Neurodevelopment of Children and Teens with Hydrocephalus

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By Jay Wellons, M.D. and David Nilsson, Ph.D.

Article first appeared in Pathways, Fall edition 2008

From a developmental perspective, hydrocephalus, as with other forms of neurologic compromise, demonstrates its most prominent disruption to ongoing neurodevelopmental progression of the individual child. As such, many of the developmental consequences of childhood are less obvious, but as the child progresses into adolescence, neurocognitive and neurobehavioral consequences (e.g., emotional disorders, reactive irritability, emotional volatility) become more apparent. Children with neurologic compromise progress adequately with some support through early grade school, but with progression to middle school and the increasing demand for speed and complexity, problems become more apparent in learning.
Given the subtlety and complexity of social interaction, children with neurologic compromise begin to struggle to a much greater degree and often do not receive sufficient educational or developmental support to optimize social interaction. It becomes critical to begin neurodevelopmental support early, usually before problems become more apparent. Helping the child “be the best he can be” is the goal of all parents.

Children with a history of hydrocephalus commonly are of normal intellectual ability, but the specific nature of their genetic predisposition and neuropathy leads to a variety of educational problems that need to be addressed individually and as early as possible in developmental progression. Often these children are able to acquire basic skills, but the inherent difficulty is that of conceptually integrating and organizing the information into more complex conceptual units. For example, children with hydrocephalus often have reading skills within normal limits, but they children with hydrocephalus often do not comprehend easily what they read or are particularly slow in processing the information. As such, children with hydrocephalus tend to require specific educational accommodations to reduce stress and facilitate optimal performance. Often they may also require a lot more specific information in explaining circumstances, consequences, and other details.

As for any teenager, the child with hydrocephalus has a strong desire to participate in activities with peers, but may struggle to keep up. Most prominent areas are sports, dating, and driving. Sports may present problems given the physical limitations for some patients with shunts and their vulnerability to more severe consequences of concussion. Many sports require visual-spatial orientation, judgment, and problem solving, which are routinely difficult for children with any neurologic injury or neurodevelopmental disorder. Given the visual-spatial compromise and decreased speed of processing, driving becomes a particular difficulty, given the difficulty finding their way around and the demands for multisensory processing required for driving, both within and outside the car. Dating is another problem given the difficulty reading nonverbal social cues, anticipating consequences, and organizing more complex social interactions than children with hydrocephalus have been required to perform earlier in their development.

Each child is unique, and many of the consequences of a child’s ability to perform are highly dependent on his or her hydrocephalus and genetic disposition. A child’s learning environment, the developmental support a child receives, as well as the complexity and severity of their neurologic insult all contribute to developmental outcome. Key factors in the developmental progression are anticipating and recognizing areas of difficulty, intervening early and providing optimal levels of neurodevelopmental and educational support.

We would like to point our readers to other resources pertaining to this subject.

10 Comments for : Neurodevelopment of Children and Teens with Hydrocephalus
  1. Reply

    With the loud sounds of machinery, broadcast music, and blarring TV & radio commercials so prevalent today, it’s hard for your “hydrocephalus” brain to get a rest. Having had hydrocephalus now for 19 years, I’ve come to understand how my headaches, cognitive, and sensory-motor complaints are caused by sensory processing disorder, or SPD, and overstimulation. I only wish we had some protections from sound and noise in public, and from many of the ridiculous radio and TV ads.

    I have found my work with drum circles, or drumming, to be of help. I’ve been asked to provide this for clients of an area brain injury (post-TBI) program. Also, meditation, being outdoors with nature, soft music, reading, and quiet time is helpful. It’s just not always possible to get this when you need it amidst the bustle of busy metro life. I certainly could do without some of the ridiculous ads and machinery. Anyone else agree?

    Orange County, CA

  2. Wow! This article answered so many questions. My son is 18 and took driver’s education when he was 14 1/2. He was unable to take the driver’s test and has yet to try to drive since. He has also had difficulties with socializing as well as with sports (although he has done his very best to participate). We have been lucky in that he has been accecepted two colleges, however, we do worry about his ability to assimilate once he is there.

    • Cathy Landers
    • May 9, 2011

    Wow ! this article made clear some of the things I have been thinking are probably going on with my own daughter. She is 23 now, and has been in college 5 years, to get an early childhood education degree. Now she has to repeat two courses, one she dropped to avoid a bad grade, and the other to repeat since a D in there is unacceptable in the program. She has not learned to drive, and this is a real problem with employment since she will need to make arrangements whereever she lives to get to work. To answer Ralph ( above) about problems getting into college due to low test scores, the student may try taking classes at a community college to transfer to a state university. Many 2 year institutions (especially state university affiliated junior or community colleges ) have agreements that the whole AA or AS degree transfers to the university. They are also much cheaper in tuition and fees. If test scores are low in certain areas, the student may have to complete developmental (remedial) courses to prepare for entering Freshman English Comp or Algebra. Good luck with all this.

    • NancyDrew
    • May 9, 2011

    I can attest to the problems with driving. At the time our daughter was a teen she seemed to have difficulty taking the car in and out of the garage, scratching the sides on two separate occassions. We chalked it up to carelessness. After two “on the road accidents” we had her evaluated by a neuro ophthomologist who found that she had some atrophy in the eye area which would explain the driving problems. Even after having this explained to her, she continued to have small accidents usually involving her bumper or side of her car to the point that she considered giving up driving altogether. Eventually with maturity she learned to compensate by driving slow and allowing extra room especially on the side areas. She’s been accident free for 6 years so we’re happy she found a workable solution.

    • Ralph
    • April 16, 2011

    Many times children with Hydrocephalus do have difficulty processing and even though neurological
    testing, and doctors confirm such disabilities organizations like College Board do not allow for
    compensation on testing, as in my sons case. Therefore they are not on the same playing field.
    Schools budgets do not allow for help children with disabilities unless the cases are severe ones.
    Parents must stay informed and pay attention to their child’s condition at all ages. There is no special college entrance exception for children like mine. Many colleges have help once excepted.
    Sad to say there still is much prejudice when it comes people with disabilities. Severe or not severe
    people with disabilities should not be discriminated against.

  3. Reply

    I agree that hydrocephalus poses a number of developmental and socialization challenges in affected teens and children. With the resources and expertise available to children via schools and related programs, affected children have a fighting chance of overcoming these obstacles. This in large part then depends on the vigilence of the parents, the school district, and the type and number of shunt related complications. We should not discount similar adverse affects from hydrocephalus on adults, as this population is without the benefit of support from schools and parents. The solution in all populations is to engage the affected individuals, and be vigilent on the appropriate interventions as they are needed. Too often, adults with disabilities will fall out of society.

  4. Reply

    Why have the other resources pertaining to this subject been taken off line, including the Hydro Resource Library?

    • Susan James
    • April 7, 2011

    Great article. none of the links listed at the bottom of the page are pointing to working page.

      • tom
      • April 7, 2011

      We were experiencing a technical difficulty. You will find that the links work now.

    • Elizabeth Burger
    • April 7, 2011

    I am static about the article on Neurodevelopment of Children and Teens with Hydrocephalus. I have been telling people that I have noticed a major change in my teenage son (should I say he is now an adult). We only found out he has hydrocephalus when he was 16 which makes it very difficult to help him developmentally. Now I know that I am doing the right thing for him.

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