Stroke in Adolescents
When Erica Singleton fell on the playground in the fourth grade and couldn’t get up, neither her teacher, the school nurse nor her mother thought much of it. Stroke was certainly not on their list of possibilities. But when she collapsed again two weeks later, her mother took her to the hospital where a clear-thinking doctor recognized her symptoms for what they were — a stroke. (See Erica’s full story in Profiles of Adolescent Survival)
Stroke in children (from birth to age 18) occurs infrequently, between 4.6 and 6.4 per 100,000 depending on the study. The most common cause of stroke in adolescents (age 10-14) is damage to a blood vessel, what doctors label arteriopathy. “Sometimes that can be caused by trauma, like a car accident, or trauma to the neck that injures one of the blood vessels going to the brain,” said Kristin Guilliams, assistant professor of Pediatric Neurology and Critical Care Medicine at Washington University in St. Louis.
Therapy Needs of Adolescent Survivors
Dr. Kristin Guilliams
Children’s brains are developing and may be more plastic than those of adults, so therapy is helpful — and as with adult survivors, more is better. Motivating them to do their therapy, however, may be a challenge.
“Children, particularly in the preteen, teenage population, struggle with just wanting to be normal,” Guilliams said. “They may not want to do their therapy or take their medicines because they don’t see other children doing those things, even though therapy helps them get better. That is a common challenge in this age group.”
As with adult survivors, it helps adolescent survivors to meet other children who are going through the same thing, such as a pediatric stroke support group, a therapy summer camp or a rehabilitation research trial. “That can help normalize their symptoms or give them motivation by seeing what another child a few steps ahead of them in therapy is able to do,” Guilliams said.
Back to School
Typically, adolescent survivors have to deal with the challenge of returning to school. The first challenge is having to catch up to their peers because they’ve likely missed classes due to hospitalization, recovery and rehabilitation. “Then there is often the additional challenge that the stroke may cause learning disabilities,” Guilliams said. “That could be difficulty with executive functioning (the cognitive skills that help us get things done) or simple attention. Or something like verbal or auditory processing that might be affected, so that the children may not learn in exactly the same way as before the stroke.”
She suggests that a neuropsychological or learning assessment can help identify the adolescent’s cognitive strengths and weaknesses, so their school curriculum can be adapted to their needs. “If we know that after a stroke a child does much better hearing information and has difficulty reading, then perhaps there could be an adaptation through an individualized education plan (or IEP) where they are read the information or lessons,” Guilliams said. “That way, it’s just the material they’re learning that provides the challenge rather than the manner in which the material is presented providing an additional challenge.”
Beyond learning, there can be other cognitive challenges such as attention and depression. “This hasn’t been formally documented in the teenage stroke or childhood stroke population, but there are several studies that indicate they have more emotional and social difficulties compared to their peers,” Guilliams said.
Of course, any parent of an adolescent deals with puberty, and stroke does not appear to complicate that. However, the growth spurts that are common in children at this age may present a bit of a challenge: “Kids with motor weakness might have a little more difficulty walking after a growth spurt,” Guilliams said, “but that usually clears up in a few weeks.”
Things that can help
Growing and supporting self-esteem in their kids can be tricky for all parents of adolescents, and this can be particularly challenging in the case of child survivors. Guilliams suggests that parents should be particularly vigilant about depression. If they see signs and symptoms, they should seek treatment right away, counseling or medication or both. “A pediatric neuropsychologist would be ideal, but they are rare,” Guilliams said. “A clinical psychologist or licensed counselor could also provide appropriate intervention. A pediatrician or psychiatrist would prescribe medication if needed.”
Learning difficulties should be addressed quickly. Guilliams suggests that the Internet and social media can be a valuable resource. Although it should be closely monitored because of the potential for cyber-bullying, it can also be used positively. “Social media can connect survivors to other kids like them and help them know they’re not the only child going through the problems and challenges they’re encountering,” Guilliams said. “That can be an enormous benefit — to see and connect with peers.
“I would also encourage parents to remember that children are enormously resilient,” she said. “They continually impress me with their motivation and perseverance. So parents can both inspire their kids and be inspired by them.”
Editor’s note: The American Stroke Association’s Support Network is an online support community that includes a section specifically for parents of children who’ve had a stroke.
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