Help for a teen-age girl who had a brain injury

I recently received this comment from someone looking to help the daughter of someone they work with.

I was wondering if you could give me some advise a woman I work with has a 13 year old daughter who was shot in the head at the age of 7. She has more or less fully “recovered” physically and mentally as according to her physicians.

Recently she has been getting in trouble at school when she gets stressed out about tests and friends and one of her problems at school is that when she gets stressed she involuntarily scratching her forearms which is alarming school officials . But when the officials approach her she becomes more stressed and scratches her self more.

So I gather you see the problem — the school has ordered my friend (who I will call Stacy) to take her daughter to a psychiatrist and to her PCP. The PCP says that there is nothing physically wrong with her so he can’t do any thing. The psychiatrist wants to medicate but is unsure what the side affects will be as seeing that she has had severe brain trauma and suggested Stacy to contact her neurologist; which she is doing but it takes awhile to get an appointment.

While they are waiting for the neurologist appointment I suggested getting her daughter involved in a support group with others who are going thru the same kind of emotional and psychological healing that she is going thru so she doesn’t feel alone and this is where I’m drawing a blank can you or can any one else get me in contact with a support group that may meet this girls needs if you can

Bless you

Thanks

I’m worried for Stacy also, I think she needs some one to talk to who is going thru what she is.

And here is my (slightly modified) response:

Hi Mel –

Thanks so much for writing and thanks for helping Stacy!

It sounds like Stacy’s daughter is using (negative) sensation as a way to calm herself down. This is not uncommon — some folks with seizure disorders will do it to stop/interrupt their meltdowns — they hit their heads or they hurt themselves in some way. Other folks who are overwhelmed will use pain to focus their thinking. They will scratch or hit themselves, bang their heads, or do something else to “get themselves back into the present”.

It could also be that she’s using it as a way to get people to back off of her — I have been known to do some kind of bizarre things — unconsciously and consciously — that caused people to back off of me. Things like twitching and behaving strangely, that made people look at me strangely, but got them to stop coming at me so hard. I didn’t WANT to act like a freak, but I found that my involuntary reflexes had the (negative) benefit of putting some distance between myself and the person who was yelling at me, so it actually helped in a way. Additional Note: I’m not saying Stacy’s daughter is intentionally doing bizarre things — I’m just saying I can relate, and the negative reactions I myself have displayed, have contributed to my own behavior and social issues, over the years.

Also, with me, my tbi’s have slowed down my reaction time, so when I have gotten into trouble with authorities in the past, and I haven’t reacted as quickly as they wanted, they acted like I was intentionally defying them, and they came at me all the harder. I wasn’t deliberately being bad, I was just “slower on the uptake” and they mis-interpreted my response as defiance. That may be happening with Stacy’s daughter, and if she’s like me, the increased attention feeds my confusion and I get even more overloaded — A Real Problem, which Stacy’s daughter may be having.

It also could be that — like me, when I was a kid — Stacy’s daughter is (mis)interpreting the school officials’ attention and concern as being in trouble and she thinks she’s being punished or disciplined, which — if she’s like me — just adds to the overwhelm. When they approach her, the school officials need to say explicitly that she is NOT in trouble. They are trying to help her. They may think she knows, but with tbi, it’s never safe to assume anything. Now, if the school officials ARE treating her like she’s in trouble, that’s another issue — a problem with the officials, themselves.

For dealing with sensory overload… Other people with sensory integration issues will do things like rub a coarse surface, tap a rhythm, hum, or do some other action which brings a single point of focus to their attention. It’s called “stimming” or “self-stimulation” and there are many different kinds that people do in different ways. If you Google “stimming” you may find something useful.

Additional Note: Stimming is often used by folks who are autistic or have some other developmental delay — I AM NOT saying Stacy’s daughter has become autistic as a result of her head injury, only that understanding stimming behaviors (as they are used by folks on the autistic spectrum), may help Stacy understand her daughter’s need to scratch her forearms.

I have been known to hurt myself (slightly) to “get out of” a downward slide into a meltdown or when I feel like I just can’t handle all the outside stimuli coming in. Before I knew about how even a mild TBI can affect the brain, I used to bang my head when I was too overwhelmed to function. (Note: since I learned more about tbi, I’ve stopped that behavior — I’ve got all the head injury I can handle, thank you very much.) I have also hit myself, grabbed my forearms really hard and squeezed long and hard enough to bruise myself, I have punched myself, and I have done other things to get a little pain into my system to clear my head. I have never severely injured myself — like cut myself or banged my hand in a drawer or something extreme like that. I just needed a little bit of pain to chill myself out and stop the chaos in my head. I have used sports in the past to create “managed pain” in a positive way — I would push myself really, really hard in practices and competitions, to the point where I was in real physical distress. But then I was able to chill, and life went on.

I’m not an expert in this, but I believe it’s because the pain triggers endorphines (and other stress hormones/adrenaline) which can help clear the mind and help someone get a single point of focus back, when they’re being bombarded with stimuli that they cannot sort out. (Interestingly, this ties in with the research I’m presently doing about how people (unconsciously) create stress and really difficult situations to help themselves function better, when they’re totally overwhelmed.) From personal experience, I can say that there’s nothing like a little pain, sometimes, to help me focus. NOTE: I am NOT advocating self-injury as a coping mechanism, I’m just observing that — on a very limited scale — self-administered pain/stress has helped me cope throughout my life. And in fact, I still use it, now and then.

Anyway, to avoid real injury and help myself focus, I use other techniques that are less stigmatized — more like stimming than self-injury. I usually have a rolled-up paper napkin or towel in one of my pockets that I carry around with me to rub and clench in my fist, when I’m feeling overwhelmed. A rolled-up napkin really works, because it’s coarse, and it fits in my hand, so I can carry it around without people noticing it. I find it very soothing. Also, I do things like rub the seam of my jeans, tap out rhythms (working on a computer keyboard is very soothing for me), and press my thumbnail into the sides of my fingers or palm. I do these things secretly, so no one will see, because if/when they do notice, they become worried and agitated, and it makes the situation worse for me.

For Stacy’s daughter, I would strongly recommend regular exercise, like getting involved in sports. I had real sensory issues and I was a total wreck, when I was a kid. Bit when I got to high school, I started getting involved in organized sports, and that made all the difference. But I couldn’t do every sport — team sports like basketball and softball and field hockey were too chaotic for me, so I ran cross country and track. I did individual sports as part of a team. If I hadn’t been so afraid of water, I would have gone out for the swim team, but I had a lot of trouble coordinating my breathing with motion when I swam, and I was (rightfully so) afraid of drowning.

If Stacy’s daughter is not athletic, I would really encourage her to do some sort of rigorous physical activity that she can do alone or with a small group. But find something physical to do, that lets her really work out her anxiety and channel all that energy. With each successive head injury I’ve had (8+), I’ve often noticed a sudden surge in my physical energy — and I felt more blocked, like I didn’t know what to do with it. That’s been a real problem over the years. But if I can find something really physically demanding to do, I’m usually able to get myself back on track.

If Stacy’s daughter can find something to do that is safe, as well as physically challenging, and not terribly expensive (running cross country and track are about the cheapest sports you can participate in), I really think it could help. And being in organized sports in school was great for me, because it gave me structure and guidance from coaches, as well as well-defined rules to play by — very important for me, after those injuries and concussions.

Now, if she cannot under any circumstances participate in sports, she may benefit from developing other (hidden) stimming techniques — like carrying a “worry stone” with her — a rough stone or some other texture that will keep her attention focused on something other than her confrontation and/or overwhelm. Or like me, carrying a rolled-up napkin to squeeze and rub, when things get a little ‘tight’. If she can be shown other ways she can dissipate the stress that don’t attract a lot of attention, that could help.

Above all, I would recommend that someone work with her in a non-judgmental way so she can develop other coping techniques. Like an occupational therapist. Since she was obviously head-injured by a gunshot wound, she must have medical records which show she is a tbi survivor, so she may be able to get help that insurance will pay for. Rather than sending her to a shrink or medicating her or treating her like she’s mentally ill, if someone can just explain to her that her brain is not processing information the same way that other people’s do, and it’s getting turned around (no fault of hers — it’s a result of the injury), and then work with her to constructively and positively deal with her unique situation, I think that could really help. Again, I’m not a trained professional in this, but as a multiple tbi survivor with sensory issues, I know it would have really helped me, when I was a kid.

As for Stacy, I would recommend that she spend some time reading about tbi online — check some of the links on my blog and learn about it. Even though her daughter has appeared to recover physically and mentally, she will likely have a bunch of issues that she needs to work through — many of which may look like “bad behavior” but are really neurological. Also, the young lady’s age tells me that because she’s going though puberty, her hormones are changing, and that can alter your neurological experience. Women with seizure disorders are known to experience changes in seizure activity which are directly related to their hormonal condition. Stacy may wish to keep a log about her daughter’s monthly cycles so she can track any kinds of behavior changes around the time of her ovulation/menstruation. That way, she can discuss it with a neurologist, and/or help her daughter prepare for times that may be tougher, due to hormonal fluctuations, and use that information to really be pro-active and common-sense about these seeming inexplicable behaviors.

I would recommend, also, that you give Stacy a copy of the self-assessment form(s) I have available on my blog, so she can see what kinds of symptoms can come with TBI. It could be that her daughter is having more problems than anyone realizes – but because of cultural bias, people think that her daughter is just being badly behaved. Or that Stacy is being a “bad mom”. I can’t tell you how many people were really hard on my parents — especially my mom — because they thought their bad parenting was responsible for my behavior. It wasn’t my parents — it was my tbi’s that caused me do do the things I did!

The more Stacy knows about tbi, the better. And her daughter’s school officials should be educated on it, as well. If nothing else, Stacy should make sure they know about her daughter’s brain injury, so they can respond appropriately and work constructively to develop positive approaches that don’t stress out the young lady. Stacy should NOT be afraid to tell them her daughter was brain injured. If she educates herself, she can advocate more effectively for her daughter.

Oh, AND — THIS IS REALLY IMPORTANT!!! if Stacy goes to a neurologist, she should make sure they know about traumatic brain injury. Not all neurologists do. I went to one who specialized in carpal tunnel and multiple sclerosis — not really helpful with tbi, I can tell you! Her local Brain Injury Association should be able to point her in the direction of a neuro with tbi experience.

Stacy may also find support through her local Brain Injury Association. Please tell her not to be afraid of the “brain injury” stigma — there are plenty of people who have had one. The association will probably have support groups she can attend, for survivors’ family members. Her daughter may be able to find support, also. On the surface, it may look like her daughter is all better, but the brain is mysterious thing. And especially since she’s going into full-blown puberty, she may find her “neurological landscape” changing, because her body and her hormones are changing, too. So, she’s going to need new and different help for her tbi, which will affect her in new ways as she matures.

Anyway, I hope that Stacy’s daughter can find other ways to relieve her stress, other than publicly injuring herself. I hope that Stacy can learn more about her daughter’s condition in a constructive and positive way. I hope that her daughter’s school can find ways to deal effectively with this young lady. And I hope you find more ways to help Stacy. It’s wonderful that you’re reaching out like this, and Stacy is lucky to have you as a friend!

Peace
BB