Assessing and Accommodating students with Brain Injuries

I wrote last week about the difficulties presented in integrating children with traumatic brain injuries (TBI) back into the educational system, with a particular focus on the challenge of just getting children with these challenges properly identified. But even when these children have been identified, that still leaves the work of assessing the individual child and adapting the classroom environment to their unique cognitive and emotional needs.

Once educators have identified that a student has experienced a TBI, it is then their responsibility to assess the student's capabilities so they can be placed in the right environment and their needs can be accommodated. Cognitive deficiencies vary widely in students with TBI, and it is important to recognize an individual student's needs.

At this point, teachers can begin to tackle the specific challenges of their student. They can make adjustments based on their knowledge of a particular students ability to concentrate, and might try to steer away from "dense" or difficult material that overly challenges the student's attention span. They can slow down the class pace somewhat, for example, if the student is somewhat slower than others at processing and responding to instructions. Some people with TBI are slower than they were prior to the injury at processing visual and auditory information. The student's memory may be an issue, and for some students multiple choice questions may become preferable to open ended tests.

Some abilities - such as organization and planning ahead - do not develop until we are older, and if the child was injured young they may have seemed normal for their grade level for a time, but in middle school or high school, they may begin to lag behind their peers. In these situations, teachers can be prepared, and coping systems put into place.

Most importantly for children with TBI, teachers can work to change their expectations and values to reflect an understanding of the child with TBI's needs. A teacher may have to accept that forcing a student with TBI to recall facts, particularly in a time limited environment, does not accurately reflect their level of learning or potential. Armed with this knowledge, educators can work to create a class environment which is positive and consistent.

Consistency can be a key tool in helping a child with TBI adapt to their changes in cognitive ability.

Aside from cognitive changes, behavioral difficulties generally follow a TBI. These can involve depression, anxiety, difficulty coping with change and disproportionate frustration. Behavioral problems come not from the student or the environment, but from the interaction between these two factors. For a student with TBI, certain environmental factors make an outburst increasingly more likely. Overstimulation, rapid class pacing, a lack of predictable structure, physical and cognitive demands over the course of the day, and negative social input can all create situations that are difficult for the student with TBI to understand and deal with.

The best strategy when facing these problems is prevention. With clear structure, predictability, consistency and positive feedback from teachers and sensitive peers, students with TBI can thrive in a classroom environment. When prevention fails, teachers should understand the student's triggers - for example, if they respond very badly to being laughed at - and be ready to intervene at the first signs.

Schools should, of course, seek expert input when they find themselves faced with the needs of students who have special needs as a result of TBI, but I hope that these two blog posts have provided a sufficient overview of a very real educational challenge.