Locus/system
Damaged
Diffuse axonal
damage
Cognitive
impairment
Slower speed of
processing
Environmental
trigger in school
setting
Conversation with
group of friends in
playground
Possible experience
thoughts &
emotions
Can’t keep up, so
feels frustrated, left
out & inferior – “I’m
useless – no-one
wants to know me”
Behaviour as result
of experience
thoughts &
emotions
Social withdrawal
Outcome – A
vicious circle of
increasing isolation
and despair
Friends stop
interacting,
increased
depression &
isolation – sense of
“what’s the point
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What might help?
 Identifying possible environmental
triggers such as – minor social
stressors, large groups, getting about in
an unfamiliar place, excess noise, bright
lights, new academic work, work that
once was easy and is now difficult.
 Ensuring all those in contact are fully
aware of the emotional and behavioural
outcomes that can occur following ABI
 Helping pupils to place emphasis on
monitoring problems and successes so
as to promote self-awareness,
confidence and autobiographical recall.
Recognising and rewarding small steps
to overcome specific difficulties such as
‘short fuse’
Providing strategies for seeking
sanctuary – for example if pupil feels
need to leave a classroom situation
Ensuring support (adults/peers) is
available, possibly in a formal structure
such as Mentors (adult), ‘Circle of
Friends’ (peers)
Encouraging pupils to seek help
whenever they need it
Never thinking “s/he should be ok by
now – s/he’s just being manipulative…”
Being aware of, and processing your
own sense of loss
Being, endlessly patient, warm,
accepting and tolerant. Suppose it was
you…
For further information, please contact:
Educational Psychology:
0114 2506800
Clinical Psychology:
0114 2717608
Speech and Language Therapy: 0114 2717617
Hospital and Home Education: 0114 2397711
PSL 18 29/09/08
This series of leaflets was developed through
the collaborative work of the above services.
Acquired Brain Injury
(ABI)
Mood and Affective
Problems
.
range of emotional disturbance. Injury to
the ventro-medial frontal areas is
thought to impact on motivation, as
does injury to the right hemisphere and
sub cortical damage. It is imperative
that this biological underpinning of
emotional response is recognised.
Difficult behaviours shown by an ABI
survivor may look as if they are under
his/her control – but may in fact be as
far from it as ,say, the ability to walk
unaided following nerve damage.
Mood and affective problems
Following ABI pupils may demonstrate
difficulties in “mood and affect” – the way
in which they respond emotionally to
everyday events. Typically 50-80% of
survivors show elements of depression,
anxiety, irritability, apathy and indifference.
If these emotional consequences of ABI are
left unrecognised and untreated there may
be long term psychological and social
difficulties. Research has shown that
families cope much better with the physical
disability ABI may have caused than the
emotional and behavioural difficulties. This
is also likely to be true of peers and school
staff:
“It’s been two years since the accident –
surely it can’t explain why s/he was so rude
to Mr Jackson”….

Psychosocial – There are two ways in
which ABI impacts on the social life of
the pupil . Firstly there is the change in
the individuals relationship to others.
He/she may be unable to take part in
many social activities previously
important to them. Peers may drift
away; new friendships may be hard to
form. At a time when the survivor most
needs a supportive social circle and is
most vulnerable and damaged, the
change in their mood and behaviour
may alienate all but the most resilient of
their friends and family. This is where
the second psychosocial factor lies.
Close family and friends are themselves
so distressed by the, in effect, ‘loss’ of
the pre-injury individual that they
struggle to offer the calm, adaptive,
problem solving approach essential to
aid the emotional recovery of the
survivor and may be overwhelmed by
their own grief.

Environment – Whether at home or at
school the pupil is in an environment,
both physical and social, and the
demands of that environment will
interact with the pupil’s vulnerabilities.
An example of the way this may happen
is as follows:
Psychological – How we see ourselves,
our self-concept, is central to who we are
and how well we function. The pupil who
has experienced ABI may find this self
perception distressingly threatened in the
following ways:
Repeated failure and associated frustration
Others not believing reports of cognitive
difficulties
In fact mood and affect disorder may last
up to and beyond three years, although for
most survivors symptoms generally
improve within 3-6 months. In analysing the
emotional consequences of ABI it may be
helpful to categorise them in three ways:
Neurological, Psychological and
Psychosocial.

same person they were prior to injury. This
is hard on the family, and hard on the
school, but it may be devastating for the
pupil who has sufficient self awareness to
recognise how much he/she has changed.
Loss of memories
Comparison of self pre and post injury
Loss of identity through labelling, and fear of
stigma
Discrepant information from medical services
(e.g. being told there is nothing wrong/being
given a very poor prognosis)
Neurological – The experience and
processing of emotions have clear
fundamental neurological underpinnings
– some of which can be fairly accurately
pinpointed in terms of brain structure.
For example, injury to the frontotemporal-limbic circuitry leads to a
Discrepancy between being ‘normal’ (but not
receiving services)and being diagnosed (but
being labeled or stigmatised by society)
In a nut shell, the pupil who has survived a
serious ABI is in very many ways not the
.