Cognitive, Emotional, Behavioural, & Social Impacts

Following Encephalitis, children may experience difficulties in their cognitive, social, emotional, and behavioural functioning. This is likely the result of the physical impact of Encephalitis on the brain due to an acquired brain injury (ABI) when neurons (nerve cells) in the brain have been damaged by the encephalitic illness.

All children are individual and it is important to acknowledge that the outcome of Encephalitis can vary from a largely full recovery to significant physical, cognitive, emotional and social difficulties due to a number of contributing factors such as severity of the illness, area of the brain affected and any ongoing neurological sequelae such as epilepsy.

It is important to also recognise the emotional impact of such an acute life changing illness on the child/young person and their family and friends, as well as the impact of the illness, time in hospital, and periods missed from education and other social experiences.

Here we will highlight some of the difficulties that some children/young people may experience with regards to their cognitive, social, emotional and behavioural functioning and ideas for where to seek further advice and support. It is important to acknowledge that this is not an exhaustive list as all children are individual and unique and it will be important to seek guidance and advice from a child’s own medical and rehabilitation team regarding potential areas of difficulty and approaches to support.


(relating to, being, or involving conscious intellectual activity, such as thinking, reasoning, or remembering)

Attention and Concentration – Children may have difficulties with sustaining their attention and concentration following Encephalitis. You may observe that they have difficulty focusing in the classroom or on homework or flit from activity to activity at home.

Within the classroom it will be important that teachers are aware of these difficulties as children will need support and understanding to implement strategies to aid their ability to focus. This may include more regular breaks during periods of sustained attention, prompting and re focusing back to the task they are doing and sitting in a position in the classroom as free from distractions as possible. For example, not next to a window looking out onto an area where lots is happening or next to the door where you can hear what is happening in the corridor.  Within the home environment it will be important to ensure that you have the child’s full attention before giving them an instruction and break information down into smaller chunks if they are having difficulty in sustaining their attention.

Memory – Children may have difficulties with memory following Encephalitis. This may impact on new learning and their ability to remember everyday instructions. This can impact significantly in the classroom where they may lose track of instructions from the teacher. Understanding the specific difficulties that a child experiences with memory can help with developing strategies to support them. For example, some children may have specific difficulties with auditory/verbal memory (memory of information that they hear) but have strengths in visual memory (remembering information that they see).

Strategies for supporting a child’s memory should be tailored to their individual strengths and difficulties, such as supporting a child’s memory of information that they are listening to in the classroom with handouts and visual prompts if they find it easier to remember information that they see. Some children will benefit from information being chunked into smaller amounts to try and process and remember and they may need this information presented to them numerous times before they can remember it. Other children may need prompts and support in recalling information.

Processing Speed – Following an ABI children can experience difficulties with their speed of information processing. This can impact on their ability to take in information in the classroom at school and also in social conversations with family and friends.

Children with speed of processing difficulties will benefit from additional time to take in information and respond. Within the classroom and within exam/test situations they will need additional time to complete tasks. Where additional time to complete tasks is not possible, reducing the expectations of the amount that the child is expected to compete in a particular time should be adjusted. The use of handouts and prompt sheets in lessons should be considered to reduce the processing demands of children having to take down notes or copy information from the board.

Executive Function – Executive Function skills are higher level functions such as emotional/behavioural regulation skills and those related to planning/organisation, problem solving and initiation. Executive Function skills are continuing to develop through childhood, adolescence and into early adulthood. Children may have difficulty in managing their emotions and behaviour and may have difficulties with organising themselves, initiating tasks and solving problems. Within the school environment this may present itself in children having difficulty in getting their homework in on time, organising their school bag with the things that they need that day or having difficulty in managing social situations.  Some children may have difficulty getting started on tasks and require prompting and support to do so, others may get fixed on a particular way of doing something and have difficulty moving on from this.

Children with executive function difficulties often find it hard to manage changes and disruptions to structure and routine. Sometimes children may function and manage their emotions and behaviour better at school due to the structure and routine of the school day but have more difficulty managing this within the home environment where the structure of the day is understandably more relaxed. Parents may find that children manage all day at school and then release their emotions on returning home.

Speech and Language Difficulties – Children may experiences difficulties in their ability to communicate verbally. They may present with difficulties with expressive and/or receptive language. Common difficulties can include word finding difficulties which can impact on a child’s levels of frustration and self-esteem as they struggle at times to find the words that they need to articulate something. If a child is presenting with speech and language difficulties, an assessment by a Speech and Language Therapist can be beneficial in highlighting any underlying impairments. Access to a Speech and Language Therapist may be through your GP, Community Paediatric team, or your hospital/rehabilitation team.

Cognitive fatigue – Following any neurological illness/ABI children and young people may experience ongoing difficulties with cognitive fatigue. Cognitive fatigue is a particular kind of fatigue or tiredness where a child/young person’s brain has to work harder to concentrate and function. This often means that children have more difficulty concentrating and staying focused on tasks. Cognitive fatigue is not related to physical energy levels or intellectual ability but can impact on a child’s mood, behavior and ability to engage with learning and other activities.

Pacing tasks and social activities, ensuring opportunities for regular rest and managing school work demands on children are ways to support cognitive fatigue.

Social, Emotional and Behavioural functioning

Emotional – Children may experience difficulties with regulating their emotions and mood as a result of an ABI which may be related to difficulties with executive function as discussed above. It is also important to recognise the emotional impact of their acute admission to hospital and the ongoing adaption to the difficulties that they may be experiencing following their discharge from hospital. Some children who have developed ongoing impairments may have insight into the skills that they have lost and the impact that this is having on their learning and functioning and their ability to communicate and socialise with friends and family. This may impact on their levels of frustration and/or self-esteem. Some children may experience increased anxiety.

Where there are concerns regarding a child/young person’s emotional wellbeing it would be beneficial to seek support. This may be through pastoral care services within the child’s school (such as the learning support centre or school counsellor) or through local community services such as the GP, child and adolescent mental health services (CAMHS) or through Clinical Psychology services within the hospital NHS trust where the child was treated.

Social – There may be challenges for children post-Encephalitis with regards to social connection with their friends. This may be as a result of their ABI and cognitive and/or communication difficulties that have altered their ability to manage social situations, such as keeping up with the speed of conversations, the impact of fatigue on their ability to socialise outside of school or their understanding of social situations. In addition, children may have missed periods of time from education during their acute illness and rehabilitation which may have impacted on their social relationships with friends.

Finding ways to support a child/young person may include working with the school to develop friendship circle and buddying systems for younger children, or finding ways to support social interactions for older children such as more accessible social groups and/or supporting their peers to understand the changes that have occurred for the young person.

Behavioural – Changes in the behaviour of a child/young person post-Encephalitis may be linked to changes in their cognition (e.g. executive function) and an ABI, as well as possibly related to changes in their experiences and environment as a result of their acute illness and rehabilitation.

Understanding the possible triggers and underlying causes for the behaviour may help to find ways to support this. Some reasons may be more evident though you may find support from a neuropsychology assessment or psychologist helpful in identifying the profile of strengths and difficulties for a child/young person in order to help identify what may be contributing to any behaviour changes.

Access to neuropsychology (accessed usually though the acute hospital and neurology services where a child was treated), educational psychology (accessed through school) and clinical psychology services (accessed through the hospital or within child and adolescent mental health services (CAMHS) usually via your GP or other health professional) may be beneficial in helping to understand the underling strengths and difficulties that a child has post-Encephalitis in order to find strategies and ways of supporting them.

Some of the cognitive, behavioural, social and emotional changes following an ABI may present as similar to those with other conditions such as Attention Deficit Hyperactivity Disorder (ADHD) and Autistic Spectrum Disorders (ASD) and Sensory Processing Disorders. While some children may have difficulties that meet criteria for a diagnosis of neurodevelopmental conditions such as these it is important to recognise that where children have been developing with no concerns prior to the ABI then these changes are most likely a result of the ABI. The way that these difficulties present and the strategies used to manage these in the classroom and home will/may be different and it is therefore important to differentiate these and ensure that misdiagnosis does not mask difficulties related to the ABI and a full understanding of the child’s needs.

Information written and provided by Dr Emily Talbot, Consultant Clinical Psychologist in Paediatric Neuropsychology, Nottingham University Hospitals NHS Trust