Emotional Issues Associated with BI
Psychological and Educational Challenges of Children with Brain Injury
Last Updated:
A neuropsychological evaluation is strongly recommended for any child diagnosed with traumatic brain injury (TBI) in order to identify any brain injury-related problems with learning, memory and emotions/behavior. Public schools do offer educational and psychological testing and sometimes therapeutic services, but specific areas affected by TBI, such as executive functions and memory, are more consistently examined by neuropsychologists. If this sort of testing is not provided by the school system, it is possible for parents to seek out the service. Sometimes insurance companies deny coverage for this evaluation, but with persistence, many families have obtained approval under their medical plans.
Once the child’s strengths and needs have been identified, an Individualized Education Plan (IEP) may be developed by the school system. Schools tend to have general IEPs that are not tailored to TBI, and children who have sustained brain injury most often receive the same interventions as those with learning disorders or behavioral challenges. Still, many professionals believe that almost any help is good, since it involves smaller class sizes, more individualized attention, and a formal behavior plan. Also, children receiving daily special education services often have more structure and routine to their day, which tends to minimize difficulty.
However, parents must closely monitor their child’s progress and adjustment to the IEP. In school systems where teachers have no prior experience or training with students with TBI, interventions may not be helpful. For example, teachers may use punishment as a consequence for unwanted behaviors, but for a child with executive dysfunction and/or memory problems, this may have little impact. Other strategies can be more effective. Neuropsychologists familiar with brain injury can participate in IEP development to equip teachers with effective learning and behavior strategies for the children with TBI.
It is very important to address behavior in the school system, because research has shown that children with severe brain injury have worse academic outcomes than their performance on neuropsychological tests would suggest. This may be because other factors beyond learning and memory problems are affecting the child’s achievement. Some of these factors may be controllable if identified.
Although problems may not appear for months or years after the brain injury, health-care providers strongly recommend early intervention for brain injury-related psychological and behavioral problems. Once behavior problems emerge, they tend to become entrenched. Intervention even before problems become remarkable is suggested. Early intervention to help the family deal with the child’s behavior problems is also important. Early intervention is the key to minimizing the impact of injury-related problems on the family and the child, thereby increasing the quality of life for all.
Dr. Taylor is Professor of Pediatrics and Psychology at Case Western Reserve University, Cleveland, Ohio. He is also Director of Pediatric Neuropsychology Service, Division of Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital, University Hospitals of Cleveland. He has published extensively in the area of outcomes after pediatric TBI and low birth weight. Dr. Taylor is Board Certified in Clinical Neuropsychology by the American Board of Professional Psychology. He has been on the editorial boards of a number of child psychology and neuropsychology journals and is on the Maternal and Child Health Review Committee, National Institute of Child Health and Human Development.
Dr. Stancin is Head of the Division of Child Psychology in the Department of Pediatrics at MetroHealth Medical Center in Cleveland, Ohio. She is also an Associate Professor of Pediatrics, Psychiatry and Psychology at Case Western Reserve University. In 2001, Dr. Stancin received the Chairman's Award for Research Excellence in the Department of Pediatrics at MetroHealth Medical Center. She serves as an editor and editorial board member for numerous journals. She has published extensively in the area of pediatric brain injury.
References:
Taylor, H.G., Yeates, K.O., Wade, S.L., Drotar, D., Stancin, T., & Klein, S.K. (1999). Influences on first-year recovery from traumatic brain injury in children. Neuropsychology, 13, 76-89.
Levi, R.B., Drotar, D., Yeates, K.O., & Taylor, H.G. (1999). Posttraumatic stress symptoms in children following orthopedic or traumatic brain injury. Journal of Clinical Child Psychology, 28, 232-243.
Kirkwood, M., Janusz, J., Yeates, K.O., Taylor, H.G., Wade, S., Stancin, T., & Drotar, D. (2000). Prevalence and correlates of depressive symptoms following traumatic brain injury in children. Child Neuropsychology, 6, 195-208.
Yeates, K. O., Taylor, H. G., Barry, C. T., Drotar, D., Wade, S. L., & Stancin, T. (2001). Neurobehavioral symptoms in childhood closed-head injuries: Changes in prevalence and correlates during the first year post-injury. Journal of Pediatric Psychology, 26, 79-91.
Taylor, H.G., Yeates, K.O., Wade, S.L., Drotar, D., Stancin, T., & Minich, N. (2002). A prospective study of short- and long-term outcomes after traumatic brain injury in children: Behavior and achievement. Neuropsychology, 16, 15-27.
Stancin, T., Drotar, D., Taylor, H.G., Yeates, K.O., Wade, S.L., & Minich, N.M. (2002). Health related quality of life of children and adolescents following traumatic brain injury. Pediatrics, 109 (electronic article), e34.
Schwartz, L.S., Taylor, H.G., Drotar, D., Yeates, K.O., Wade, S.L., & Stancin, T. (in press). Long-term behavior problems following pediatric traumatic brain injury: Prevalance, predictors, and correlates. Journal of Pediatric Psychology.
Taylor, H.G., Yeates, K.O., Wade, S.L., Drotar, D., Stancin, T., & Montpetite, M. (in press). Long-term educational interventions after traumatic brain injury in children. Rehabilitation Psychology.
Yeates, K.O. (1999). Closed-head injury. In K.O. Yeates, M.D. Ris, & H.G. Taylor (Eds.), Pediatric Neuropsychology: Research, theory, and practice (pp.92-116). New York: Guilford.