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

The Impact of Traumatic Brain Injury on
Military Families and Children
An important and often forgotten
gunshot wounds, shrapnel, falls,
TBI
isuniquebecauseit
oftenleads
toand motor vehicle accidents. In
aspect of traumatic brain injury(TBI) awareness is its impact on theaddition to combat, many TBI
changes in personality and behavior
injuries can occur in garrisonchildren of the injured. TBI is unique
without
altering
one’s
physicalappearance.
because it often leads to changes induring training exercises. TBI canThis can be especially troubling andpersonality and behavior without
be mild (referred to as mTBI orconcussion), moderate, or severe.
altering one’s physical appearance.
confusing for children.
This can be especially troubling andEven in milder forms, when combat
veterans say that they are “fine” they
confusing for children, and may
cause discomfort for the entire family.
may exhibit changes in their personality or behavior.
With more serious TBI, often occurring with complex
Military families are extremely vulnerable to the effects
of TBI due to its prevalence and range of severity in combat war injuries, there can be profound changes in personality
or behaviors, such as inappropriate outbursts, anger, socialveterans. TBI is often referred to as the “signature wound”
withdrawal, apathy, or depression.
of our war on terrorism, the result of exposure to blast,
Injuries such as TBI affect parenting when both theinjured and the non-injured spouse struggle to adapt tochanges in personality, family relationships, and routines.
Being less emotionally or physically available, or lessconsistent and predictable, can have short and long term
consequences for children. Despite limited research on
the impact of TBI on children, clinical case studies, focus
groups, and small samples have shown that their responses
to parental TBI are variable, 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 parent’s
appearance or any potentially inappropriate behaviors■ 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 parent’s irritability
Family support professionals and stakeholders needto provide services and outreach that fosters family
functioning during injury recovery.
How Families Can Help Children Integrate the Injury
Experience within a Family Context
1. Seek out resources and instrumental support. As
families 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
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.
Continued

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 theytrust (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 ishelping 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 in shared family goal setting. Goal setting helps
family members prioritize what is most importantand to consider what activities they would like to try
sooner. Parents and children can select family goals
together and practice them as they plan for future funor 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.
Resources:■ Defense and Veterans Brain Injury Center
https://dvbic.dcoe.mil/■ Military OneSource
https://www.militaryonesource.mil/

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