For the most part, the nature of the psychosocial difficulties represents an interaction between the injury itself and the child-specific and environmental factors outlined below. A child who was often angry before her injury may become more angry and even aggressive afterwards, as those parts of her brain that enabled her to exercise control over her anger before her injury are now damaged. The child who was a perfectionist before an injury often struggles with the notion that he can no longer do things perfectly but must find ways to adapt and to compensate for impaired abilities. Because of differing developmental expectations, the young child may appear to fare better following injury. By the time a child reaches school age, he or she is involved in mastery of social relationships, academic achievements, and cooperative and competitive activities.
Social comparisons are even more pronounced in adolescence.
Important milestones such as high school graduation or getting a driver's license are often delayed following brain injury. The loss of independence, self-confidence, and the comforting sense of invulnerability may result in adolescent withdrawal, depression, or rebellion. Many of the effects of brain injury are also due to others' reactions and to post-injury environment. Initially following injury, family members may downplay the child's problems and push the child to try harder. Other families become overprotective after a traumatic injury.