An interacting subsystems approach to understanding and meeting the needs of children with acquired brain injury

Referral to psychology services for children with a history of acquired brain injury often relates to concerns about ‘personality’ change and school difficulties (behavioural disruption and falling behind in academic attainments). The aetiology of these difficulties is typically located within the child and to the effects of the brain injury on cognitive processes in particular. While this is undoubtedly a primary factor in understanding such outcomes, it is not the only one. The present paper argues that it is not helpful to simply locate aetiological processes relating to outcome within the child with the brain injury. Rather, changes in the interpersonal system (at home and school), or aspects of this system which, although not problematic prior to the brain injury, become so afterwards, also merit attention as they relate to child adjustment. A systemic model is proposed which suggests pathways through which intrapersonal (cognitive and emo-tional) and interpersonal (family and school) forces interact to result in the behavioural outcomes which precipitate psychological referral. It is argued that such a model not only offers a deeper understanding of the negative outcomes experienced by affected children, but also significantly expands the range of possible interventions open to the practitioner.