Learning and cognitive effects of acquired brain injury

Meningis and sepcaemia can be a cause of acquired brain injury (ABI). This is an injury to the

brain that has happened aer birth.

This fact sheet includes informaon about problems with thinking, learning and making decisions as

a result of ABI aer meningis and sepcaemia.

ABI can adversely aect the way a child is able to use and develop cognive skills such as memory,

aenon, concentraon, and execuve funcons such as reasoning, problem solving and the use

and understanding of language. This in turn can have a signicant impact on all aspects of learning.

Because dierent mental abilies are located in dierent parts of the brain, ABI as a result of

meningis and sepcaemia can aect some, but not necessarily all of these skills.

The brain takes over 20 years to fully develop. Dicules with cognive skills may not be

immediately apparent when a child leaves hospital because they may be too young to have

developed certain skills. If a young child has meningis or sepcaemia, it may be months or even

years before any problems become evident. Older children will probably retain skills that have

already developed, but there may be problems with skills that usually develop at a later stage.

Addionally, children who demonstrate problems at an early stage may make progress in these

areas over me but then go on to experience dierent problems as they connue to develop.

It is really important that you report any concerns about your child’s development to your GP,

health visitor or child’s teacher as soon as possible.

Somemes cognive problems will become apparent when a child starts school for the rst me,

but this will not always be the case. Some problems may not become apparent unl a child goes to

secondary school when they are expected to show more independence, planning and responsibility

compared to primary school. This, along with more homework and ghter deadlines, can make

it very dicult for a child with a brain injury to keep up with their peers without geng some

appropriate addional support.

The special educaonal needs of children with ABI are oen complex, somemes dicult to idenfy

and generally dierent from those of other children with special educaonal needs. An individual

educaon plan (IEP) is oen needed to ensure that the child’s specic needs are met. Other

professionals, such as educaonal psychologists, may be involved in the assessment and support of

children with ABI.

connued ...

Meningis Research Foundaon

freephone helpline: 080 8800 3344

www.meningis.org

Meningis Now

freephone helpline: 0808 80 10 388

www.MeningisNow.org

Registered charity number 803016 (England & Wales), SC037790 (Scotland)

Registered charity number 1091105 (England & Wales), SC037586 (Scotland), CHY 12030 (Ireland)

Memory problems

Dierent areas of the brain are responsible for the many processes that make up our memory ability. ABI

can aect some or all of these processes to varying degrees, so every child who experiences memory

problems will have their own individual, specic strengths and weaknesses.

For memory to funcon properly, the brain needs to be able to gather, store and categorise informaon

so that it can be easily retrieved when needed. If any of these stages are aected by ABI, a child’s

memory can be impaired.

• Encoding is the term used for “taking in” informaon that is read, heard, seen or experienced and

then registered in the brain. The ability to do this relies on other factors, such as aenon, that

can also be adversely aected by ABI

• Storage is a complex process by which informaon is led away for future reference. There are

dierent levels of storage e.g. on a short or long term basis

• Retrieval of informaon that has been stored completes the memory process. This can be

deliberate e.g. remembering a fact to answer a queson, or automac e.g. remembering how to

get dressed without really thinking about it. Following ABI, it can be very dicult for children to

retrieve stored informaon.

There are many dierent ways that informaon is remembered or recalled for dierent purposes. These

can all be aected by ABI.

• Working memory is the term used to describe the inial “holding point” for informaon as it is

registered by the brain. There is only a limited capacity to hold informaon in this way; it needs to

be deliberately and quickly sorted or organised to be of any use. Instrucons given by a teacher

are held in working memory whilst they are sorted. Following ABI, children can nd it dicult to

organise or sort informaon in their working memory. This is oen related to problems with

aenon and organisaon skills. These problems can make it dicult for a child to follow

instrucons.

• Episodic memory comes from personal experiences or episodes in life, e.g. what you did on your

summer holiday. These are not always consciously remembered, but they are retained. The ability

to remember these experiences can be aected by ABI.

• Procedural memory involves learning a procedure or set of acons, usually by pracce and

repeon, which then becomes automac and doesn’t need to be thought about consciously. In

young people with ABI, the ability to use this type of memory is not oen aected.

• Semanc memory involves learning informaon deliberately e.g. a list of facts or rules. Children

with ABI can nd this very dicult, especially if the informaon is out of context and doesn’t

relate to other aspects of their life.

• Explicit and implicit memory

o Explicit memory involves consciously learning and remembering informaon, and being

aware of how this was done, e.g. studying for an exam. This can be dicult for children

following ABI

o Implicit memory is used when skills or knowledge are acquired without the child

consciously trying to learn e.g. the child “picks it up” through play and interacon with

others

connued ...

Meningis Research Foundaon

freephone helpline: 080 8800 3344

www.meningis.org

Meningis Now

freephone helpline: 0808 80 10 388

www.MeningisNow.org

Registered charity number 803016 (England & Wales), SC037790 (Scotland)

Registered charity number 1091105 (England & Wales), SC037586 (Scotland), CHY 12030 (Ireland)

• Sensory factors can aect a child’s ability to encode informaon. Most people have a preference

as to how they remember things;

o Visual memory – remembering things that have been seen

o Auditory memory – remembering things that have been heard

o Motor memory – using physical acons to help remember things e.g. some people recall

phone numbers by remembering the paern of movement their ngers make on the key

pad as the number is dialled.

The ability to encode informaon in a specic, preferred way can be aected by ABI. This may

mean that a child has to try to develop and pracce other ways to do this, which can be dicult

• Recall is an essenal part of the memory process that allows the retrieval and use of informaon

that has been stored. This ability can be impaired following ABI and a child may need to prompted

or given cues to help with recall.

Memory loss in the early recovery period aer meningis or sepcaemia can somemes be restored.

However, in general, prolonged memory loss is unlikely to recover. This can have a signicant impact on

a child’s life; aecng their home, school and social life. As with other problems, it is important to report

any concerns to your GP or child’s teacher. A referral to a neuropsychologist, who will assess your child’s

memory, may be needed.

There are many strategies that children with memory problems, and their families, friends or teachers,

can use which will make the most of the memory ability that has been retained.

The Brain Injury Hub, wrien by The Children’s Trust, contains an extensive amount of informaon on all

aspects of brain injury, including memory loss and praccal ps to help children at home and at school:

hp://www.braininjuryhub.co.uk/informaon-library/memory

Headway is a charity that provides informaon and gives support to people aected by brain injury, and

also has praccal ps to help with memory loss, which you can access from:

hps://www.headway.org.uk/Cognive.aspx

Aenon and concentraon

A child’s ability to pay aenon and concentrate is oen reduced during the early recovery period

following meningis or sepcaemia. This is usually a short term problem, but in some children, these

dicules can connue as a result of ABI and have an impact on their ability to learn.

Aenon is a term used to describe the skills needed to hold informaon consciously. It is closely related

to memory and other cognive skills, which can also be impaired following ABI. Concentraon is the

ability to maintain aenon over a period of me.

connued ...

Meningis Research Foundaon

freephone helpline: 080 8800 3344

www.meningis.org

Meningis Now

freephone helpline: 0808 80 10 388

www.MeningisNow.org

Registered charity number 803016 (England & Wales), SC037790 (Scotland)

Registered charity number 1091105 (England & Wales), SC037586 (Scotland), CHY 12030 (Ireland)

Aenon and concentraon problems can mean that children nd it dicult to focus on a task or piece

of school work, and are easily distracted, parcularly in a noisy or busy classroom where lots of things are

happening at the same me. It can also be dicult to do more than one thing at a me; something that

most other children take for granted e.g. talking whilst riding a bike. These problems tend to get worse

when the child is red, stressed or worried. As a child moves from primary to secondary school, there can

also be problems coping with a varied metable and nding the way around a larger building.

As with memory problems, there are strategies that can be used to help children make the most of the

abilies they have and overcome some of their dicules. It is really important to raise any concerns you

have with your child’s teacher so that support can be put in place.

The Child Brain Injury Trust is a charity providing non-medical services to families aected by childhood

acquired brain injury across the UK. These services include training for parents and teachers on

understanding the educaonal needs of children following ABI.

hps://childbraininjurytrust.org.uk/

Execuve funcon

The term execuve funcon describes a set of abilies that control and regulate other abilies and

behaviours. Execuve funcons include the ability to iniate and stop acons, to monitor and change

behaviour as needed, and to plan future behaviour when faced with new tasks and situaons. Execuve

funcons allow us to ancipate outcomes and adapt to changing situaons. The ability to form concepts

and think abstractly is oen considered a component of execuve funcon. Cognive skills, emoons and

behaviour are all regulated by execuve funcon.

Although dierent areas of the brain are involved in execuve funcon processes, it is the frontal lobes

that are most signicant. If these are injured as a result of meningis or sepcaemia, then a child can be

le with some of the following dicules:

• Planning and organising; if thinking is disorganised, it can be dicult to plan the sequence of

events needed to complete a task.

• Iniang and sustaining; a child may be unable to get started with a task even if they have the

knowledge or skills to carry it out

• Goal seng; a child may start a task, but not have a clear goal in mind. This can lead to them

seeming unmovated or disorganised

• Inhibing and self-monitoring; language or behaviour may be inappropriate because the child isn’t

able to stop and think about the implicaons of what is being said or done. This can lead to

dicules with friends when children are young, but can also put older children at risk if their

behaviour is inappropriate in certain situaons.

• Problem solving; these skills are oen needed to overcome daily obstacles or changes in roune.

ABI can make it very dicult for a child to think of dierent ways to solve problems

• Flexible thinking; a child may nd it dicult to cope with changes to roune or meeng new

people.

connued ...

Meningis Research Foundaon

freephone helpline: 080 8800 3344

www.meningis.org

Meningis Now

freephone helpline: 0808 80 10 388

www.MeningisNow.org

Registered charity number 803016 (England & Wales), SC037790 (Scotland)

Registered charity number 1091105 (England & Wales), SC037586 (Scotland), CHY 12030 (Ireland)

As with most aspects of brain development, execuve funcon skills mature throughout childhood and

early adulthood. Dicules may not therefore be evident immediately aer the child has been ill. The

move from primary to secondary school is oen a me that problems are noced, and as with other

cognive skills, it is very important to raise any concerns with your child’s teacher.

The charity Headway has a helpful fact sheet about impairments to execuve funcon with some useful

praccal advice to help overcome some of the eects.

hps://www.headway.org.uk/execuve-dysfuncon-aer-brain-injury.aspx

How to get help for your child

It is really important that you report any concerns about your child’s development to your GP, health

visitor or child’s teacher as soon as possible.

There is growing evidence to show that having bacterial meningis and sepcaemia in childhood can have

an impact on children’s learning

1-5

. If you are not happy aer speaking to your child’s GP do not be afraid

to be persistent. You can ask to be referred for a neuropsychological assessment and you may nd it

helpful to take a copy of this fact sheet along with your guide and journal to help explain your concerns.

Addionally, if you are not happy that your child’s teacher is acng on your concerns you can ask to see

the head teacher and request that they make a referral to have your child assessed by an educaonal

psychologist.

An educaonal psychologist or neuropsychologist can help to idenfy the special educaonal needs of

children with ABI. The underlying cause of a child’s dicules following ABI may oen be unclear unl an

appropriate assessment has been done.

Once the causes of a child’s problems have been idened, an individual educaon plan (IEP) is oen

needed to ensure that the child’s specic needs are met and strategies are put in place to help your child’s

learning.

It is also possible to seek help from a psychologist privately. A directory of chartered psychologists is

available from the Brish Psychological Society website at www.bps.org.uk/bpslegacy/dcp

Further sources of informaon and support

The Brain and Spine Foundaon

The Brain and Spine Foundaon is a charity commied to providing reliable informaon and support to

people living with neurological condions across the UK.

hp://www.brainandspine.org.uk/

connued ...

Meningis Research Foundaon

freephone helpline: 080 8800 3344

www.meningis.org

Meningis Now

freephone helpline: 0808 80 10 388

www.MeningisNow.org

Registered charity number 803016 (England & Wales), SC037790 (Scotland)

Registered charity number 1091105 (England & Wales), SC037586 (Scotland), CHY 12030 (Ireland)

Brain Injury Hub

The Brain Injury Hub, produced by the Children’s Trust, Tadworth provides excellent informaon and

praccal advice about acquired brain injury.

hp://www.braininjuryhub.co.uk/

The Child Brain Injury Trust (CBIT)

CBIT is a charity providing non-medical services to families aected by childhood acquired brain injury

across the UK. These services include training for parents and teachers on understanding the educaonal

needs of children following ABI. They also produce a range of useful publicaons.

hps://childbraininjurytrust.org.uk/

If you are parcularly concerned about your child’s educaon following ABI, a really useful resource

entled “Must try harder? Meeng the educaonal needs of children aer an acquired brain injury” can

be obtained by contacng the charity.

Headway

Headway is a charity that provides informaon and gives support to people aected by brain injury.

hps://www.headway.org.uk/home.aspx