Children with a physical disability or chronic condition may find it difficult to “fit in” with peers, as their care and needs are different than those of normally developing children of the same age. It has been suggested children having experienced head trauma may have even greater challenges, as they must often contend with dysfunctions of critical brain regions that enable normal social interaction (Lewis et al. 2000). Following a brain injury, the most detrimental lasting effects for children and adolescents are the loss of friends, the inability to participate in many social and leisure activities, and the absence of social support (Glang et al. 1997). The importance of social networks is crucial to the psychological wellbeing of students, as those with social support are less likely to experience difficulties relating to depression, anxiety or other affective disorders. Returning to school can be a daunting prospect for a young student who has just recovered from TBI. Hawley (2012) reported that levels of self-esteem in children with TBI at school were significantly lower self-esteem than controls and population norms as well as significant associations with anxiety and depression.
A literature review by Mealings et al. (2012) on school re-entry revealed that students with a TBI found special accommodation/consideration, individual assistance, effective planning and a transition program as the most helpful methods of reintegrating back into education. Conversely, lack of understanding and awareness of TBI, and not receiving help that had been planned were regarded as the most unhelpful issues. While these methods suit an educational setting, there may be different requirements in social environments. Two thirds of children had difficulties co-operating with others and difficulties participating in school and everyday activities (Soo et al. 2014). Younger children had more behavioural problems, but older adolescents had more emotional and anxiety-related difficulties following an ABI. Therefore, psychological adjustment levels are low following an ABI.
Wade et al. (2015) used a family online program solving therapy to determine long-term improvements for adolescents an average of 3 months post-injury. Adolescents in the intervention group improved in their everyday and community function at 12 months, but not in their home function, compared to a control group (Wade, Taylor, et al. 2015). Such improvements were not apparent until 12 months, which the authors suggest that perhaps changes in problem solving and executive function from the intervention may take time to translate to improve everyday functioning (Wade, Taylor, et al. 2015). Improvements in school/work and community functioning were significant and are important for re-integration for a child post-discharge (Wade, Taylor, et al. 2015).
Glang et al. (1997) investigated the results of a program designed to increase social networks for three children with brain injury. The model appeared beneficial; however, no lasting changes in social functioning were reported. The ability to participate in social networking in childhood and adolescence is an important issue and should be investigated further. Indeed, social skills may be an important area for future focus given that social problems may be among the most significant and long-lasting sequelae of brain injury in children (Glang et al. 1997).
There is Level 1b evidence that family based online problem solving programs compared to an internet resource comparison group improves everyday functioning as well as functioning in school and the community in adolescents following a TBI.
There is Level 4 evidence that interventions directed at strengthening the social interactions of children with brain injury may be beneficial; however, more research is required prior to making a more definitive conclusion.
Online family problem solving interventions improve everyday functioning, specifically in the school and community domains, for adolescents that have sustained a TBI.
The benefits of interventions directed at improving social interaction for children with brain injury are unclear. More research is required.