Understanding and Supporting Peer Relationships in Adolescents with Acquired Brain Injury: A Stakeholder Engagement Study

Peer relationship difficulties in adolescents with acquired brain injury (ABI) are under-recognised and targets for intervention are unclear. From a social constructionist position, this study aimed to engage with stakeholders to develop a collaborative understanding of peer relationship difficulties in adolescents with ABI and seek consultation on what might be required to improve them. Focus groups and semi-structured interviews were conducted with four stakeholder groups: adolescents with ABI (n=4); parents of adolescents with ABI (n=7); adults who sustained an ABI in adolescence (n=2); and specialist practitioners (n=3). Qualitative data were analysed using thematic analysis. The analysis yielded 11 themes, grouped into two domains. The first, understanding peer relationship difficulties, included themes from ‘exclusion and a need to belong’, to ‘loss of past self’. The second, supporting peer relationships, comprised themes of ‘building understanding’ and ‘meaningful social connection’, amongst others. A logic model of stakeholder experiences of peer relationship difficulties was constructed. Difficulties with peers can increase vulnerability to feelings of loneliness, shame, and hopelessness for adolescents post-ABI. Stakeholders described that a meaningful intervention would be multi-layered, targeting change within the adolescent’s environment and within the adolescent themselves. The presented logic model provides a framework for future intervention development