Parent's Guide: promoting your family's wellbeing
In the aftermath of your child
acquiring a brain injury it can be easy to neglect your family.
Caring for a child with a brain injury can take a great deal of
time and energy. It's easy for everyone else's needs to get
side-lined, and difficult to get the balance right.
Let your other children know that you care about
them and that you understand that things are tough for
them. Try to give each child some time regularly, when he or she is
the focus of your attention.
Don't be afraid of feelings - your own or other
people's. Let everyone in the family understand that it is okay to
express their feelings. Try to maintain as much family structure as
possible, to give you all a sense of security and continuity. Keep
on doing some of the things you used to do as a family.
Encourage teenagers to get on with their lives
and make their own plans (remembering that it's always best to know
where your teenagers are and who they are with). Don't sweep
conflicts and problems under the carpet - talk about them openly,
and deal with them. Set aside times when the family can discuss
responsibilities and problems.
Let teachers or school counsellors know what's
happening at home. Keep in contact with the school to make
sure things are okay and 'troubleshoot' any problems.
Use respite services or find other ways to give
everyone a break (including yourself). Accept offers of help from
friends and relatives. Take care of yourself - both for your own
sake, and for your family's. Do at least one thing a week that is
just for you - pamper yourself occasionally. If your children
see you having fun and getting satisfaction out of life, they will
tend see this as a good model to follow, a good way to be. Try to
make opportunities to recognize and celebrate what's been achieved.
Observe the same special occasions as you did before the
RESPONDING TO YOUR OTHER
Your child's brain injury will affect any other
children in your family. Parents usually see these effects, but
professionals may be unaware of what siblings are feeling.
Children's reactions to a brain
injury in a sibling
Sadness is common and reactions may include both positive and
negative elements. Different responses can occur at the same time
or in quick succession. It's a challenge to encourage more positive
responses without 'putting the lid' on the negative ones.
Helping children express
The most important thing you can do for your other children is
to listen and be there for them. This means making time to be with
them-something that is often not easy, either practically or
emotionally. Brothers, sisters and other young relatives need
opportunities to express their feelings freely. They may believe
that some of their normal responses - anger, resentment, rejection
- are wrong or abnormal. Let them tell you their worries without
judging or trying to change how they're feeling.
Some young people don't talk to parents because they don't want
to worry them or be a burden. They may prefer to talk to friends,
other relatives or counsellors. This can be a good thing, but if
these people have little knowledge of brain injury try
to tactfully correct the wrong information if it comes up.
Young children can't take in too much information at one time.
Keep explanations simple and respond to questions at the level the
child can understand.
Take advantage of the chances you get to be with each of your
children - clearing up the kitchen, getting some breakfast together
or watching a match. You can't force children to talk, but you can
be there when they are ready.
Listening - active listening - is very important. Give the child
your attention, and show that you're interested without breaking
the flow of the conversation.
Often they don't volunteer how they're feeling - but they may
answer direct questions. Sometimes a gentle prompt can help, when
the child is ready to talk, such as "How do you think (your brother
or sister) has changed?"
When children do talk, try not to jump in too quickly with
reassurance or advice. Give them time to talk, to express their
feelings. It is important to remember children's behaviour may give
clues to how they are feeling, by withdrawing, acting out, sleep
disturbances or poor school results.
Providing factual information to
Children who are well informed are better able to understand and
accept what's happened. They are also usually better able to
support and understand the difficulties facing their brother or
sister with a brain injury. Don't overload your children with
information but answer their immediate questions and concerns. Be
aware that children vary widely in the amount of information they
want, and their ability to take it in.
In the early days after the injury, hospital or rehabilitation
staff may help to explain to your children what's happening, or
they may have useful pamphlets, books, videos or computer programs.
Ask the staff how your other children can be involved with your
child - maybe helping with care in some way, talking and listening,
or simply just being there and being reassuring.
injury & mental health
Ups and downs are a normal part of life. Teenagers in particular
have wide swings of mood as they learn to deal with increasing
independence and a changing body. This is to be expected, it's a
normal part of growing up, though it can often be demanding to live
Sometimes, however, changes in behaviour are the first sign of
something more serious. Many children with a brain
injury can remember how they were before the injury, and
adjusting to the changes can be very difficult. Changed abilities,
disrupted schooling, loss of friendships can cause great
unhappiness, and young people often become depressed as they
gradually become aware of the full impact of their brain
If depression is severe or prolonged, it can interfere with a
young person's normal development and increase the risk that they
will harm themselves in some way. Anyone with depression of this
nature (whether or not they have a brain injury) needs
treatment for their depression-and depression can be successfully
The young person may find it helpful to talk about what he or
she is experiencing. Sometimes it's easier to talk to a friend or
professional rather than a family member.
A brain injury may cause problems with thinking and
speech that make it harder to talk through problems, so it's
particularly important to teach concrete ways to help the young
person cope. But even if speech and thinking are limited, the young
person can often communicate their sadness and distress. It's
important to listen to what your young person is saying rather than
how he or she is saying it-simply having someone listen and care is
Can a brain injury
lead to mental illness?
Mental disorders can occur in anyone, and are common in our
society. Most disorders don't have a single cause, but result from
a complex combination of events and conditions, including the
person's biological and inherited make-up, their psychological
make-up and skills, and their family, social and community
Risk factors such as stress increase the likelihood that a
person will develop a mental disorder. Protective factors, on the
other hand, help people to cope with adversity such as an easy
temperament, a strong and supportive family and school environment,
and a sense of belonging.
Adolescence- particularly later adolescence- is the time when
mental disorders are at their most common. Some of these disorders
start in childhood, some during adolescence.
Many young people with a brain injury will
not develop a mental disorder, but some inevitably will. Each young
person's level of risk and protective factors will be different,
but some of the effects of a brain injury do increase
the risk of some mental disorders. For example, a brain
injury can erode a young person's confidence and
self-esteem, and behavioural problems can put teenagers and young
adults at high risk of becoming socially isolated and without
In short, a brain injury may both increase stress
and decrease the person's ability to cope with stress.
The most common symptom in young people with a brain
injury is depression - often probably a response to the
adjustments necessary after an injury. Young people with a
brain injury may also experience severe anxiety, sometimes
diagnosed as 'post-traumatic stress disorder'.
There is no evidence that a brain injury increases
the risk of a number of other mental disorders, including
schizophrenia and bipolar disorder.
Suicide is always a concern for parents. Remember that only a
small number of young people actually take their own lives, though
many more attempt suicide, and still more think about it. Mental
illness-particularly depression-is one of the main risk factors for
suicide, and young people who have previously attempted suicide, or
have deliberately harmed themselves in some way, are particularly
of a mental illness
Parents are the people most likely to notice signs of a mental
illness or emotional disorder. The signs can be difficult to pick,
as many resemble the effects of a brain injury. They
- A drop in school performance
- Rigidity in thinking and behaviour
- Unwarranted worry or anxiety and inability to cope with
- Changes in sleeping or eating habits
- Aggression (verbal or physical) towards others
- Excessive fear and feelings of persecution, paranoia
- Recurrent nightmares and seeing, hearing or experiencing things
that are not there
- Depression or social withdrawal
- Difficulty 'getting going'.
What to do if you suspect a mental
If you're worried about your child's emotional health or suspect
a mental illness, it's useful to consult a health
professional-preferably someone who understands brain injury
and its effects on your child, and preferably someone you've worked
well with before. Together you could first try some strategies to
deal with the problem. Your child's response will provide useful
Refusing to go to school may reflect relatively mild anxiety
that could be helped changing the child's school environment, or by
using carefully chosen strategies to change the child's behaviour.
If the anxiety is severe - for example, if the child is having
panic attacks - medication may be necessary.
Treatment for mental disorders has improved vastly over recent
years. Medication can usually reduce symptoms, and a range of
psychological, behavioural and social therapies help people to
address the problems in their lives and learn healthy ways of
coping and behaving.
If the young person's problems continue, try to see a mental
health professional with experience of both brain
injury and young people (ask about their experience). If you
can't find someone with these skills, make sure the mental health
professional knows your child's history. Mental health
professionals include psychiatrists and psychologists.
Brain injury specialists and mental health
specialists must coordinate their care, as treatment needs to take
account of both conditions. For example, the dose of medications
for mental illness may need to be adjusted for a person with
a brain injury.
Coordination may not be easy. The brain injury and
mental health treatment systems are separate, and experts in one
area may know relatively little about the other.
Good case management can help to ensure that services are
coordinated and the right treatment identified. Often, though,
parents have to be the 'go between' to make sure information is
References and further information
Many thanks to Brain Foundation Victoria for permission to adapt
their material for this fact sheet.