Educational Outcomes after Paediatric Brain Injuries and the Role of Special Educational Needs Support

“Acquired Brain Injury (ABI) affects one in every 37 children before the age of 18 – that is one in every classroom. [...] It is a ‘hidden disability’ meaning that children might be really struggling with cognition, attention, memory, fatigue, and social communication – but there may be no signs from the outside. Together with the UK ABI Forum (UKABIF), this project aims to improve the recognition of, and outcomes for children with ABI.”
— Dr Hope Kent, Research Fellow

This study was led by Dr Hope Kent (University of Exeter) and was funded by ADR UK and ESRC. The study finished in 2025.

‍This project was reviewed and approved through ECHILD's data access process. Learn how ECHILD data is kept safe.‍

  • We wanted to understand long-term educational outcomes (attainment, exclusion, and persistent absence) for children following Acquired Brain Injury (ABI) and how special educational support can improve these outcomes.

  • Children with Acquired Brain Injury (ABI) are vulnerable to long-term academic difficulties and are over-represented in our youth justice systems. It is important therefore to understand what is happening when they return to school and investigate how punitive school discipline affects these children.

  • We used a birth cohort of half a million children in the ECHILD dataset to examine education outcomes for children following an injury or illness indicative of ABI. We also explored what formal educational support children with ABI receive and how it links to educational outcomes.

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  • Why does this matter?

    Children with Acquired Brain Injury (ABI) are vulnerable to long-term academic difficulties and are over-represented in our youth justice systems. But, because ABI is not a SEN category, they are relatively invisible in our school data – so not much is known about what happens to these children once they return to school after their ABI.

    What did we want to find out?

    We wanted to find out firstly how many children are affected by ABI, and whether some groups of children are more vulnerable. We then wanted to know more about education outcomes (e.g. educational attainment, school exclusion, persistent absence from school) for children following an injury or illness indicative of ABI.

    What we did

    Using descriptive and regression analysis on ECHILD, we established the prevalence of ABI across socio-demographic profiles and how SEN provision relates to ABI status. We also analysed the relationship between ABI and exclusion from school, looking at the importance of diagnosis in hospital.

  • Background and aims

    Acquired Brain Injury (ABI) is a chronic condition, often considered a ‘hidden’ disability as cognitive, social, and emotional symptoms may occur with or without physical disability. Children with an ABI often have ongoing difficulties that can significantly impact on their educational engagement, including fatigue, difficulties processing information, impaired memory, difficulties with organisation, reduced concentration, impulsivity, and hyperactivity. Such difficulties can emerge over subsequent months or years following ABI.

    Cross-sectional evidence indicates that children with ABI are vulnerable to long-term academic difficulties, when compared to both healthy controls and children with orthopaedic injury. There is also emerging cross-sectional evidence that the consequences of ABI can affect academic performance, school absences, peer group exclusion and bullying, and school exclusion, which can contribute to a ‘school-to-prison pipeline’. All of these factors can significantly influence health-related quality of life.

    ‘Time for Change’ report in the UK also identified significant gaps in the provision of Special Educational Needs (SEN) support for children with ABI, as well as a significant lack of data relating to the number of children who present at hospital following an ABI. Furthermore, health data has only recently been linked to education data. This means that educational support available after ABI (e.g. through formal SEN provision) and educational outcomes for these children are not yet known in England.

    This project aims to address these gaps by using the ECHILD dataset to examine education outcomes for children in England who present at hospital, following an injury or illness indicative of ABI. We also aim to elucidate what formal educational support children with injuries or illness indicative of ABI receive, and how this links to educational outcomes.

    Methods and analysis

    We use a prospective cohort study design, following children born between September 2003 and August 2004. We first conduct descriptive analysis of the prevalence of children with an injury or illness indicative of ABI and how it varies across socio-demographic profiles (particularly by child poverty). We also document how many children with ABI receive SEN support at school and under which categories.

    In further analysis, we use a target trial emulation method with Cox’s stop-start survival models to analyse the relationship between ABI and exclusion from school. We also extend this analysis by assessing how SEN provision interacts with the relationship between ABI and educational outcomes.

    ECHILD data used

    • HES: Admitted Patient Care (2003-2022)

    • NPD: Children Looked After (2003-2022), Children in Need (2008-2022), Early Years Foundation Stage Profile and Early Years Census (2008/09), Key Stage 1 (2010/11), KS2 (2014/15), KS3 (2019/20), KS5 (2021/22), Absences and School Census (2008-2022), Exclusions (2008-2021), PRU Census (2009-2013), AP Census (2008-2022)

  • We collaborate with the National ABI in Learning and Education Syndicate (NABLES) and their experts by lived experience group (YEBEABI) to co-create resources and guidance for schools and education professionals based on our findings.

  • Blog post

    Policy report on the economic costs of acquired brain injury