Memory, thinking and concentration (cognition) after childhood stroke

Stroke in children and young people can affect memory, thinking and concentration, also known as cognition. Cognitive problems can sometimes be hard to spot, because they can appear at different ages and stages of development. Understanding a child's unique challenges is the first step towards finding solutions and strategies that work for you all.

How can stroke affect memory, thinking and concentration?

Stroke can affect these areas in two ways:

Directly

Stroke can affect the specific parts of the brain that control memory, thinking and concentration.

Indirectly

Fatigue after stroke can make it harder for a young person to remember, organise their thoughts or concentrate. Communication problems and vision problems can also place greater demands on a child's concentration and memory.

Try to get an educational psychology assessment that can be used to guide additional support in learning and exams.
Parent

What are the signs of memory, thinking and concentration difficulties?

Stroke may result in obvious cognitive difficulties, but it can often be subtle and harder to spot. A young person may have a range of difficulties:

Attention and concentration

They may seem restless, or may 'zone out' and appear to be daydreaming. They may find it hard to stick to tasks, especially those they don't enjoy. They may find it hard to sit through lessons, read independently or watch full-length films. They might miss details or make frequent mistakes in their work.

Thinking

They may have difficulty with executive functions, which include things like organising, planning and problem solving. They may also have slower-than-average processing speed. This means that it may take them longer to digest what someone says, or to plan how they will respond.

Memory

Problems with memory could make it hard to follow instructions. A child may need repeated prompts to do things, and often forget or lose items. At school they may seem to learn something and then need reminding again only minutes later. A child may remember things they learned before their stroke, but have trouble retaining new knowledge.

What can look like a child not listening may be due to problems with memory and concentration, or not understanding the words. They may also have difficulty organising their equipment or finding their way around. Teachers may think a young person is not listening when actually the problem is that they are not remembering or not understanding, which impacts on ability to remember. The young person themselves may be unaware of this.

Overlapping effects of stroke

Stroke may also cause apraxia, also known as dyspraxia if it is mild. This is when the brain cannot fully coordinate muscle movements. This can affect muscles including those needed for fine motor skills, as well as facial muscles needed for speech. This can mean it takes longer for a child to respond when asked a question or told to do something. It can appear as if they are ignoring an instruction when they are unable to respond quickly enough.

Some effects of stroke can mimic conditions like dyslexia, autism and ADHD. At the same time, some children may already have these as separate, underlying conditions. For this reason it might not always be easy to get a clear diagnosis. However, over the years many strategies have been developed for these conditions and they could help your child too.

Even if your child has not been diagnosed, you may find it useful to look at resources designed for those conditions. For recommendations, talk to the teacher or special needs staff at the school or childcare setting.

What could memory, thinking and concentration difficulties mean for my child?

If a child does not get the support they need, or even get in trouble because they are not performing tasks as expected, it can mean they do not reach their full potential at school. It can also have a bad effect on their mood, confidence and self-esteem. So it is very important to get these difficulties identified, with strategies put in place to help.

Repeat things if needed, offering reassurance.
Parent

Useful tips and techniques

Techniques to develop memory, thinking and focus

If your child has difficulty in these areas, it can be tempting to provide all the answers for them, but eventually they need to develop these skills themselves.

One approach is to build skills gradually while building their confidence over time. This is sometimes called 'scaffolding', because it helps support the young person to eventually do things for themselves, using visual schedules and timetables.

Talk to school about the approaches they use and try to use a consistent system.

Backward chaining

This technique breaks an activity into individual steps, asking the child to complete only the last one until they are confident, before adding another step, and so on. This could include putting on a shoe, going to the toilet or doing homework. Reducing any tasks to these tiny steps reduces anxiety and helps embed the learning gradually until the whole sequence becomes a habit.

Visual reminders to support focus

Visual reminders can help a child to focus on a task. The visual reminders you use will depend on your child's age and stage of development. For example, to help them tidy their bedroom you could provide a photograph of their tidy bedroom, so they understand what they are aiming for. You can make cards yourself or buy readymade ones online, or you can use images on a phone or laptop.

Using technology

Many young people will prefer to use their phones or smart speaker to set reminders. There are many apps available, from the standard 'reminders' tools that come with their phone, to gamified task manager apps. The young person can customise the experience and add their own sound effects or music to make the experience fun.

Memory, thinking and concentration at school

Getting through the school day requires a lot of different memory and thinking skills, and many of these may be affected by stroke. Even if it happened some time ago, new issues may become apparent over time as demands increase.

If it is not clear where the difficulties lie, start with the basics: ask for a full range of tests, including eyesight and hearing. You can ask for a referral to a relevant specialism such as neurocognitive psychology, speech and language or occupational therapy. Ask your child's paediatrician, school nurse or school Special Educational Needs Coordinator (SENCO) how to access educational psychology.

Once you have a clearer picture, you can work with the school to put support in place. This may include formal assessment of special educational needs. Your school will be able to advise you how this works.