Children with brain tumours often face more complex difficulties in returning to school than children with other tumours as Education Consultant Beth Wicks explains.  

Implications for the Future Education of Children with Brain Tumours:

"The child's return to school is not the end point of rehabilitation. Rather school is an extension of the rehabilitation process begun in hospital…" (Larkin, 1992)

Any cancer and its treatment can obviously affect a child's access to education and academic potential, as a result of both the physical and emotional consequences. However, there is an added complication for children with brain tumours. The existence of the tumour, plus the effects of therapy or surgery can cause an acquired brain injury (ABI). The difficulties these children may subsequently face are, therefore, similar to those encountered after other injuries or illnesses that cause ABI. 

Such an injury can provoke special educational needs that may be complex and different from other learning difficulties with which teachers are familiar. There are a number of reasons for this: 

Until that time the child's cognitive and neurological development was, in most cases, normal.

Characteristically, the pattern of difficulties is "patchy". The child retains previous knowledge and some areas of current skills are preserved but with an overlay of acquired difficulties.

An ABI can affect future neurological and cognitive development (which continues throughout the first two decades of life). 

When a child returns to school the physical and medical problems he may face are often recognised and addressed. Learning difficulties as a result of the injury, rather than absence from school or anxiety, may not be particularly apparent at that time. Problems in areas such as concentration, organisation or memory skills may well be attributed to those other factors. Any emotional difficulties can be exacerbated by the child's awareness that he cannot complete academic tasks or engage in social communication in the way he did previously. Frequently, the possibility of acquired cognitive problems is never raised with the child, family or school.

Some children, particularly young children, cope well when they initially return to school, but encounter problems years later. This is as a result of the fact that the pace and demands of the school curriculum increase and damage may have affected areas of the brain controlling particular skills that develop as the child matures. It is only at the time when this would normally happen that the difficulty becomes obvious. 

Unfortunately, the majority of teachers and educational psychologists have no training or information regarding ABI and, therefore, the specific difficulties facing these children are frequently missed or misunderstood. As the child's previous learning is often intact, his difficulties may be initially masked and are more likely to affect his ability to acquire new learning in the future. Sometimes the problems are superficially subtle, but can have very significant effects on the child's academic progress and potential and therefore on his self-confidence and self-esteem.

Without appropriate understanding and provision a child's difficulties can escalate. Ongoing monitoring is vital, even if initial difficulties are not apparent. Appropriate intervention is often simple, but requires understanding as the needs of these children differ from others with learning difficulties. Teachers may say that these children do not require any additional or different assistance because there are many others in the school whose academic performance is less good. The only relevant comparison for these children is with their previous and present potential, not with other children. 

Education is a crucial part of continuing rehabilitation. Appropriate provision enables maximum curricular access and achievement and helps in rehabilitation of, and compensation for, acquired deficits.

In order that these children's needs are appropriately met we must ensure that: 

- families and education personnel have appropriate information 
- there are efficient links between health and education services so that these children's needs are highlighted
- there is a partnership with parents when planning provision.

Although it may require additional funding, it would be of considerable benefit to these children and others with ABI if appropriate guidelines were produced with recommendations for long term provision and monitoring to include both health and education services.

This article was reprinted with the kind permission of CONTACT magazine, the magazine of UKCCSG and NACCPO (Spring issue No. 18, 2003)