Center for the Study of Traumatic Stress
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

Understanding the Impact of TBI on
Military Families and Children
An important and often
gunshot wounds and shrapnel,Animportantandoftenoverlooked
aspectoverlooked aspect of traumatic brain
falls and motor vehicle accidents.
injury (TBI) is its impact on theIn addition to combat, many TBI
of traumatic brain injury (TBI) is its impact
families and children of the injured.
injuries can occur in garrison
onthefamilies
andchildren
oftheinjured.
TBI is unique because it often leads
during training exercises. TBI canto dramatic changes in personality
be mild (referred to as mTBI orand behavior without altering physical appearance. Invisible concussion), moderate or severe. Even in milder forms,
injuries such as TBI can be especially troubling, confusing
when combat veterans say that they are “fine” they mayand embarrassing for one’s children and family.
exhibit changes in their personality or behavior. With more
Military families are extremely vulnerable to the effects
serious TBI, often occurring with complex war injuries,of TBI due to its prevalence and range of severity in combat profound changes in personality or inappropriate behaviors
veterans. TBI, often referred to as the “signature wound”(lack of inhibition, anger, and outbursts, or possiblyof our war on terrorism, results from exposure to blast,withdrawal, apathy, and depression) can be present.

Despite limited research on the impact of TBI on
children, clinical case studies, focus groups, and small
samples have shown that children’s responses to parental
TBI vary, and may involve the following:
Impact of TBI on Children■■ Increased acting out behaviors, such as disobedience,tantrums, or risk-taking behaviors■■ Emotional distress, such as crying, increased anxiety, orwithdrawal■■ Feelings of loss and grief related to the change in theinjured parent■■ Feelings of isolation■■ Taking on additional responsibilities, such as caring foryounger children, household tasks, and caring for theinjured parent■■ Feelings of embarrassment about the injured parents’appearance or behavior■■ Misinterpreting parent TBI-related fatigue and apathy
as indicators that the parent no longer loves them■■ Feelings of anger or resentment about new
responsibilities or changes in the family■■ Feelings of self-blame for the injured parents’ irritability

TBI affects parenting as both the injured and the noninjured spouse struggle to adapt to changes in personality,
family relationships and routines. Being less emotionallyor physically available, or less consistent and predictable,
can have short and long-term consequences for children’s
health and development. Family support professionals
and stakeholders should be sensitive to the impact of TBI
on children and help families access services that sustain
effective parenting and support the needs of children
affected by parental injury.
Helping Children Understand Parental Injury:
An Action Plan
How Families Can Help Children Integrate the Experience
within a Family Context
It is important for families to:
1. Seek out resources and instrumental support. Asfamilies deal with the adjustment to having a changed
parent, families may need help in ensuring that basic
needs are met in the areas of work and finance, medicalcare, military concerns, housing, education, and childcare. Children may need special services or support toaddress behavioral/mental health problems that develop
Continued on reverse sideor to connect them with community resources (e.g.,sports organizations, educational programs, or boy/girl scouts) that provide them with social support andstructured activities.
2. Support children by helping them monitor changes
or extremes in their emotional states and reduce
emotional distress. As children deal with stress, they
may find it difficult to express emotions, to relax, or tocalm themselves. Parents can help children by teachingthem to label and express their emotions and by giving
them specific strategies (such as deep/belly breathing,progressive muscle relaxation, or visualizing a safespace) for dealing with strong emotions and/or stress.
3. Share information with children about the injury ina way they can comprehend it. Particularly importantis information that helps children understand what
the injury is, what the effects of the injury are in termsof parent functioning and/or symptoms, and what toexpect over time. Children may need reassurance thatthe injury is not their fault and that specific symptoms/
emotional changes in the parent are expected. This
helps to normalize and contextualize the family’s
current difficulties and helps children understand what
is happening in their family.
4. Talk about the injury with each other and others in
the community, including health care and community

service providers. Children should be encouraged toask questions about the injury among family members
and with medical providers, and they should beencouraged to talk about the injury with people they
trust (e.g., other family members, close friends, and/orteachers). Children should be encouraged to talk about
what they experience and feel so that their concerns canbe better understood and addressed.
5. Develop problem solving skills. Particularly important is
helping children identify relevant problems, name theirgoals, brainstorm possible solutions, and pick a solution
to try out. This helps children break down problems
into manageable parts and gives them the tools theyneed to plan for future challenges.
6. Engage children in shared family goal setting. Goal
setting helps family members prioritize what is mostimportant and to consider what activities they would
like to try sooner. Parents and children can selectfamily goals together and practice them as they planfor future fun or challenges, recognizing incremental
improvements over time.
7. Remember that adjusting to life with TBI can take time.
Families should be patient and hopeful as they learn tolive with the changes that result from the injury. Whilefamily life can change, parents and children can learn
new ways of being together and enjoying each other.

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org