Emotions & behaviour
All children misbehave on occasions - it is part of growing up and learning about the world. This behaviour can become more concerning when it begins to affect the quality of life of the child and those around them.
Brain injuries and behaviour that challenges
The research that has been done shows us that having a brain injury, like those that cause hemiplegia, makes children more vulnerable to displaying challenging behaviour. It is thought that the brain injury that caused the hemiplegia may also be responsible for a difference in temperament: evidence suggests that some children with hemiplegia feel more irritation than their peers.
The brain is very clever and often 'rewires' pathways to work around damaged areas and find a way to get messages through. This is called neuroplasticity. Sometimes, however, this means that information gets sent to parts of the brain where it shouldn't go. There are signals flying back and forth in the brain that aren't helpful, they are just 'noise'.
This noise means that there is less room to process the genuine signals, which can cause the build up that many parents will be familiar with: a tough day at school leads to an outburst at home over something that seems small to you, like the television or a fork. With less capacity to cope with the stresses of everyday life it's inevitable that children will feel cranky and overwhelmed.
This neuroplasticity can also increase worries and anxieties. It seems that sometimes areas of the brain that detect things that usually don't make us feel anxious can become 'rewired' to the parts of the brain that cause us to feel fear, making children more vulnerable to phobias and anxiety.
Unfortunately, behavioural challenges can easily be overlooked by some health professionals, when their focus is on improving physical skills. But ignoring challenging behaviour can have a significant impact on the young person's quality of life and that of their parents and siblings.
Behavioural traits of children with hemiplegia
Children's emotional wellbeing and behaviour lie on a range, from causing no concern to being challenging (but not enough to warrant a diagnosis), right through to behaviour indicating a diagnosable psychiatric or psychological condition. Most children fall within the first two categories but for some, the symptoms are persistent and so extreme that they cause considerable distress and have a debilitating effect on daily life or affect the wellbeing of others.
Dr Robert Goodman, Professor of Brain and Behaviour Medicine at King's College London, looked at this question in the 1987 London Hemiplegia Study, still the biggest of its kind. He showed that around half of children with hemiplegia had significant emotional and behavioural difficulties, regardless of their social or economic background.
The three biggest areas of difficulty were:
- Conduct. This refers to unacceptable behaviour. About 25% of children in his study were identified as having conduct difficulties that include disobedience, arguing with adults and losing their temper. Interestingly very few of the children with hemiplegia displayed more severe antisocial behaviours such as stealing, fighting or destroying other people's property that might get them into trouble with the authorities.
- Emotional difficulties. Persistent fears and moods that interfere with life and cause others to be concerned about the welfare of the child. Again approximately 25% of young people with hemiplegia fit into this category.
- Activity or hyperactivity. Approximately 13% of the young people had significant difficulties with over-activity, impulse control and attention at home and at school that affected their learning and relationships. This figure was higher if home and school were looked at separately.
These are some of the issues that you may encounter. Every child and situation is unique so not all of these will be relevant.
Common behavioural difficulties:
- Irritability and anger
- Verbal and physical aggression
- Impulsive behaviour
- Defiance and opposition
- Destructive behaviour
Common emotional difficulties:
- Shyness or social anxiety
- Emotional immaturity
- Low self-esteem
- Mood swings
These behaviours and emotions are commonly experienced from time to time but become problematic when they begin to negatively affect the child's wellbeing and engagement in typical activities and learning, or that of people around them.
Advice on managing behaviour that challenges
Visit our behaviour webpage for our general advice on managing your child's challenging behaviour.