young person at risk. Loss of
confidence, self-esteem and friendship networks may make the young
person more susceptible to the influence of peer groups, as he/she
tries to impress, fit in, and make friends.
At the same time, if you try to protect your young person by
restricting them more than others of their age, this can also
affect their self-esteem and relationships with other young
What protects young people from risk?
Research has shown that some of the most important factors that
protect young people from getting involved in some of the riskier
activities of adolescence are a strong and caring family and
school, and a sense of connection to family and school, coupled
with personal skills that enable the young person to develop
self-esteem and confidence. Other things that help are a stable
family structure, open lines of communication, a pro-active
approach to solving problems, and having a good relationship with
an adult outside the family-someone who believes in the young
It is always important to equip young people with the skills,
knowledge and confidence to say 'no' to things they do not want to
do. At the same time, risky activities are a normal part of growing
up, and it is imperative to try to minimize any harm that may
Where a brain injury is present, there are further
considerations. For example:
- Can the young person understand and remember instructions,
rules or laws and apply general rules to specific situations?
- Are impulsiveness and poor judgement issues?
- What sort of training or instruction does the young person need
to maximize the chances that he/she will act responsibly and
The following strategies may help:
- Set sensible and firm limits based on your family's values and
respect for laws and regulations.
- Be a good example and role model.
- Try to keep the communication lines open within the
family-listen to what your children have to say, respect their
point of view (even if you don't agree with it).
Provide a 'safety net' of appropriate supervision - be aware of
your child's friendships, know where they are at night, be awake
when they get home.
For young people with a brain injury, the small steps toward
independence that their peers manage easily may require extra
training or supervision. If they lack foresight or are impulsive,
some activities possibly should be avoided, controlled or
Very young children are generally under adult supervision when
they walk to shops or cross the road. Sometime during primary
school, many children begin to do these things without assistance.
Throughout secondary school, young people are generally expected to
get themselves to school and other places. With increasing
independence, children and young people might, for example, want to
walk to local shops alone, ride a bike around the local
neighbourhood or take public transport to social events as well as
A young person will usually want to do what others their age are
allowed to do. However, parents need to decide whether their child
with a brain injury has, for example:
- The necessary skills for traffic safety
- A good enough memory to remember rules, how to get where they
are going and home again, and what to do if they have problems
- The necessary physical skills and reflexes for a bicycle or
- The ability to organize what they need to do, including things
such as handling transport timetables and buying tickets.
If your child does not have the skills needed, then a structured
learning program - combined with an appropriate 'safety net' - may
Some children and young people with a brain injury may be
worryingly ready to trust and be friends with anyone and
everyone. Younger children may not have the separation anxiety
that most of their peers experience, because they are so used to
seeing many different people in hospital. All age groups can be
very trusting. This openness can have positive aspects, but it also
exposes the young person to risk of danger. Rules need to be very
specific and structured, about how to behave in particular
situations. They need to be practiced over and over, in social
Other everyday risks
If the young person wants to play a contact sport, a
neurosurgeon (if one has been involved) can say whether it's safe
and what precautions are necessary (for example, a helmet).
Otherwise, ask your pediatrician or general practitioner to advise.
The young person may need coaching to learn the rules of the game
or to manage any frustration they may feel.
Using household equipment like stoves and knives can be risky
if, for example, memory difficulties make it hard to learn a
sequence of steps. Again, set very specific rules and practize and
rehearse them repeatedly. Where necessary, you may need to put some
activities off limits, or install protective devices around, for
example, stoves. Talk to an occupational therapist about managing
risks of this nature.
Some kids always seem to be looking for something ambitious-and
possibly forbidden-to do. Try to step back and ask yourself what
you would do for a child who didn't have a brain injury. Make sure
lines of communication remain open, boost the young person's
self-esteem, encourage more positive friendships and provide
appropriate supervision-for example, have friends visit your house,
rather than letting your child go out with them.
Obtaining a driving license will not be possible for some young
people with a brain injury, but it will be an option for many
Problems that may affect a young person's ability to drive
- Physical weakness and/or poor coordination
- Altered sensation - for instance, lack of awareness of one side
of the body
- Difficulties in perception - for instance, difficulty judging
- Slowed reaction time
- Changed vision - for instance, a restricted visual field
- Difficulty concentrating
- Impulsive behaviour
- Confusion between left and right, difficulty in understanding
maps and directions
- Risk of epilepsy.
Even if the effects of a brain injury appear minor, it is
crucial that you find out the requirements to be met if someone is
applying for a driver's license and has a brain injury. It is
important to get this done, as it provides you, your child and
others with legal protection should an accident occur. Failure to
disclose a medical matter may be an offence, and any license or
permit obtained by false statement could be rendered null and
An assessment by an occupational therapist and/or a
neuropsychologist is recommended.
Many thanks to Brain Foundation Victoria for permission to adapt
their material for this fact sheet.