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.

See Also: Developing Resilience: A Mother's Perspective

 

This information is provided as a resource to our readers. The tips, products or resources listed have not been reviewed or endorsed by the American Stroke Association.

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Pediatric Resources

Brendon's Smile

World Pediatric Stroke Association (formerly known as Brendon's Smile) provides opportunities to advocate and raise awareness among the general public locally and online.

Children's Stroke Foundation

The Children's Stroke Foundation has a simple mission: to educate doctors throughout the United States about Pediatric Stroke. Their model program will teach, and be used as a resource for, other hospitals while implementing their own programs.

Pediatric Stroke Warriors

We are dedicated in our mission of building community awareness for pediatric stroke and hope for impacted children and families throughout the Greater Pacific Northwest Region and beyond.

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Sickle Cell Disease Association of America

The SCDAA's mission is to promote finding a universal cure for sickle cell disease while improving the quality of life for individuals and families where sickle cell-related conditions exist.

Share the Strokes Can Happen At Any Age infographic

International Alliance for Pediatric Stroke (IAPS)

The International Alliance for Pediatric Stroke (IAPS) was created to unite pediatric stroke communities around the world. IAPS provides knowledge, hope, resources and the connection between families, medical specialists, researchers, healthcare providers and anyone affected by pediatric stroke. Our mission is proudly supported by leading pediatric neurologists and all of our information is approved by the physicians on our board.

Colorado Pediatric Stroke: Parent Support Group

Offers local monthly support group meetings to provide support, education, and advocacy for families impacted by the range of outcomes of all types of pediatric strokes.

I am Jayden Foundation

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Pediatric Stroke Program at the Children's Hospital of Philadelphia

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Children's Hemiplegia and Stroke Association

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