Brain Injury During Young Adulthood - A developmental look through the lens of Erik Erikson.

Your age at the time of brain injury matters. 

Brain development is a complex, dynamic process, and individual differences play a significant role. During young adulthood the brain undergoes changes, refining its structure and function. Damage to the brain during this period of development can cause  significant changes to both structure and function. It may affect development of emotional regulation, impulse control, social skills, executive function, and decision-making.

Brain injury during young adulthood can impact development in several ways:

Cognitive Development:

• Executive function: Injury can affect decision-making, planning, and problem-solving skills.

• Memory and learning: Injury can impact consolidation of new information and memories.

• Attention and concentration: Injury can affect ability to focus and filter distractions.

Emotional and Social Development:

• Emotional regulation: Injury can impact ability to manage emotions, leading to mood swings or impulsivity.

• Social relationships: Injury can affect ability to form and maintain relationships, leading to social isolation.

• Identity formation: Injury can impact exploration of identity, values, and beliefs.

Brain Injury during young adulthood can have life long consequences. Injury can lead to persistent cognitive and emotional difficulties. Injury may increase risk of depression, anxiety, and other mental health conditions. Injury can affect daily functioning, relationships, and overall quality of life. Brain Injury is not one size fits all. 

Many factors contribute to outcome and recovery:

• Severity and location of injury: More severe injuries or those affecting critical areas can have greater impact.

• Age and developmental stage: Injuries during young adulthood may have more significant effects due to ongoing development.

• Rehabilitation and support: Access to or lack of rehabilitation and support services can impact recovery and outcome.

There are many theories of development that can help us understand the important relationship between brain injury and age but one of the most well known is Eric Erikson's theory of psychosocial development. Erik Erikson's theory proposes that individuals progress through eight stages, from infancy to old age, each characterized by a unique psychosocial crisis that must be resolved to achieve healthy development and a strong sense of self. Understanding Erik Erikson's theory is essential to understanding young adult brain injury recovery because it highlights the sixth critical stage, Intimacy vs. Isolation, where young adults typically form meaningful relationships and establish their identities. A brain injury can disrupt this process, leading to challenges in forming and maintaining relationships, achieving emotional intimacy, and developing a stable sense of self. 

Keep in mind that individual differences play a significant role in determining the effects of brain injury, and outcome can vary widely but understanding brain injury under Erikson’s lens in the stages of Adolescence and Young Adulthood can be impactful. There is an over-lap between Adolescence and Young Adulthood so it is important to consider both developmental stages in brain injury recovery.

Considering Erikson’s stages of development:

Adolescence (13-19 years):

• Injury can impact significant changes in brain structure and function

• May affect development of emotional regulation, impulse control, and social skills

Young Adulthood (20-40 years):

• Injury can impact consolidation of neural connections and refinement of skills

• May affect development of executive function, decision-making, and emotional regulation

Through the lens of Erik Erikson's theory, a brain injury during young adulthood can significantly impact an individual's ability to return to work or school, lead to challenges in forming and maintaining relationships and hinder developing a stable sense of self, which is essential for successful relational, vocational, and academic pursuits.

Impact on a young adult's ability to form and maintain healthy, intimate relationships. 

Intimacy Challenges:

• Brain injury can lead to mood swings, impulsivity, or emotional numbing, making it hard to connect with others on a deep level.

• Cognitive and linguistic deficits can hinder effective communication, leading to misunderstandings and conflict in relationships.

• Memory problems or difficulty interpreting social cues can lead to trust issues and feelings of vulnerability.

• Brain injury can lead to increased self-doubt, making it harder to take risks and form intimate connections.

• Brain injury can affect sexual function, leading to feelings of inadequacy and impacting intimate relationships.

Isolation Risks:

• Brain injury can lead to fatigue, anxiety, or depression, causing individuals to withdraw from social interactions and relationships.

• Changes in cognitive or physical abilities can lead to a loss of identity and purpose, making it harder to connect with others.

• Individuals with brain injury may feel like they're a burden to others, leading to feelings of isolation and disconnection.

• Brain injury can affect impulse control, leading to difficulty setting and maintaining healthy boundaries in relationships.

• Brain injury can result in a sense of loss for the person they used to be, leading to feelings of isolation and disconnection from others.

Brain injuries can lead to cognitive, emotional, and behavioral changes that may challenge relationships with colleagues, classmates, and friends. These challenges can make it difficult for young adults to build and sustain supportive networks, which are essential for successful reintegration into work or school. Additionally, a brain injury can impact a young adult's sense of identity and self-esteem, complicating their ability to meet the demands of work or school and potentially causing feelings of inadequacy, shame, or frustration. 

The psychosocial implications of a brain injury during young adulthood for vocational and academic pursuits:

Difficulty with job or school retention:

• Young adults with brain injuries are at increased risk of developing anxiety and depression, which can impact academic and vocational performance.

• Difficulty regulating emotions can lead to impulsive behaviors, mood swings, and irritability, affecting relationships and academic or vocational success

• Executive functioning challenges, such as difficulties with planning, organization, and time management can lead to decreased productivity, missed deadlines, and increased stress.

• Sensory sensitivities and fatigue can lead to reduced ability to adapt to new work environments or job demands

Brain injury can result in cognitive deficits, such as memory loss, attention deficits, and processing speed difficulties, impacting academic and career performance. 

Challenges in achieving career or academic goals can lead to:

• Reduced ability to adapt to new work environments

• Increased risk of unemployment or underemployment

• Potential for decreased earning potential or socioeconomic status

• Increased risk of job instability or career changes

Recognizing these psychosocial implications enables healthcare providers and caregivers to effectively tailor support and interventions to meet the unique needs of young adults recovering from brain injury. Young adults with brain injuries will benefit from accommodations and support in their academic or career pursuits.

Cognitive Accommodations

• Work with cognitive and speech therapists to develop strategies for improving memory, attention, and executive function.

• Use tools like calendars, reminders, and to-do lists to compensate for cognitive deficits.

• Break down complex tasks into smaller, more manageable steps.

• Allow extra time for completing tasks and assignments.

Emotional Accommodations

• Provide emotional support and validation to help the individual cope with feelings of frustration, anxiety, or depression.

• Encourage participation in counseling or therapy to address emotional and psychological challenges.

• Teach and model stress management techniques, such as deep breathing, relaxation, or meditation.

• Encourage self-care activities, such as exercise, hobbies, or spending time with loved ones.

Social Accommodations

• Help the individual build and maintain a social support network of friends, family, and peers.

• Provide social skills training to help the individual develop and maintain relationships.

• Encourage participation in support groups for individuals with brain injuries.

• Encourage participation in recreational activities, such as sports, hobbies, or creative pursuits.

• Specialized therapy can help individuals with brain injury and their partners navigate relationship challenges.

Return to Work/School Accommodations

• Work with a vocational rehabilitation counselor to develop a plan for returning to work or school.

• Provide accommodations at work or school, such as modifications to job duties or coursework.

• Provide job coaching or mentorship to help the individual learn new skills and adapt to new work environments.

• Provide tutoring or academic support to help the individual succeed in school.

Additional Supports

• Work with a case manager or coach to coordinate medical and rehabilitation services.

• Make modifications to the home environment to promote safety and independence.

• Provide transportation support to help the individual get to work, school, or other activities.

• Targeted rehabilitation programs can address cognitive, emotional, and social deficits

• Provide respite care to give the individual and caregiver a break and reduce burnout.

Young adulthood is a pivotal phase of brain development, marked by significant structural and functional changes. Damage to the brain during this time can profoundly and permanently impact an individual's emotional regulation, impulse control, social skills, executive function, and decision-making abilities. It is essential to provide comprehensive support and accommodations for those who have experienced a brain injury during young adulthood. By recognizing the unique challenges and opportunities of this developmental stage, we can effectively support young adults in reaching their full potential and successfully navigating the complexities of adulthood.

K. Wilson RN BSN CSN