What is resilience, and how does it help children recover from brain injury?

Resilience is a word used loosely in everyday conversation, often to mean little more than coping well or bouncing back from a setback. In research on children’s wellbeing, though, it has a more precise meaning, and measuring it can show where a child’s strengths lie and where extra support might be most useful. For my MSc dissertation, I looked at resilience in children with acquired brain injury (ABI), alongside the family functioning findings described in our previous article.

What we mean by ‘resilience’

One widely used framework for measuring resilience in children is the Resiliency Scales for Children and Adolescents (RSCA). It breaks resilience down into three core areas. Sense of mastery describes a child’s belief that they can influence what happens to them, together with their optimism, self-efficacy and adaptability. Sense of relatedness describes how comfortable a child feels trusting other people, and how supported they feel by those around them. Emotional reactivity describes how sensitive a child is to stress, how intensely they react, and how long it takes them to recover once upset (Prince-Embury, 2008). From these three scales, two further indices are calculated: resourcefulness, which draws on both mastery and relatedness, and vulnerability, which reflects high emotional reactivity combined with low mastery.

What the research found

Tonks et al. (2011) first used the RSCA with children aged nine to fifteen, comparing those with ABI to children without brain injury. For my dissertation, I carried out a secondary analysis of this dataset, comparing 21 children with ABI with 70 healthy controls of the same age range.

Children with ABI scored significantly lower than controls on Mastery and on Resourcefulness, and significantly higher on Emotional Reactivity and on Vulnerability. There was no significant difference between the two groups on Social Relatedness. In other words, children with ABI were, on average, less likely to feel in control of their circumstances and more likely to feel overwhelmed by stress, but no less likely to feel supported by the people around them.

How resilience and family life are connected

The family functioning findings described in our previous article fit together with these results. Across the whole sample, poorer family functioning was significantly correlated with lower mastery and lower resourcefulness, and with higher emotional reactivity and higher vulnerability. The one resilience scale that was not linked to family functioning was, again, Social Relatedness.

This pattern suggests that a child’s sense of mastery, their resourcefulness and their emotional regulation are closely tied to the environment they live in, whereas their friendships and peer relationships may draw on something that sits a little more apart from the home. Gracey et al. (2015) describe these as reciprocal processes, in which a child’s emotional response to their injury affects the family, and the family’s response affects the child, often forming an ongoing cycle.

Why this matters for support

Tonks et al. (2011) suggested that a child’s sense of mastery may be protective following ABI, helping them engage with rehabilitation and adjust to changes in their abilities. If mastery and resourcefulness are also linked to family functioning, then building resilience is not only something to work on directly with a child. It can also mean working with the family as a whole, supporting the communication, problem-solving and shared routines that, in turn, support the child’s own sense of control.

At Hawkley Rehab, this is part of why case management looks beyond a child’s individual therapy goals. Assessments consider a child’s resilience and the family’s functioning together, and goals are set in a way that builds on existing strengths rather than focusing only on what has been lost. Our article on family functioning says more about this approach, and our Immediate Needs Assessment article explains how this picture is built from the outset.

If you would like to talk about what this might mean for your family, please get in touch.

References

Gracey, F., Olsen, G., Austin, L., Watson, S. and Malley, D. (2015) ‘Integrating Psychological Therapy into Interdisciplinary Child Neuropsychological Rehabilitation’, in Neuropsychological Rehabilitation of Childhood Brain Injury. London: Palgrave Macmillan UK, pp. 191–214. doi: 10.1057/9781137388223_10.

Prince-Embury, S. (2008) ‘The Resiliency Scales for Children and Adolescents, psychological symptoms, and clinical status in adolescents’, Canadian Journal of School Psychology, 23(1), pp. 41–56.

Tonks, J., Yates, P., Frampton, I., Williams, W. H., Harris, D. and Slater, A. (2011) ‘Resilience and the mediating effects of executive dysfunction after childhood brain injury: a comparison between children aged 9–15 years with brain injury and non-injured controls’, Brain Injury, 25(10), pp. 870–881. doi: 10.3109/02699052.2011.581641.