post-concussion behavioral changes in child after frontal lobe concussion
My 4-year-old daughter had a bad face-first fall several weeks ago, on Feb. 14, and we were told she had a mild concussion. In the first few days and weeks afterward, there were some behavioral changes, but we attributed them to lingering discomfort from the injury (and from an ear infection that came on right after the injury). For example, she immediately began having nightly sleep disturbances, which had never happened at all before. She also became angry or agitated at very minor things, which was also unusual for her. However, we assumed these were normal and would eventually pass.
But a couple of new behavioral changes just began recently (about 4-5 weeks after the concussion) that are causing us serious concern. She will laugh/giggle uncontrollably at inappropriate things -- things that previously would have either upset her or seemed very serious to her (such as being scolded). The giggling then quickly spirals into a period of extremely hyper behavior, where she seems unable to control herself or to process anything. She also suddenly seems to have no attention span and an inability to focus on what someone else says for more than half a sentence. (Previously, teachers always mentioned that she had a very long attention span for her age.) Her behavior actually reminds me of two children I used to know years ago, before ADHD was so commonly diagnosed, who had serious hyperactivity problems.
My specific questions are: (a) Where a behavioral change first occurs weeks after a concussion, what would be causing this? I would have assumed that symptoms would improve over time -- not that new symptoms would present themselves. And (b) does this delayed onset tend to suggest that the changes are more likely to be permanent?
We saw a neurologist today, who said that concussions in the frontal lobe area often result in "disinhibited behavior," such as what our daughter is showing. However, he said that these changes usually go away within a short time (a week to 2 months) after the injury. We are hoping with all our hearts that this will happen with our daughter. But I have a deep fear that this change -- which is a complete reversal of her entire personality -- will be permanent.
I understand that these behaviors, by themselves, aren't uncommon in 4-year-olds. But they are not remotely normal for her. She was an exceptionally sweet, calm child before her injury who rarely even had a minor temper tantrum and never demonstrated any type of hyperactive behavior. I would just really appreciate more information on what could be causing this and what to expect, just so I know how to deal with this.
I really appreciate any advice, information, or even general thoughts.
I realize my post was already ridiculously long, but I thought I should probably mention what actually happened at the time of the injury. She was standing on a chair and fell onto the concrete floor, which resulted in significant swelling in the nose/eye/forehead area, a severe bloody nose, and a purple bruise on her forehead.)
She did not lose consciousness or vomit, but she was dazed and began nodding off shortly after. At the ER, she was unable to identify letters in a children's book (which is very strange; she has known her letters for 2 years and had just started reading). She became very upset, saying that she couldn't see the letters. The ER doctor said that a CT scan was probably not necessary, and she was sent home after several hours.
I had to join this forum just to post an answer to your post. A year and a half ago my 4 year old daughter had a brain hemmorage and almost died. She spent 3 weeks in the hospital (2 1/2 was in medically induced coma) and a week in inpatient rehab. The symptoms that your daughter is having is almost exactly like what my daughter has been experiencing. Especially right after coming out of the coma. Laughing inappropiately, behavior problems, being loud, etc. Before this happended her teacher told me she was a very well behaved preschooler that was very smart. After, she was completely different. She has improved somewhat over the last year and a half but still is exhibits inhabition, trouble concentrating, etc. I could go on and on. She also is very obsession about things, like asking what we are doing that day, over and over, sometimes 15 times a day or more. It's very hard to keep my patience but I do. I don't know if this helps or not but it sounds like your daughter had more going on than just a simple concussion.
Thank you so much for your reply. I'm so sorry that happened to your daughter. I can't imagine how awful the experience (the weeks in the hospital) must have been. Were the doctors able to give you any helpful information about the kind of behavioral changes that happened with your daughter? Or did they suggest any kind of therapy or ongoing rehab?
I will mention your post to my daughter's neurologist. Based on what you wrote, it seems that the same areas of the brain must have been affected in your daughter and mine.
We are working on getting an appointment with a university neuropsych center near us, to see if they can evaluate my daughter and tell us whether there's any rehab therapy that might be helpful. (I've been doing a lot of reading and trying to educate myself on what the appropriate next steps are, but it's been surprisingly hard to get good information. I was also surprised at how difficult it is, even in NYC, to find a specialist with expertise in this type of brain injury in young children. The first neurologist we saw gave us information that, as we later learned, was many years out-of-date.)
Thank you again for writing. I can't even tell you how much I appreciate it. I'm still very, very anxious about what's going to happen in the long run for my daughter -- whether things will improve, or whether new issues will arise as she gets older. And I'm still struggling trying to figure out how to deal with the new behaviors. But I know we'll get through this.
It was the worst experience of our lives. But thinking how she was and how she is now she is doing a lot better. She went through tons of outpatient rehab with ST, PT, and OT and continues to get them through school now. We also went to a psychologist to help with the behavior problems but not sure if it really helped or not. I really think she needed to go to a behavior therapist to help with her acting out and inhibition but never got linked to one. We are just trying to deal with it on our own.
One thing that has definately gotten better over time with her personality change was after she got out of the hospital she would go up to anyone and sit on their lap, talk to them, anythind even if she didnt' know them. It was a little embarrassing to say the least. She doesn't do that anymore thank goodness.
I can tell you your best source of information or to know what to do next would be with the rehab therapists. At least it was in my case. It's so hard to know what to do. We live in a small town and we can get rehab done here but to get any specialized rehab like for behavior we have to drive an hour each way. Hard to do. Good luck. Let me know what you find out and if you have anymore questions.
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