{"id":69,"date":"2019-03-28T18:04:20","date_gmt":"2019-03-28T18:04:20","guid":{"rendered":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/chapter\/traumatic-brain-injury\/"},"modified":"2026-01-12T21:15:29","modified_gmt":"2026-01-12T21:15:29","slug":"traumatic-brain-injury","status":"publish","type":"chapter","link":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/chapter\/traumatic-brain-injury\/","title":{"raw":"Traumatic Brain Injury","rendered":"Traumatic Brain Injury"},"content":{"raw":"<div class=\"textbox key-takeaways\">\r\n<h3>Traumatic Brain Injury<\/h3>\r\n.\u00a0\u2026means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that\u00a0<strong>adversely affects<\/strong>\u00a0a child\u2019s educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.\u00a0<span id=\"visual\">\u00a0<\/span>\r\n\r\n(Center for Parent Information and Resources, 2017)\r\n\r\n<\/div>\r\n<div class=\"textbox shaded\">\r\n\r\nTable of Contents\r\n<ul>\r\n \t<li>About the IDEA definition of TBI<\/li>\r\n \t<li>Introduction<\/li>\r\n \t<li><strong>Characteristics and Impact on Learning<\/strong><\/li>\r\n \t<li><strong>Adaptive Behavior<\/strong><\/li>\r\n \t<li>Susan\u2019s Story<\/li>\r\n \t<li><strong>Interventions and Strategie<\/strong>s<\/li>\r\n \t<li>Concussion<\/li>\r\n \t<li><strong>Assistive Technology<\/strong><\/li>\r\n \t<li><strong>Related Service Providers<\/strong><\/li>\r\n<\/ul>\r\n<\/div>\r\n<h3>About the IDEA definition of TBI<\/h3>\r\n\"<em>The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma<\/em>. \" (IDEA)\r\n\r\n<strong>The definition of TBI isn't universal<\/strong>. Let's take a closer look at why.\r\n\r\nThe General Medical\/Clinical Definition\r\n\r\nWhen you search online or look at medical literature, you'll typically find TBI defined very broadly by organizations like the CDC or medical institutions.\r\n\r\n<strong>IDEA's More Specific Definition<\/strong>\r\n\r\nThe <strong>Individuals with Disabilities Education Act (IDEA)<\/strong>, which governs special education services in schools, defines TBI much more narrowly. Under IDEA, TBI is defined as:\r\n\r\n<em>An acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child's educational performance<\/em>, followed by what the term does and does not apply to.\r\n\r\n<strong>Why Does IDEA Define It Differently?<\/strong>\r\n\r\nThere are several important reasons:\r\n<ol>\r\n \t<li><strong> Educational Impact Focus<\/strong> IDEA is all about educational services, so the TBI must specifically impact the student's ability to learn or function in school. A student who had a concussion but fully recovered without lasting educational effects wouldn't qualify under IDEA's TBI category.<\/li>\r\n \t<li><strong> Excludes Congenital and Degenerative Conditions<\/strong> IDEA explicitly states that TBI does <em>not<\/em> include brain injuries that are congenital (present at birth) or degenerative (progressively worsening diseases). This distinguishes TBI from conditions like cerebral palsy or dementia.<\/li>\r\n \t<li><strong> Excludes Birth Trauma<\/strong> Brain injuries caused during the birth process are also excluded from IDEA's TBI definition. These might be covered under other IDEA categories, like \"Other Health Impairment,\" or have their own classifications.<\/li>\r\n \t<li><strong> Service Eligibility Requirements:<\/strong> IDEA needs clear criteria to determine who receives specialized services. The narrower definition helps schools identify students who need specific TBI-related accommodations (such as cognitive strategies, memory aids, or gradual return-to-learn protocols) rather than students whose needs might be better addressed under other disability categories.<\/li>\r\n \t<li><strong> Resource Allocation:<\/strong> Schools have limited resources. Hence, IDEA's definition helps ensure that the TBI classification applies to students whose educational challenges stem specifically from an acquired brain injury and require specialized interventions.<\/li>\r\n<\/ol>\r\n<strong>Why This Matters for You<\/strong>\r\n\r\nAs a college student studying education or related fields, understanding this distinction is crucial because:\r\n<ul>\r\n \t<li><strong>Research vs. Practice<\/strong>: When you're reading research studies about TBI, they might use the broad medical definition. But when you're working in schools, you'll need to apply IDEA's specific criteria.<\/li>\r\n \t<li><strong>Multiple Disability Categories<\/strong>: Sometimes a student with a brain injury might be better served under a different IDEA category, like \"Other Health Impairment,\" if that better describes their educational needs.<\/li>\r\n<\/ul>\r\nThe key takeaway? <strong>Context matters.<\/strong> Always pay attention to whether you're reading medical literature (broad definition) or educational\/legal documents (IDEA's specific definition), because they're talking about different populations and purposes.\r\n\r\n<hr \/>\r\n\r\n<h3><strong>Introduction<\/strong><\/h3>\r\nTraumatic brain injury is among the leading causes of morbidity and mortality among youth, with prior work documenting nearly 500,000 annual cases of TBI in the United States among newborns to 14-year-olds.\r\n\r\nChildren with brain injury are at increased risk for long-term neurocognitive, emotional, social, and behavioral effects. Such effects place youth at increased risk for poorer educational functioning post-injury. Indeed, prior research shows that children with a history of brain injury have reduced academic achievement and greater educational needs following school re-entry. Yet, pediatric brain injury is under-identified within school settings. Under-identification of pediatric brain injury occurs for multiple reasons, including ineffective communication between the medical and education systems as youth return to school. Perhaps more commonly, in the case of mild brain injuries, brain injuries are under-reported, or teachers, parents, and clinicians fail to link academic challenges to said brain injury.\r\n\r\nThe cognitive domains most severely disrupted by pediatric brain injury include executive functioning, processing speed, attention, and, to a lesser degree, verbal memory, fluency, and planning and problem-solving. Broadly, executive functions are the skills necessary to regulate thoughts, behaviors, and emotions and include skills such as impulse control, self-monitoring, behavioral and emotional modulation, task initiation and completion, problem-solving, and cognitive flexibility. In children with brain injuries, executive difficulties are generally most pronounced in the areas of cognitive flexibility and inhibition. Critically, given the lengthy nature of brain development, long-term effects on executive functioning may not become apparent until adolescence. In TBI populations, prior findings have demonstrated a persistent dose-dependent relationship between injury severity and cognitive outcome. Challenges with memory, attention, or working memory, and processing speed tend to remit several months to years after injury, though they remain relatively more pronounced and persistent in those with more severe injuries. Moreover, parents of children with severe TBI continue to perceive executive functioning problems in their children up to three years after their injury. In addition to injury severity, injury age has been shown to moderate long-term effects. Recent findings show that executive functioning challenges are often most devastating in children whose TBI occurred before age 5 years.\r\n<h5>Other Issues<\/h5>\r\nChildren are at increased risk for externalizing disorders following brain injury. TBI enhances the risk for personality change and disruptive behavior disorders, with prevalence estimates of oppositional defiant disorder and conduct disorder ranging from 12 to 23%. Most often, there are increases in affective lability, aggression, and disinhibition, and less commonly apathetic or paranoid behaviors. Internalizing disorders can also manifest among children with brain injury. Predictors of internalizing disorders following head injuries include premorbid psychosocial adversity and anxiety, as well as injury severity. Incidence rates of PTSD are estimated to range from about 6 to 15% in youth with brain injury compared to 5% of adolescents in the general population. Incidence rates of novel internalizing disorders vary based on injury type and severity, age of injury, and time of measurement. Following TBI, post-traumatic stress, anxiety, and depression are present in 20 to 25% of children. For children with mild TBI, anxiety symptoms generally resolve within several months after injury; however, in those with severe TBI, anxiety can become more severe over time. Novel anxiety disorder has also been associated with a younger age at the time of injury. In contrast, older age at the time of injury, particularly adolescence, is associated with more depressive symptoms. Of note, though, internalizing disorders resolve more often than externalizing disorders among youth with a history of TBI.\r\n\r\nBroad social challenges and physical changes are also observed in children with brain injuries. Social challenges include reduced social participation stemming from activity restrictions and changes in functioning, distressing reductions in social acceptance, and changes in peer relationships. Generally, those with more severe injuries are more likely to have more interfering and persistent social difficulties.\r\n\r\nWith regard to physical changes, it is not uncommon for this patient population to present with motor and sensory changes related to their injuries. Some degree of novel hearing impairment is especially common (i.e., 30%) in children following bacterial meningitis. Other common symptoms associated with pediatric brain injury include headache, nausea, pain, sleep disturbances, and fatigue\r\n<h5>Academic Outcomes<\/h5>\r\n<p style=\"text-align: left\">Cognitive and psychiatric challenges can significantly influence a child\u2019s school functioning. Not only are children absent from school due to hospitalization, rehabilitative care, and ongoing monitoring appointments, but ongoing symptomatology can also impede learning and participation. Difficulties with attention regulation, processing speed, executive functioning, and memory make it harder for children to engage academically and to acquire and retain new knowledge and skill sets. Significant emotional and behavioral challenges can exacerbate cognitive weaknesses, encumber peer and teacher interactions, and reduce academic engagement. Consistently, children with a history of brain injury show poorer academic functioning in a variety of ways, including lower levels of academic achievement and increased need for educational supports.<\/p>\r\n\r\n<h5>Academic Achievement<\/h5>\r\nTBI in preschool-aged children is associated with reduced school readiness, which, in turn, is predictive of lower academic achievement later in development. Further, school-aged children with a history of TBI show academic underachievement, though weaknesses may vary across subject areas. Word-reading tends to be preserved across TBI, especially if the injury occurs after the development of early reading abilities. Conversely, TBI has been associated with poorer outcomes on measures of mathematical ability, particularly among those with severe TBI. Severe TBI has also been associated with poorer performance on measures of decoding, reading comprehension, spelling, and arithmetic when compared to mild and moderate TBI samples, and group differences remained over a five-year follow-up period.\r\n\r\nIn addition to formal measures of academic achievement, other indicators have been used to examine academic functioning following brain injury. Compared to an orthopedic control group, children with a history of moderate or severe TBI are more likely to be diagnosed with a learning disability and have lower academic competency, per parent or teacher report. Concussion, often synonymously referred to as mild TBI, has been associated with greater GPA declines, especially for individuals with a history of two or more concussions. Whereas concussion does not appear to impact graduation rates, severe childhood TBI has been associated with greater drop-out rates and an increased likelihood of unemployment during adulthood.\r\n<h5>Need for Academic Supports<\/h5>\r\nParalleling the data on reduced academic achievement among youth with brain injury, there is a greater need for educational supports among this population as they begin or re-enter school.\r\n\r\nNotably, provision of academic support for less severe TBI groups may increase over time since the injury. Taken together, academic needs among youth with mild or moderate TBI may increase over time, likely due to greater academic demands and emergent executive functioning challenges across grade levels. This trend may also demonstrate the under-recognition of educational needs among less severe TBIs during the early stages of returning to school.\r\n<h5>Moderators of Academic Outcomes<\/h5>\r\nSeveral factors moderate the degree of academic difficulties following brain injury, including injury severity, degree of cognitive changes, age of injury, and level of premorbid functioning. Greater injury severity tends to predict poorer outcomes, including higher rates of educational supports. Similarly, TBI severity is associated with poorer academic achievement, higher rates of academic need, and greater provision of school supports. It is also worth restating that academic needs among youth with a history of less severe TBI may be under-recognized and\/or may become more apparent over time.\r\n\r\nGreater injury-related cognitive change contributes to subsequent academic functioning. In particular, greater levels of executive dysfunction following TBI are associated with weaker academic performance.\r\n\r\nChanges in other cognitive domains have been linked to poor academic outcomes. Among youth with TBI, greater language or intellectual impairment is associated with the amount of school adaptations, greater short-term verbal memory impairment is associated with greater listening comprehension difficulty, and greater long-term verbal memory impairment is associated with greater arithmetic difficulty.\r\n\r\nAge of injury has also been linked to academic outcomes. Early age of TBI has been linked to flatter trajectories of academic achievement over a five-year span.\r\n\r\nPremorbid functioning is a strong predictor of post-injury functioning, especially within the TBI literature. Stronger preinjury educational abilities are predictive of better post-TBI word reading, spelling, arithmetic, and listening comprehension skills. Conversely, a greater degree of premorbid (preinjury) challenge has been associated with poorer outcomes post-injury. Children with a pre-existing diagnosis of attention deficit hyperactivity disorder (ADHD) or learning disability take longer to return to school following a mild TBI than those without a premorbid neurodevelopmental disorder. Similarly, youth with greater levels of anxiety symptoms prior to sustaining a mild TBI have a more delayed return to school than their relatively lower-anxiety counterparts. A higher number of prior head injuries has also been shown to predict poorer post-TBI outcomes. The number of prior concussions has been positively associated with GPA decline and with more academic dysfunction.\r\n<h5>Limitations in Identification<\/h5>\r\nMany students who experience a brain injury, especially a mild injury, go untreated and\/or do not report the event to hospitals or schools. Canto et al. indicated that, over a two-year period in a Florida school district, approximately 1300 schoolchildren were treated for TBI at the local hospital, but only 129 students were served by the school district\u2019s TBI program. The findings point to how many students with brain injury\u2014in that study, TBI specifically\u2014are not being screened or identified by school districts for appropriate services under Section 504 or IDEA.\r\n\r\nStill, more students with brain injury are not seen at hospitals nor identified by school districts. These issues point to the fact that many students with milder forms of brain injury are not being identified and are not receiving any form of educational support. Such support may be lacking for the simple reason that school personnel are uninformed about the brain injury and, thus, injury- related issues may be mistaken for other high-incidence disabilities such as emotional or behavioral disturbance, specific learning disability, or speech\/language impairment, which may misguide the identification of the most appropriate services. Even in cases of more moderate or severe injuries, communication gaps can exist between the medical and educational systems. In one study, over 20% of parents of children with brain injury indicated that school systems did not receive any communication or information regarding the injury. Communication between the medical and education sectors tends to be more reliable for youth who are involved in inpatient rehabilitative care or who receive transitional services.\r\n\r\nObtaining medical documentation of the injury is essential in the <strong>evaluation process<\/strong> for students with TBI. Because <strong>TBI is considered a medically related disability,<\/strong> such as ADHD, states require formal validation from a provider attesting that a TBI occurred and that it affects educational performance. The primary issue is that often, brain injury is not formally documented by medical staff for children with mild brain injury, even if they are taken to an emergency room. Difficulties obtaining such documentation may complicate the evaluation process and may increase the risk for an inappropriate classification. Importantly, though, if a school has good reason to suspect a student\u2019s poor\/declining educational performance is due to TBI but overlooks it in favor of an \u201ceasier,\u201d more expedient IDEA disability category, it could lead to a FAPE violation and legal proceedings.\r\n<h5>Avenues for next steps<\/h5>\r\nSolutions for ensuring youth with brain injury are properly identified and effectively supported in schools include (but are not limited to):\r\n\r\n(a) improving hospital-to-school transition services\/models;\r\n\r\n(b) providing effective professional development and in-service education to administrators and teachers about brain injury and legal responsibilities under IDEA and Section 504;\r\n\r\n(c) enhancing the IDEA identification process in schools;\r\n\r\n(d) training parents on how to be more effective in communicating with schools about their child\u2019s educational needs; and\r\n\r\n(e) changing state-level policies designed to assist schools in identifying and serving students with brain injury more efficiently.\r\n\r\n(Vanderlind, Demers, Engelson, Fowler, and\u00a0 McCart, 2022)\r\n\r\n<hr \/>\r\n\r\n<h2>Characteristics and Impact on Learning<\/h2>\r\nA traumatic brain injury (TBI) is an injury to the brain caused by the head being hit by something or shaken violently. (The exact definition of TBI, according to special education law, is discussed in the first section of the chapter.) This injury can change how the person acts, moves, and thinks. A traumatic brain injury can also change how a student learns and acts in school. The term TBI is used for head injuries that can cause changes (<strong>impact learning)<\/strong> in one or more areas, such as:\r\n<ul>\r\n \t<li>thinking and reasoning,<\/li>\r\n \t<li>understanding words,<\/li>\r\n \t<li>remembering things,<\/li>\r\n \t<li>paying attention,<\/li>\r\n \t<li>solving problems,<\/li>\r\n \t<li>thinking abstractly,<\/li>\r\n \t<li>talking,<\/li>\r\n \t<li>behaving,<\/li>\r\n \t<li>walking and other physical activities,<\/li>\r\n \t<li>seeing and\/or hearing, and<\/li>\r\n \t<li>learning.<\/li>\r\n<\/ul>\r\n<h2>What Are the Signs of Traumatic Brain Injury?<\/h2>\r\nThe signs <strong>\u00a0(characteristics and issues of adaptive behavior)<\/strong>\u00a0of brain injury can be very different depending on where the brain is injured and how severely. Children with TBI may have one or more difficulties, including:\r\n\r\n<strong><em>Physical disabilities<\/em>:<\/strong>\u00a0Individuals with TBI may have problems speaking, seeing, hearing, and using their other senses. They may have headaches and feel tired a lot. They may also have trouble with skills such as writing or drawing. Their muscles may suddenly contract or tighten (this is called spasticity). They may also have seizures. Their balance and walking may also be affected. They may be partly or completely paralyzed on one side of the body, or both sides.\r\n\r\n<strong><em>Difficulties with thinking<\/em>:<\/strong> Because the brain has been injured, the person\u2019s ability to use the brain can change. For example, children with TBI may have trouble with short-term memory (remembering something from one minute to the next, such as what the teacher just said). They may also have trouble with their long-term memory (remembering information from a while ago, such as facts learned last month). People with TBI may have trouble concentrating and only be able to focus their attention for a short time. They may think slowly. They may have trouble talking and listening to others. They may also have difficulty with reading and writing, planning, understanding the order of events (called sequencing), and judgment.\r\n\r\n<em><strong>Social, behavioral, or emotional problems:\u00a0<\/strong><\/em>These difficulties may include sudden changes in mood, anxiety, and depression. Children with TBI may have trouble relating to others. They may be restless and may laugh or cry a lot. They may not have much motivation or much control over their emotions.\r\n\r\n<em>A child with TBI may not have all of the above difficulties<\/em>. Brain injuries can range from mild to severe, and so can the changes that result from the injury. This means that it\u2019s hard to predict how an individual will recover from the injury. Early and ongoing help can make a big difference in how the child recovers. This help can include physical or occupational therapy, counseling, and special education.\r\n\r\nIt\u2019s also important to know that, as the child grows and develops, parents and teachers may notice new problems. This is because, as students grow, they are expected to use their brain in new and different ways. The damage to the brain from the earlier injury can make it hard for the student to learn new skills that come with getting older. Sometimes parents and educators may not even realize that the student\u2019s difficulty comes from the earlier injury.\r\n\r\nAlthough TBI is very common, many medical and education professionals may not realize that some difficulties can be caused by a childhood brain injury. Often, students with TBI are thought to have a learning disability, emotional disturbance, or intellectual disability. As a result, they don\u2019t receive the type of educational help and support they really need.\r\n\r\n<strong>When children with TBI return to school, their educational and emotional needs are often very different than before the injury.<\/strong>\u00a0Their disability has happened suddenly and traumatically. They can often remember how they were before the brain injury. This can bring on many emotional and social changes. The child\u2019s family, friends, and teachers also recall what the child was like before the injury. These other people in the child\u2019s life may have trouble changing or adjusting their expectations of the child.\r\n\r\nTherefore, it is extremely important to<strong>\u00a0plan carefully for the child\u2019s return to school<\/strong>. Parents will want to learn about the school's special education services in advance. This information is usually available from the school\u2019s principal or special education teacher. The school will need to evaluate the child thoroughly. This evaluation will inform the school and parents of the student\u2019s educational needs. The school and parents will then develop an <strong>Individualized Education Program<\/strong>\u00a0(IEP) that addresses those educational needs.\r\n\r\nIt\u2019s important to remember that the IEP is a\u00a0<strong><em>flexible\u00a0<\/em><\/strong>plan. It can be changed as the parents, the school, and the student learns more about what the student needs at school.\r\n\r\n(Center for Parent Information &amp; Resources, n.d.)\r\n\r\n<hr \/>\r\n\r\n<h3><strong>Adaptive Behavior<\/strong><\/h3>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Adaptive behaviors encompass the practical, everyday skills required for independence and social functioning, including communication, self-care, home living, social interaction, community participation, self-direction, health and safety awareness, functional academics, leisure activities, and work-related skills (Schalock et al., 2021). For school-aged children, these competencies are fundamental to educational engagement, peer relationships, and successful transition through developmental milestones.<\/p>\r\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Impact on Communication and Social Skills<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Students who have sustained TBI frequently demonstrate significant deficits in pragmatic language skills and social communication (Narad et al., 2018). These difficulties manifest as challenges in understanding non-verbal cues, maintaining topic relevance during conversations, taking conversational turns appropriately, and comprehending abstract language or humor. Ryan et al. (2021) found that children with moderate-to-severe TBI exhibited persistent deficits in social cognition that directly impaired their ability to navigate peer relationships and participate effectively in collaborative classroom activities.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">The social isolation that often follows TBI can be particularly devastating during the school years when peer relationships become increasingly central to identity development and emotional well-being (Schmidt et al., 2020). Students may struggle to maintain friendships established prior to their injury and find it challenging to form new social connections, leading to increased risk for anxiety, depression, and behavioral problems (Jones et al., 2019).<\/p>\r\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Self-Care and Daily Living Skills<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">TBI can significantly impair students' ability to perform age-appropriate self-care tasks and daily living skills. Depending on injury severity, students may require assistance with basic activities such as dressing, grooming, feeding, and toileting\u2014skills that are typically mastered in early childhood (Keenan et al., 2018). Even students with mild TBI may experience subtle difficulties with organization, time management, and independent completion of multi-step tasks necessary for school success.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Wade et al. (2020) documented that executive function deficits following pediatric TBI directly impact adaptive functioning in daily routines, with children demonstrating difficulties in planning morning routines, organizing school materials, managing homework completion, and maintaining personal hygiene standards. These challenges place additional stress on families and may require ongoing support and accommodations within the educational setting.<\/p>\r\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Academic and Learning Adaptations<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">The cognitive sequelae of TBI\u2014including difficulties with attention, memory, processing speed, and executive functioning\u2014profoundly affect students' adaptive behaviors in academic contexts (K\u00f6nigs et al., 2018). Students may struggle to adapt to increasing academic demands as they progress through grade levels, particularly during transitions such as moving from elementary to middle school or from middle to high school, where organizational demands and expectations for academic independence increase substantially (Glang et al., 2019).<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Research indicates that students with TBI often require explicit instruction in compensatory strategies and environmental modifications to successfully navigate academic settings (Davies et al., 2020). Deficits in metacognitive awareness may prevent students from independently recognizing when they need assistance or which strategies might be helpful, necessitating ongoing adult support and monitoring.<\/p>\r\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Behavioral and Emotional Regulation<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Impairments in behavioral and emotional regulation are among the most challenging adaptive behavior deficits following pediatric TBI. Students may exhibit increased impulsivity, emotional lability, difficulty managing frustration, reduced behavioral inhibition, and challenges with transitioning between activities or adapting to changes in routine (Treble-Barna et al., 2020). These difficulties can manifest as disruptive classroom behaviors, conflict with peers and adults, and reduced capacity to benefit from typical behavioral management approaches.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Narad et al. (2019) found that children who sustained TBI were at significantly elevated risk for developing behavioral and emotional problems, with approximately 25-50% experiencing clinically significant symptoms. These behavioral and emotional challenges directly impact students' ability to function adaptively within the structured school environment and can strain relationships with teachers, peers, and family members.<\/p>\r\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Safety Awareness and Judgment<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">TBI can impair students' safety awareness and judgment, creating concerns about their ability to navigate school and community environments independently (Gagner et al., 2018). Students may demonstrate reduced awareness of potential hazards, impulsive decision-making that places them at risk, and difficulty learning from previous mistakes or consequences. This is particularly concerning for adolescents who are typically developing increasing independence and may not recognize their own vulnerabilities.<\/p>\r\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Long-Term Adaptive Functioning Outcomes<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Longitudinal research indicates that adaptive behavior deficits following pediatric TBI often persist or even emerge years after the initial injury, particularly as environmental demands increase and the scaffolding provided in early recovery phases is withdrawn (Anderson et al., 2021). The concept of \"growing into deficits\" describes how children with TBI may appear to recover initially but then demonstrate increasing difficulties as they fail to acquire new skills at the expected rate or struggle to meet age-appropriate expectations for independence.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Wade et al. (2019) emphasized that adaptive functioning outcomes are influenced not only by injury severity but also by family functioning, socioeconomic status, access to rehabilitation services, and the quality of school-based support. Students from disadvantaged backgrounds or those with limited access to specialized services face heightened risk for poor long-term adaptive outcomes.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Ewing-Cobbs et al. (2018) found that children with severe TBI demonstrated persistent deficits in adaptive functioning across communication, daily living skills, and socialization domains even several years post-injury. These findings underscore the chronic nature of adaptive impairments following significant brain injury during childhood.<\/p>\r\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Developmental Considerations<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">The impact of TBI on adaptive behaviors varies significantly based on the child's age at injury. Younger children may be at particular risk of long-term adaptive difficulties due to disruptions in foundational skill development, while adolescents face challenges related to increasing expectations for independence and more complex social navigation (Beauchamp et al., 2019). Ryan et al. (2018) emphasized that injury during critical developmental periods can have cascading effects on subsequent skill acquisition across multiple domains.<\/p>\r\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>School-Based Assessment and Monitoring<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Regular assessment of adaptive functioning is essential for students with TBI, as deficits may not be immediately apparent or may emerge over time as demands increase (Glang et al., 2019). Standardized measures of adaptive behavior, combined with functional observation and input from multiple informants, provide critical data for educational planning and intervention development (Keenan et al., 2018)..<\/p>\r\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Conclusion<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Traumatic brain injury during the school years can have devastating and long-lasting effects on adaptive behaviors across multiple domains of functioning. The impact extends beyond academic skills to encompass the practical, social, and behavioral competencies essential for independence and quality of life. Understanding these challenges and implementing comprehensive, individualized support systems within educational settings is critical for helping students with TBI reach their full potential and successfully transition to adulthood.<\/p>\r\n\r\n\r\n<hr \/>\r\n\r\n<h2>Susan\u2019s Story<\/h2>\r\nSusan was 7 years old when she was hit by a car while riding her bike. She broke her arm and leg. She also hit her head very hard. The doctors say she sustained a traumatic brain injury. When she came home from the hospital, she needed lots of help, but now she looks fine.\r\n\r\nIn fact, that\u2019s part of the problem, especially at school. Her friends and teachers think her brain has healed because her broken bones have. But there are changes in Susan that are hard to understand. It takes Susan longer to do things. She has trouble remembering things. She can\u2019t always find the words she wants to use. Reading is hard for her now. It\u2019s going to take time for people to really understand the changes they see in her and how best to meet her learning needs.\r\n\r\n(Center for Parent Information and Resources, 2015)\r\n\r\n<hr \/>\r\n\r\n<h3><strong>Interventions and Strategies<\/strong><\/h3>\r\nGo to your primary reading for this section of the summary: Bowen, J. (2018),\u00a0<em>Classroom Interventions for Students with Traumatic Brain Injury<\/em> from <a href=\"https:\/\/www.brainline.org\/article\/classroom-interventions-students-traumatic-brain-injuries\" target=\"_blank\" rel=\"noopener\">https:\/\/www.brainline.org\/article\/classroom-interventions-students-traumatic-brain-injuries\u00a0<\/a>\r\n<ul>\r\n \t<li>Include strategies for <strong>structuring the school environment (and<\/strong><strong>\u00a0classroom <\/strong><strong><strong>accommodations)\u00a0<\/strong>and <strong>specialized teaching strategies<\/strong><\/strong><\/li>\r\n<\/ul>\r\n\r\n<hr \/>\r\n\r\nThe following text is an excerpt from:\r\n\r\nDeMatteo CA, Randall S, Lin C-YA, and Claridge EA (2019). What Comes First: Return to School or Return to Activity for Youth After Concussion? Maybe We Don't Have to Choose.\r\n<h3><strong>Concussion<\/strong><\/h3>\r\nConcussions have become an epidemic in children and youth. The number of reported head injuries in Emergency Departments among youth playing sport has increased in the past decade by over 40%. The symptoms of concussions can often interfere with participation and performance in home, school, and community activities. The current consensus for standard concussion management is the six-stage Berlin Return to Play recommendations. This statement and much of the literature now suggest a more conservative approach to the management of children\/youth with concussion. It is, however, still unclear as to what \u201cmore conservative\u201d entails. When they are symptomatic, children and youth are advised to rest for 48 hours, then gradually resume regular activity with incremental increases in physical and cognitive activity within symptom tolerance. Depression and anxiety may result as a secondary sequelae if youth are socially isolated and removed from normal activity and participation for prolonged periods of time. Prolonged rest can lengthen recovery time and contribute to deconditioning. Protocols for children must contain a balance of activity and rest to promote physical, emotional, and cognitive recovery.\r\n\r\nBoth Return to School (RTS) and Return to Activity\/Play \u00a0(RTA) protocols for pediatric concussion management should be conservative and individualized. A number of protocols guiding families and youth through progressive recovery steps for safe Return to School (RTS) and Return to Activity\/Play (RTA) have now been developed, are widely accepted, and are important aspects of pediatric concussion management.\r\n\r\n<strong>Download Return to School Guidelines <\/strong><a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2019.00792\/full#supplementary-material\">https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2019.00792\/full#supplementary-material<\/a>\r\n\r\nYouth return to school faster than they return to play in spite of the self-reported, school-related symptoms they experience while moving through the protocols. Youth can progress simultaneously through the RTS and RTA protocols during the early stages 1\u20133. Considering the number of youth having school difficulties post-concussion, full contact sport, stage 6, of RTA, should be delayed until full and successful reintegration back to school has been achieved. In light of the\u00a0<span style=\"margin: 0px;padding: 0px\"><strong>wide variability in recovery<\/strong>, determining how to resume participation in activities despite ongoing symptoms remains<\/span>\u00a0a challenge for each individual child. There is much to be learned, with further research needed in this area\r\n\r\n*Research sample mean age of the research is \u201c46% male, 13 yrs. of age.\r\n\r\n(DeMatteo, Randall, and Lin, 2019)\u00a0 The Full article and references can be accessed at: <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2019.00792\/full#h14\">https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2019.00792\/full#h14<\/a>\r\n\r\n<hr \/>\r\n\r\n<h3><strong>Assistive Technology<\/strong><\/h3>\r\nAssistive technology offers powerful support for students with traumatic brain injury (TBI) who struggle with memory and organizational challenges. These tools can compensate for cognitive difficulties and help students succeed academically and independently.\r\n\r\nFocus specifically on AT for memory and organization.\u00a0 Two critical areas affect learning and day-to-day life.\r\n<div data-test-render-count=\"1\">\r\n<div class=\"group\">\r\n<div data-is-streaming=\"false\" class=\"group relative pb-3\">\r\n<div class=\"font-claude-response relative leading-[1.65rem] [&amp;_pre&gt;div]:bg-bg-000\/50 [&amp;_pre&gt;div]:border-0.5 [&amp;_pre&gt;div]:border-border-400 [&amp;_.ignore-pre-bg&gt;div]:bg-transparent [&amp;_.standard-markdown_:is(p,blockquote,h1,h2,h3,h4,h5,h6)]:pl-2 [&amp;_.standard-markdown_:is(p,blockquote,ul,ol,h1,h2,h3,h4,h5,h6)]:pr-8 [&amp;_.progressive-markdown_:is(p,blockquote,h1,h2,h3,h4,h5,h6)]:pl-2 [&amp;_.progressive-markdown_:is(p,blockquote,ul,ol,h1,h2,h3,h4,h5,h6)]:pr-8\">\r\n<div>\r\n<div class=\"standard-markdown grid-cols-1 grid gap-4 [&amp;_&gt;_*]:min-w-0 standard-markdown\">\r\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Memory Support<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Students with TBI often experience difficulties with short-term memory, working memory, and prospective memory (remembering to do things in the future). Technology can serve as an external memory system:<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Digital reminders and alerts<\/strong> are perhaps the most fundamental tool. Smartphones, smartwatches, and tablets can provide auditory or vibration alerts for class transitions, assignment deadlines, medication schedules, or therapy appointments. Apps like Google Calendar or specialized tools designed for cognitive support can send repeated notifications until acknowledged.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Voice recording applications<\/strong> allow students to record lectures, instructions, or their own verbal notes, which they can replay as needed. This reduces the cognitive load of trying to remember everything in real-time and allows students to focus on understanding during class.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Note-taking apps with audio sync<\/strong> (like Notability or OneNote) let students take minimal notes while recording, then tap any written word to hear what was said at that moment. This creates a multimedia memory aid that's far more accessible than traditional notes.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Memory notebooks or apps<\/strong> can store important information students need frequently\u2014locker combinations, class schedules, teacher names, or step-by-step procedures for recurring tasks. Digital versions offer search functionality that makes retrieval faster than flipping through pages.<\/p>\r\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Organization Support<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">TBI often disrupts executive functioning, making it difficult to plan, prioritize, sequence tasks, and manage time. Assistive technology can provide external structure:<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Task management apps<\/strong> break down complex assignments into manageable steps with individual deadlines. Apps like Todoist or specialized educational planners can use visual cues, color-coding, and priority rankings to help students see what needs attention first. Some apps use gamification elements that provide positive reinforcement for task completion.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Digital planners and organizational systems<\/strong> offer advantages over paper planners\u2014they can't be lost as easily, provide automatic backup, and integrate with reminder systems. Visual schedules with pictures or icons can help students who process visual information more easily than text.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Cloud-based file organization<\/strong> (Google Drive, Dropbox, OneDrive) ensures students can access their work from any device and reduces the risk of losing important documents. These systems also allow for shared folders with teachers or support staff who can help monitor the organization.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Graphic organizers and mind-mapping software<\/strong> help students structure their thoughts for writing assignments or studying. Tools like Inspiration or digital whiteboards provide templates that guide students through brainstorming, outlining, and organizing information hierarchically.<\/p>\r\n\r\n<h4 class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Integrated Benefits<\/h4>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">What makes assistive technology particularly effective is how these tools work together. A student might receive a reminder about an assignment, access their task list to see the broken-down steps, listen to a recorded lecture for information, and use a graphic organizer to structure their response\u2014all supported by technology that compensates for their specific cognitive challenges.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">The key is individualized assessment and training. Not every student with TBI needs the same tools, and successful implementation requires teaching students how to use the technology consistently until it becomes habitual. When properly matched to a student's needs and integrated into their routine, assistive technology can dramatically improve academic performance and independence, allowing students to demonstrate their knowledge despite memory and organizational impairments.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<div class=\"flex justify-start\" role=\"group\" aria-label=\"Message actions\">\r\n<div class=\"text-text-300\">\r\n<div class=\"text-text-300 flex items-stretch justify-between\">\r\n<div class=\"w-fit\" data-state=\"closed\">\r\n<div class=\"relative text-text-500 group-hover\/btn:text-text-100\">\r\n<div class=\"flex items-center justify-center transition-all opacity-100 scale-100\"><\/div>\r\n<div class=\"flex items-center justify-center absolute top-0 left-0 transition-all opacity-0 scale-50\">(<span>Ownsworth et all, 2023)<\/span><\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<div>\r\n\r\n<hr \/>\r\n\r\n<\/div>\r\n<h3><strong>Related Service Providers<\/strong><\/h3>\r\n<div>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Children with traumatic brain injury (TBI) who qualify for special education services under IDEA can access a comprehensive range of related service providers, as TBI often affects multiple areas of functioning. The specific services depend on the individual child's needs as determined by their IEP team.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Highly relevant service providers for students with TBI:<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Speech-language pathologists are frequently essential for students with TBI, as these injuries commonly affect language processing, word retrieval, verbal expression, and pragmatic language skills (understanding social cues, conversation skills, humor). They may also address cognitive-communication difficulties like organization, sequencing, and problem-solving through language.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Occupational therapists help students rebuild or compensate for lost fine motor skills, visual-motor integration, handwriting abilities, and executive functioning skills needed for academic tasks. They're particularly important for addressing cognitive effects of TBI like attention, memory, organization, and planning. OTs also work on sensory processing issues and fatigue management, which are common after brain injury.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Physical therapists support students who have motor impairments, balance difficulties, coordination problems, or mobility challenges resulting from their TBI. They help with safe navigation of the school environment and may recommend adaptive equipment.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">School psychologists and counselors provide crucial support for the emotional and behavioral changes that often follow TBI. Students may experience personality changes, mood swings, depression, anxiety, irritability, or difficulty with social relationships. These providers offer counseling, behavioral interventions, and strategies for emotional regulation.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Additional specialized services:<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">School nurses play a particularly important role for students with TBI who may have seizure disorders, require medication management, need monitoring for post-concussion symptoms, or have other medical needs requiring oversight during the school day.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Vision specialists or teachers of the visually impaired may be needed if the TBI resulted in visual impairments, visual processing difficulties, or visual field defects that affect learning.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Assistive technology specialists can be critical, as many students with TBI benefit from technology supports like voice-to-text software, organizational apps, memory aids, audiobooks, or modified computer access to compensate for cognitive, motor, or sensory changes.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Orientation and mobility specialists might work with students who have visual-spatial difficulties or physical mobility challenges, navigating the school environment.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Important considerations for TBI:<\/strong><\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">The needs of students with TBI can change significantly over time, especially in the months and years following the injury. Recovery patterns vary widely, so IEP teams should regularly reassess services and adjust support as the student progresses or as new challenges emerge. Some students show remarkable recovery while others have persistent difficulties.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">TBI can affect seemingly unrelated areas - a student might have physical recovery but struggle with subtle cognitive changes affecting memory, processing speed, attention, or executive functions. Related services should address the full scope of impact, not just the most visible effects.<\/p>\r\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Coordination among service providers is particularly important for students with TBI, as their challenges often overlap multiple domains and require an integrated approach to support their return to successful learning.<\/p>\r\n\r\n<\/div>\r\n\r\n<hr \/>\r\n\r\n<strong>Optional Extended Learning \/ Teacher Resources<\/strong>\r\n<ul>\r\n \t<li>From the Wisconsin Department of Public Instruction, <a href=\"https:\/\/dpi.wi.gov\/sites\/default\/files\/imce\/sped\/pdf\/tbi-mildtchrbroc.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Mild Brain Injury Brochure for Educators<\/a><\/li>\r\n \t<li style=\"font-weight: 400\">Colorado Dept. of Education, (2012). Brain Injury in Children and Youth: A Manual for Educators. Retrieved from \u00a0<a href=\"http:\/\/www.cde.state.co.us\/cdesped\/tbi_manual_braininjury\">http:\/\/www.cde.state.co.us\/cdesped\/tbi_manual_braininjury<\/a><\/li>\r\n \t<li>Brain Injury Association of VA (2013).\u00a0<a href=\"http:\/\/www.doe.virginia.gov\/special_ed\/disabilities\/traumatic_brain_injury\/brain_injury_schools.pdf\" target=\"_blank\" rel=\"noopener\">Brain Injury and the\u00a0<\/a>S<a href=\"http:\/\/www.doe.virginia.gov\/special_ed\/disabilities\/traumatic_brain_injury\/brain_injury_schools.pdf\" target=\"_blank\" rel=\"noopener\">chools: A Guide for Educators<\/a>, Ch.\u00a0B &amp; C, Educational Implications. Retrieved from <a href=\"http:\/\/www.doe.virginia.gov\/special_ed\/disabilities\/traumatic_brain_injury\/brain_injury_schools.pdf\">http:\/\/www.doe.virginia.gov\/special_ed\/disabilities\/traumatic_brain_injury\/brain_injury_schools.pd<\/a><\/li>\r\n<\/ul>\r\n\r\n<hr \/>\r\n\r\nReferences\r\n\r\nAnderson, V., Spencer-Smith, M. M., Coleman, L., Anderson, P. J., Greenham, M., Jacobs, R., Lee, K. J., &amp; Leventer, R. J. (2021). Predicting neurocognitive and behavioral outcome after early brain insult. <em>Developmental Medicine &amp; Child Neurology<\/em>, <em>63<\/em>(3), 329-336. <a href=\"https:\/\/doi.org\/10.1111\/dmcn.14749\">https:\/\/doi.org\/10.1111\/dmcn.14749<\/a>\r\n\r\nBeauchamp, M. H., Vera-Estay, E., Morasse, F., Julien, J., &amp; Dooley, J. J. (2019). Sociomoral reasoning and behavior in children with traumatic brain injury. <em>Developmental Neurorehabilitation<\/em>, <em>22<\/em>(5), 301-310. <a href=\"https:\/\/doi.org\/10.1080\/17518423.2018.1500519\">https:\/\/doi.org\/10.1080\/17518423.2018.1500519<\/a>\r\n\r\n<span>Bowen, J. M. (2008).<\/span><span>\u00a0<\/span><em>Classroom Interventions\u00a0for\u00a0Students With Traumatic Brain Injuries, Preventing School Failure<\/em><span>: posted on brainline.org,<\/span><a class=\"external\" href=\"https:\/\/www.brainline.org\/article\/classroom-interventions-students-traumatic-brain-injuries\" target=\"_blank\" rel=\"noopener\"><span> https:\/\/www.brainline.org\/article\/classroom-interventions-students-traumatic-brain-injuries\u00a0<\/span><\/a>\r\n\r\n<span>Brainline, (n.d.)\u00a0<em>Using External Aids to Compensate for Memory and Organization Post-TBI<\/em><strong>.<\/strong>\u00a0from\u00a0<\/span><a class=\"external\" href=\"https:\/\/www.brainline.org\/article\/using-external-aids-compensate-memory-and-organizational-problems-post-tbi\" target=\"_blank\" rel=\"noopener\"><span>https:\/\/www.brainline.org\/article\/using-external-aids-compensate-memory-and-organizational-problems-post-tbi<\/span><\/a>\r\n\r\nCenter for Parent Information and Resources (2015), <em>Traumatic Brain Injury, <\/em>from <a href=\"https:\/\/www.parentcenterhub.org\/tbi\/\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.parentcenterhub.org\/tbi\/<\/a> public domain\r\n\r\nDavies, S. C., Shultz, E. L., &amp; Glang, A. (2020). Traumatic brain injury facts and stats: What educators need to know. <em>TEACHING Exceptional Children<\/em>, <em>52<\/em>(6), 368-370. <a href=\"https:\/\/doi.org\/10.1177\/0040059920927060\">https:\/\/doi.org\/10.1177\/0040059920927060<\/a>\r\n\r\n<span style=\"font-size: 1em\">DeMatteo CA, Randall S, Lin C-YA, and Claridge EA (2019).\u00a0<\/span><a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2019.00792\/full#h14\" target=\"_blank\" style=\"font-size: 1em\" rel=\"noopener\">What Comes First: Return to School or Return to Activity for Youth After Concussion?<\/a><a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2019.00792\/full#h14\" target=\"_blank\" rel=\"noopener\">\u00a0Maybe We Don't Have to Choose<\/a>.\u00a0Front. Neurol.\u00a010:792. doi: 10.3389\/fneur.2019.00792 This is an open-access article distributed under the terms of the\u00a0<a href=\"http:\/\/creativecommons.org\/licenses\/by\/4.0\/\" target=\"_blank\" rel=\"noopener noreferrer\">Creative Commons Attribution License (CC BY)<\/a>.\r\n\r\nEwing-Cobbs, L., Johnson, C. P., Juranek, J., DeMaster, D., Prasad, M., Duque, G., Kramer, L., Cox, C. S., &amp; Swank, P. R. (2018). Longitudinal diffusion tensor imaging after pediatric traumatic brain injury: Impact of age at injury and time since injury on pathway integrity. <em>Human Brain Mapping<\/em>, <em>37<\/em>(11), 3929-3945. <a href=\"https:\/\/doi.org\/10.1002\/hbm.23286\">https:\/\/doi.org\/10.1002\/hbm.23286<\/a>\r\n\r\nGagner, C., Landry-Roy, C., Lain\u00e9, F., Beauchamp, M. H., &amp; Bernier, A. (2018). Traumatic brain injury and its consequences for the development of self-regulation: Implications for interventions focused on social competence. <em>Frontiers in Psychology<\/em>, <em>9<\/em>, 2325. <a href=\"https:\/\/doi.org\/10.3389\/fpsyg.2018.02325\">https:\/\/doi.org\/10.3389\/fpsyg.2018.02325<\/a>\r\n\r\nGlang, A., Todis, B., Sublette, P., Eagan Brown, B., &amp; Vaccaro, M. (2019). Professional development in TBI for educators: The importance of context. <em>Journal of Head Trauma Rehabilitation<\/em>, <em>25<\/em>(6), 426-432. <a href=\"https:\/\/doi.org\/10.1097\/HTR.0b013e3181fb8f45\">https:\/\/doi.org\/10.1097\/HTR.0b013e3181fb8f45<\/a>\r\n\r\nJones, K., Marquez de la Plata, C., Wilde, E. A., Hanten, G. R., Scheibel, R. S., Yallampalli, R., Chapman, S. B., &amp; Levin, H. S. (2019). Profiles of executive and memory function following pediatric traumatic brain injury. <em>Developmental Neuropsychology<\/em>, <em>44<\/em>(5), 393-413. <a href=\"https:\/\/doi.org\/10.1080\/87565641.2019.1635606\">https:\/\/doi.org\/10.1080\/87565641.2019.1635606<\/a>\r\n\r\nKeenan, H. T., Clark, A. E., Holubkov, R., Cox, C. S., &amp; Ewing-Cobbs, L. (2018). Psychosocial and executive function recovery trajectories one year after pediatric traumatic brain injury: The influence of age and injury severity. <em>Journal of Neurotrauma<\/em>, <em>35<\/em>(2), 286-296. <a href=\"https:\/\/doi.org\/10.1089\/neu.2017.5265\">https:\/\/doi.org\/10.1089\/neu.2017.5265<\/a>\r\n\r\nK\u00f6nigs, M., Engenhorst, P. J., &amp; Oosterlaan, J. (2018). Intelligence after traumatic brain injury: Meta-analysis of outcomes and prognosis. <em>European Journal of Neurology<\/em>, <em>23<\/em>(1), 21-29. <a href=\"https:\/\/doi.org\/10.1111\/ene.12719\">https:\/\/doi.org\/10.1111\/ene.12719<\/a>\r\n\r\nNarad, M. E., Kennelly, M., Zhang, N., Wade, S. L., Yeates, K. O., Taylor, H. G., Stancin, T., &amp; Kirkwood, M. W. (2018). Secondary attention-deficit\/hyperactivity disorder in children and adolescents 5 to 10 years after traumatic brain injury. <em>JAMA Pediatrics<\/em>, <em>172<\/em>(5), 437-443. <a href=\"https:\/\/doi.org\/10.1001\/jamapediatrics.2017.5746\">https:\/\/doi.org\/10.1001\/jamapediatrics.2017.5746<\/a>\r\n\r\nNarad, M. E., Minich, N., Taylor, H. G., Kirkwood, M. W., Brown, T. M., Stancin, T., &amp; Wade, S. L. (2019). Effects of family environment on behavioral and emotional outcomes in children and adolescents with traumatic brain injury. <em>Journal of Developmental &amp; Behavioral Pediatrics<\/em>, <em>40<\/em>(5), 376-384. <a href=\"https:\/\/doi.org\/10.1097\/DBP.0000000000000674\">https:\/\/doi.org\/10.1097\/DBP.0000000000000674<\/a>\r\n\r\n<span>Ownsworth T, Mitchell J, Griffin J, Bell R, Gibson E, Shirota C. Electronic Assistive Technology to Support Memory Function After Traumatic Brain Injury: A Systematic Review of Efficacy and User Perspectives. J Neurotrauma. 2023 Aug;40(15-16):1533-1556. doi: 10.1089\/neu.2022.0434. Epub 2023 May 3. PMID: 36792919.<\/span>\r\n\r\nRyan, N. P., Catroppa, C., Godfrey, C., Cooper, J. M., Hearps, S., Beauchamp, M. H., Yeates, K. O., &amp; Anderson, V. (2021). Longitudinal outcome and recovery of social problems after pediatric traumatic brain injury (TBI): Contribution of brain insult and family environment. <em>International Journal of Developmental Neuroscience<\/em>, <em>49<\/em>, 23-30. <a href=\"https:\/\/doi.org\/10.1016\/j.ijdevneu.2015.12.004\">https:\/\/doi.org\/10.1016\/j.ijdevneu.2015.12.004<\/a>\r\n\r\nSchalock, R. L., Luckasson, R., &amp; Tass\u00e9, M. J. (2021). An overview of intellectual disability: Definition, diagnosis, classification, and systems of supports (12th ed.). <em>American Journal on Intellectual and Developmental Disabilities<\/em>, <em>126<\/em>(6), 439-442. <a href=\"https:\/\/doi.org\/10.1352\/1944-7558-126.6.439\">https:\/\/doi.org\/10.1352\/1944-7558-126.6.439<\/a>\r\n\r\nSchmidt, A. T., Hanten, G. R., Li, X., Orsten, K. D., &amp; Levin, H. S. (2020). Emotion recognition following pediatric traumatic brain injury: Longitudinal analysis of emotional prosody and facial emotion recognition. <em>Neuropsychologia<\/em>, <em>48<\/em>(10), 2869-2877. <a href=\"https:\/\/doi.org\/10.1016\/j.neuropsychologia.2010.05.029\">https:\/\/doi.org\/10.1016\/j.neuropsychologia.2010.05.029<\/a>\r\n\r\nTreble-Barna, A., Zang, H., Zhang, N., Taylor, H. G., Yeates, K. O., &amp; Wade, S. L. (2020). Long-term neuropsychological profiles and their role as mediators of adaptive functioning after traumatic brain injury in early childhood. <em>Journal of Neurotrauma<\/em>, <em>34<\/em>(2), 353-362. <a href=\"https:\/\/doi.org\/10.1089\/neu.2016.4476\">https:\/\/doi.org\/10.1089\/neu.2016.4476<\/a>\r\n\r\nVanderlind, W.M.; Demers, L.A.; Engelson, G.; Fowler, R.C.; McCart, M.<em> Back to School: Academic Functioning and Educational Needs among Youth with Acquired Brain Injury.<\/em> <em>Children <\/em><strong>2022<\/strong>, <em>9<\/em>, 1321. <a href=\"https:\/\/doi.org\/10.3390\/children9091321\">https:\/\/doi.org\/10.3390\/<\/a> children9091321\u00a0 Creative Commons Attribution (CC BY) license\r\n\r\nWade, S. L., Cassedy, A., Shultz, E. L., Zang, H., Zhang, N., Kirkwood, M. W., Stancin, T., Yeates, K. O., &amp; Taylor, H. G. (2019). Randomized clinical trial of online parent training for behavior problems after early brain injury. <em>Journal of the American Academy of Child &amp; Adolescent Psychiatry<\/em>, <em>58<\/em>(9), 887-896. <a href=\"https:\/\/doi.org\/10.1016\/j.jaac.2018.12.023\">https:\/\/doi.org\/10.1016\/j.jaac.2018.12.023<\/a>\r\n\r\n&nbsp;\r\n\r\nThere is a wealth of important information on Brainline under the \"Children with TBI\" and \"Teens with TBI\" tabs. In this one-week module, these readings are optional. Do bookmark these resources for future reading\r\n\r\n<hr \/>\r\n\r\nUpdated 1\/12\/2026\r\n\r\n&nbsp;","rendered":"<div class=\"textbox key-takeaways\">\n<h3>Traumatic Brain Injury<\/h3>\n<p>.\u00a0\u2026means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that\u00a0<strong>adversely affects<\/strong>\u00a0a child\u2019s educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.\u00a0<span id=\"visual\">\u00a0<\/span><\/p>\n<p>(Center for Parent Information and Resources, 2017)<\/p>\n<\/div>\n<div class=\"textbox shaded\">\n<p>Table of Contents<\/p>\n<ul>\n<li>About the IDEA definition of TBI<\/li>\n<li>Introduction<\/li>\n<li><strong>Characteristics and Impact on Learning<\/strong><\/li>\n<li><strong>Adaptive Behavior<\/strong><\/li>\n<li>Susan\u2019s Story<\/li>\n<li><strong>Interventions and Strategie<\/strong>s<\/li>\n<li>Concussion<\/li>\n<li><strong>Assistive Technology<\/strong><\/li>\n<li><strong>Related Service Providers<\/strong><\/li>\n<\/ul>\n<\/div>\n<h3>About the IDEA definition of TBI<\/h3>\n<p>&#8220;<em>The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma<\/em>. &#8221; (IDEA)<\/p>\n<p><strong>The definition of TBI isn&#8217;t universal<\/strong>. Let&#8217;s take a closer look at why.<\/p>\n<p>The General Medical\/Clinical Definition<\/p>\n<p>When you search online or look at medical literature, you&#8217;ll typically find TBI defined very broadly by organizations like the CDC or medical institutions.<\/p>\n<p><strong>IDEA&#8217;s More Specific Definition<\/strong><\/p>\n<p>The <strong>Individuals with Disabilities Education Act (IDEA)<\/strong>, which governs special education services in schools, defines TBI much more narrowly. Under IDEA, TBI is defined as:<\/p>\n<p><em>An acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child&#8217;s educational performance<\/em>, followed by what the term does and does not apply to.<\/p>\n<p><strong>Why Does IDEA Define It Differently?<\/strong><\/p>\n<p>There are several important reasons:<\/p>\n<ol>\n<li><strong> Educational Impact Focus<\/strong> IDEA is all about educational services, so the TBI must specifically impact the student&#8217;s ability to learn or function in school. A student who had a concussion but fully recovered without lasting educational effects wouldn&#8217;t qualify under IDEA&#8217;s TBI category.<\/li>\n<li><strong> Excludes Congenital and Degenerative Conditions<\/strong> IDEA explicitly states that TBI does <em>not<\/em> include brain injuries that are congenital (present at birth) or degenerative (progressively worsening diseases). This distinguishes TBI from conditions like cerebral palsy or dementia.<\/li>\n<li><strong> Excludes Birth Trauma<\/strong> Brain injuries caused during the birth process are also excluded from IDEA&#8217;s TBI definition. These might be covered under other IDEA categories, like &#8220;Other Health Impairment,&#8221; or have their own classifications.<\/li>\n<li><strong> Service Eligibility Requirements:<\/strong> IDEA needs clear criteria to determine who receives specialized services. The narrower definition helps schools identify students who need specific TBI-related accommodations (such as cognitive strategies, memory aids, or gradual return-to-learn protocols) rather than students whose needs might be better addressed under other disability categories.<\/li>\n<li><strong> Resource Allocation:<\/strong> Schools have limited resources. Hence, IDEA&#8217;s definition helps ensure that the TBI classification applies to students whose educational challenges stem specifically from an acquired brain injury and require specialized interventions.<\/li>\n<\/ol>\n<p><strong>Why This Matters for You<\/strong><\/p>\n<p>As a college student studying education or related fields, understanding this distinction is crucial because:<\/p>\n<ul>\n<li><strong>Research vs. Practice<\/strong>: When you&#8217;re reading research studies about TBI, they might use the broad medical definition. But when you&#8217;re working in schools, you&#8217;ll need to apply IDEA&#8217;s specific criteria.<\/li>\n<li><strong>Multiple Disability Categories<\/strong>: Sometimes a student with a brain injury might be better served under a different IDEA category, like &#8220;Other Health Impairment,&#8221; if that better describes their educational needs.<\/li>\n<\/ul>\n<p>The key takeaway? <strong>Context matters.<\/strong> Always pay attention to whether you&#8217;re reading medical literature (broad definition) or educational\/legal documents (IDEA&#8217;s specific definition), because they&#8217;re talking about different populations and purposes.<\/p>\n<hr \/>\n<h3><strong>Introduction<\/strong><\/h3>\n<p>Traumatic brain injury is among the leading causes of morbidity and mortality among youth, with prior work documenting nearly 500,000 annual cases of TBI in the United States among newborns to 14-year-olds.<\/p>\n<p>Children with brain injury are at increased risk for long-term neurocognitive, emotional, social, and behavioral effects. Such effects place youth at increased risk for poorer educational functioning post-injury. Indeed, prior research shows that children with a history of brain injury have reduced academic achievement and greater educational needs following school re-entry. Yet, pediatric brain injury is under-identified within school settings. Under-identification of pediatric brain injury occurs for multiple reasons, including ineffective communication between the medical and education systems as youth return to school. Perhaps more commonly, in the case of mild brain injuries, brain injuries are under-reported, or teachers, parents, and clinicians fail to link academic challenges to said brain injury.<\/p>\n<p>The cognitive domains most severely disrupted by pediatric brain injury include executive functioning, processing speed, attention, and, to a lesser degree, verbal memory, fluency, and planning and problem-solving. Broadly, executive functions are the skills necessary to regulate thoughts, behaviors, and emotions and include skills such as impulse control, self-monitoring, behavioral and emotional modulation, task initiation and completion, problem-solving, and cognitive flexibility. In children with brain injuries, executive difficulties are generally most pronounced in the areas of cognitive flexibility and inhibition. Critically, given the lengthy nature of brain development, long-term effects on executive functioning may not become apparent until adolescence. In TBI populations, prior findings have demonstrated a persistent dose-dependent relationship between injury severity and cognitive outcome. Challenges with memory, attention, or working memory, and processing speed tend to remit several months to years after injury, though they remain relatively more pronounced and persistent in those with more severe injuries. Moreover, parents of children with severe TBI continue to perceive executive functioning problems in their children up to three years after their injury. In addition to injury severity, injury age has been shown to moderate long-term effects. Recent findings show that executive functioning challenges are often most devastating in children whose TBI occurred before age 5 years.<\/p>\n<h5>Other Issues<\/h5>\n<p>Children are at increased risk for externalizing disorders following brain injury. TBI enhances the risk for personality change and disruptive behavior disorders, with prevalence estimates of oppositional defiant disorder and conduct disorder ranging from 12 to 23%. Most often, there are increases in affective lability, aggression, and disinhibition, and less commonly apathetic or paranoid behaviors. Internalizing disorders can also manifest among children with brain injury. Predictors of internalizing disorders following head injuries include premorbid psychosocial adversity and anxiety, as well as injury severity. Incidence rates of PTSD are estimated to range from about 6 to 15% in youth with brain injury compared to 5% of adolescents in the general population. Incidence rates of novel internalizing disorders vary based on injury type and severity, age of injury, and time of measurement. Following TBI, post-traumatic stress, anxiety, and depression are present in 20 to 25% of children. For children with mild TBI, anxiety symptoms generally resolve within several months after injury; however, in those with severe TBI, anxiety can become more severe over time. Novel anxiety disorder has also been associated with a younger age at the time of injury. In contrast, older age at the time of injury, particularly adolescence, is associated with more depressive symptoms. Of note, though, internalizing disorders resolve more often than externalizing disorders among youth with a history of TBI.<\/p>\n<p>Broad social challenges and physical changes are also observed in children with brain injuries. Social challenges include reduced social participation stemming from activity restrictions and changes in functioning, distressing reductions in social acceptance, and changes in peer relationships. Generally, those with more severe injuries are more likely to have more interfering and persistent social difficulties.<\/p>\n<p>With regard to physical changes, it is not uncommon for this patient population to present with motor and sensory changes related to their injuries. Some degree of novel hearing impairment is especially common (i.e., 30%) in children following bacterial meningitis. Other common symptoms associated with pediatric brain injury include headache, nausea, pain, sleep disturbances, and fatigue<\/p>\n<h5>Academic Outcomes<\/h5>\n<p style=\"text-align: left\">Cognitive and psychiatric challenges can significantly influence a child\u2019s school functioning. Not only are children absent from school due to hospitalization, rehabilitative care, and ongoing monitoring appointments, but ongoing symptomatology can also impede learning and participation. Difficulties with attention regulation, processing speed, executive functioning, and memory make it harder for children to engage academically and to acquire and retain new knowledge and skill sets. Significant emotional and behavioral challenges can exacerbate cognitive weaknesses, encumber peer and teacher interactions, and reduce academic engagement. Consistently, children with a history of brain injury show poorer academic functioning in a variety of ways, including lower levels of academic achievement and increased need for educational supports.<\/p>\n<h5>Academic Achievement<\/h5>\n<p>TBI in preschool-aged children is associated with reduced school readiness, which, in turn, is predictive of lower academic achievement later in development. Further, school-aged children with a history of TBI show academic underachievement, though weaknesses may vary across subject areas. Word-reading tends to be preserved across TBI, especially if the injury occurs after the development of early reading abilities. Conversely, TBI has been associated with poorer outcomes on measures of mathematical ability, particularly among those with severe TBI. Severe TBI has also been associated with poorer performance on measures of decoding, reading comprehension, spelling, and arithmetic when compared to mild and moderate TBI samples, and group differences remained over a five-year follow-up period.<\/p>\n<p>In addition to formal measures of academic achievement, other indicators have been used to examine academic functioning following brain injury. Compared to an orthopedic control group, children with a history of moderate or severe TBI are more likely to be diagnosed with a learning disability and have lower academic competency, per parent or teacher report. Concussion, often synonymously referred to as mild TBI, has been associated with greater GPA declines, especially for individuals with a history of two or more concussions. Whereas concussion does not appear to impact graduation rates, severe childhood TBI has been associated with greater drop-out rates and an increased likelihood of unemployment during adulthood.<\/p>\n<h5>Need for Academic Supports<\/h5>\n<p>Paralleling the data on reduced academic achievement among youth with brain injury, there is a greater need for educational supports among this population as they begin or re-enter school.<\/p>\n<p>Notably, provision of academic support for less severe TBI groups may increase over time since the injury. Taken together, academic needs among youth with mild or moderate TBI may increase over time, likely due to greater academic demands and emergent executive functioning challenges across grade levels. This trend may also demonstrate the under-recognition of educational needs among less severe TBIs during the early stages of returning to school.<\/p>\n<h5>Moderators of Academic Outcomes<\/h5>\n<p>Several factors moderate the degree of academic difficulties following brain injury, including injury severity, degree of cognitive changes, age of injury, and level of premorbid functioning. Greater injury severity tends to predict poorer outcomes, including higher rates of educational supports. Similarly, TBI severity is associated with poorer academic achievement, higher rates of academic need, and greater provision of school supports. It is also worth restating that academic needs among youth with a history of less severe TBI may be under-recognized and\/or may become more apparent over time.<\/p>\n<p>Greater injury-related cognitive change contributes to subsequent academic functioning. In particular, greater levels of executive dysfunction following TBI are associated with weaker academic performance.<\/p>\n<p>Changes in other cognitive domains have been linked to poor academic outcomes. Among youth with TBI, greater language or intellectual impairment is associated with the amount of school adaptations, greater short-term verbal memory impairment is associated with greater listening comprehension difficulty, and greater long-term verbal memory impairment is associated with greater arithmetic difficulty.<\/p>\n<p>Age of injury has also been linked to academic outcomes. Early age of TBI has been linked to flatter trajectories of academic achievement over a five-year span.<\/p>\n<p>Premorbid functioning is a strong predictor of post-injury functioning, especially within the TBI literature. Stronger preinjury educational abilities are predictive of better post-TBI word reading, spelling, arithmetic, and listening comprehension skills. Conversely, a greater degree of premorbid (preinjury) challenge has been associated with poorer outcomes post-injury. Children with a pre-existing diagnosis of attention deficit hyperactivity disorder (ADHD) or learning disability take longer to return to school following a mild TBI than those without a premorbid neurodevelopmental disorder. Similarly, youth with greater levels of anxiety symptoms prior to sustaining a mild TBI have a more delayed return to school than their relatively lower-anxiety counterparts. A higher number of prior head injuries has also been shown to predict poorer post-TBI outcomes. The number of prior concussions has been positively associated with GPA decline and with more academic dysfunction.<\/p>\n<h5>Limitations in Identification<\/h5>\n<p>Many students who experience a brain injury, especially a mild injury, go untreated and\/or do not report the event to hospitals or schools. Canto et al. indicated that, over a two-year period in a Florida school district, approximately 1300 schoolchildren were treated for TBI at the local hospital, but only 129 students were served by the school district\u2019s TBI program. The findings point to how many students with brain injury\u2014in that study, TBI specifically\u2014are not being screened or identified by school districts for appropriate services under Section 504 or IDEA.<\/p>\n<p>Still, more students with brain injury are not seen at hospitals nor identified by school districts. These issues point to the fact that many students with milder forms of brain injury are not being identified and are not receiving any form of educational support. Such support may be lacking for the simple reason that school personnel are uninformed about the brain injury and, thus, injury- related issues may be mistaken for other high-incidence disabilities such as emotional or behavioral disturbance, specific learning disability, or speech\/language impairment, which may misguide the identification of the most appropriate services. Even in cases of more moderate or severe injuries, communication gaps can exist between the medical and educational systems. In one study, over 20% of parents of children with brain injury indicated that school systems did not receive any communication or information regarding the injury. Communication between the medical and education sectors tends to be more reliable for youth who are involved in inpatient rehabilitative care or who receive transitional services.<\/p>\n<p>Obtaining medical documentation of the injury is essential in the <strong>evaluation process<\/strong> for students with TBI. Because <strong>TBI is considered a medically related disability,<\/strong> such as ADHD, states require formal validation from a provider attesting that a TBI occurred and that it affects educational performance. The primary issue is that often, brain injury is not formally documented by medical staff for children with mild brain injury, even if they are taken to an emergency room. Difficulties obtaining such documentation may complicate the evaluation process and may increase the risk for an inappropriate classification. Importantly, though, if a school has good reason to suspect a student\u2019s poor\/declining educational performance is due to TBI but overlooks it in favor of an \u201ceasier,\u201d more expedient IDEA disability category, it could lead to a FAPE violation and legal proceedings.<\/p>\n<h5>Avenues for next steps<\/h5>\n<p>Solutions for ensuring youth with brain injury are properly identified and effectively supported in schools include (but are not limited to):<\/p>\n<p>(a) improving hospital-to-school transition services\/models;<\/p>\n<p>(b) providing effective professional development and in-service education to administrators and teachers about brain injury and legal responsibilities under IDEA and Section 504;<\/p>\n<p>(c) enhancing the IDEA identification process in schools;<\/p>\n<p>(d) training parents on how to be more effective in communicating with schools about their child\u2019s educational needs; and<\/p>\n<p>(e) changing state-level policies designed to assist schools in identifying and serving students with brain injury more efficiently.<\/p>\n<p>(Vanderlind, Demers, Engelson, Fowler, and\u00a0 McCart, 2022)<\/p>\n<hr \/>\n<h2>Characteristics and Impact on Learning<\/h2>\n<p>A traumatic brain injury (TBI) is an injury to the brain caused by the head being hit by something or shaken violently. (The exact definition of TBI, according to special education law, is discussed in the first section of the chapter.) This injury can change how the person acts, moves, and thinks. A traumatic brain injury can also change how a student learns and acts in school. The term TBI is used for head injuries that can cause changes (<strong>impact learning)<\/strong> in one or more areas, such as:<\/p>\n<ul>\n<li>thinking and reasoning,<\/li>\n<li>understanding words,<\/li>\n<li>remembering things,<\/li>\n<li>paying attention,<\/li>\n<li>solving problems,<\/li>\n<li>thinking abstractly,<\/li>\n<li>talking,<\/li>\n<li>behaving,<\/li>\n<li>walking and other physical activities,<\/li>\n<li>seeing and\/or hearing, and<\/li>\n<li>learning.<\/li>\n<\/ul>\n<h2>What Are the Signs of Traumatic Brain Injury?<\/h2>\n<p>The signs <strong>\u00a0(characteristics and issues of adaptive behavior)<\/strong>\u00a0of brain injury can be very different depending on where the brain is injured and how severely. Children with TBI may have one or more difficulties, including:<\/p>\n<p><strong><em>Physical disabilities<\/em>:<\/strong>\u00a0Individuals with TBI may have problems speaking, seeing, hearing, and using their other senses. They may have headaches and feel tired a lot. They may also have trouble with skills such as writing or drawing. Their muscles may suddenly contract or tighten (this is called spasticity). They may also have seizures. Their balance and walking may also be affected. They may be partly or completely paralyzed on one side of the body, or both sides.<\/p>\n<p><strong><em>Difficulties with thinking<\/em>:<\/strong> Because the brain has been injured, the person\u2019s ability to use the brain can change. For example, children with TBI may have trouble with short-term memory (remembering something from one minute to the next, such as what the teacher just said). They may also have trouble with their long-term memory (remembering information from a while ago, such as facts learned last month). People with TBI may have trouble concentrating and only be able to focus their attention for a short time. They may think slowly. They may have trouble talking and listening to others. They may also have difficulty with reading and writing, planning, understanding the order of events (called sequencing), and judgment.<\/p>\n<p><em><strong>Social, behavioral, or emotional problems:\u00a0<\/strong><\/em>These difficulties may include sudden changes in mood, anxiety, and depression. Children with TBI may have trouble relating to others. They may be restless and may laugh or cry a lot. They may not have much motivation or much control over their emotions.<\/p>\n<p><em>A child with TBI may not have all of the above difficulties<\/em>. Brain injuries can range from mild to severe, and so can the changes that result from the injury. This means that it\u2019s hard to predict how an individual will recover from the injury. Early and ongoing help can make a big difference in how the child recovers. This help can include physical or occupational therapy, counseling, and special education.<\/p>\n<p>It\u2019s also important to know that, as the child grows and develops, parents and teachers may notice new problems. This is because, as students grow, they are expected to use their brain in new and different ways. The damage to the brain from the earlier injury can make it hard for the student to learn new skills that come with getting older. Sometimes parents and educators may not even realize that the student\u2019s difficulty comes from the earlier injury.<\/p>\n<p>Although TBI is very common, many medical and education professionals may not realize that some difficulties can be caused by a childhood brain injury. Often, students with TBI are thought to have a learning disability, emotional disturbance, or intellectual disability. As a result, they don\u2019t receive the type of educational help and support they really need.<\/p>\n<p><strong>When children with TBI return to school, their educational and emotional needs are often very different than before the injury.<\/strong>\u00a0Their disability has happened suddenly and traumatically. They can often remember how they were before the brain injury. This can bring on many emotional and social changes. The child\u2019s family, friends, and teachers also recall what the child was like before the injury. These other people in the child\u2019s life may have trouble changing or adjusting their expectations of the child.<\/p>\n<p>Therefore, it is extremely important to<strong>\u00a0plan carefully for the child\u2019s return to school<\/strong>. Parents will want to learn about the school&#8217;s special education services in advance. This information is usually available from the school\u2019s principal or special education teacher. The school will need to evaluate the child thoroughly. This evaluation will inform the school and parents of the student\u2019s educational needs. The school and parents will then develop an <strong>Individualized Education Program<\/strong>\u00a0(IEP) that addresses those educational needs.<\/p>\n<p>It\u2019s important to remember that the IEP is a\u00a0<strong><em>flexible\u00a0<\/em><\/strong>plan. It can be changed as the parents, the school, and the student learns more about what the student needs at school.<\/p>\n<p>(Center for Parent Information &amp; Resources, n.d.)<\/p>\n<hr \/>\n<h3><strong>Adaptive Behavior<\/strong><\/h3>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Adaptive behaviors encompass the practical, everyday skills required for independence and social functioning, including communication, self-care, home living, social interaction, community participation, self-direction, health and safety awareness, functional academics, leisure activities, and work-related skills (Schalock et al., 2021). For school-aged children, these competencies are fundamental to educational engagement, peer relationships, and successful transition through developmental milestones.<\/p>\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Impact on Communication and Social Skills<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Students who have sustained TBI frequently demonstrate significant deficits in pragmatic language skills and social communication (Narad et al., 2018). These difficulties manifest as challenges in understanding non-verbal cues, maintaining topic relevance during conversations, taking conversational turns appropriately, and comprehending abstract language or humor. Ryan et al. (2021) found that children with moderate-to-severe TBI exhibited persistent deficits in social cognition that directly impaired their ability to navigate peer relationships and participate effectively in collaborative classroom activities.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">The social isolation that often follows TBI can be particularly devastating during the school years when peer relationships become increasingly central to identity development and emotional well-being (Schmidt et al., 2020). Students may struggle to maintain friendships established prior to their injury and find it challenging to form new social connections, leading to increased risk for anxiety, depression, and behavioral problems (Jones et al., 2019).<\/p>\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Self-Care and Daily Living Skills<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">TBI can significantly impair students&#8217; ability to perform age-appropriate self-care tasks and daily living skills. Depending on injury severity, students may require assistance with basic activities such as dressing, grooming, feeding, and toileting\u2014skills that are typically mastered in early childhood (Keenan et al., 2018). Even students with mild TBI may experience subtle difficulties with organization, time management, and independent completion of multi-step tasks necessary for school success.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Wade et al. (2020) documented that executive function deficits following pediatric TBI directly impact adaptive functioning in daily routines, with children demonstrating difficulties in planning morning routines, organizing school materials, managing homework completion, and maintaining personal hygiene standards. These challenges place additional stress on families and may require ongoing support and accommodations within the educational setting.<\/p>\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Academic and Learning Adaptations<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">The cognitive sequelae of TBI\u2014including difficulties with attention, memory, processing speed, and executive functioning\u2014profoundly affect students&#8217; adaptive behaviors in academic contexts (K\u00f6nigs et al., 2018). Students may struggle to adapt to increasing academic demands as they progress through grade levels, particularly during transitions such as moving from elementary to middle school or from middle to high school, where organizational demands and expectations for academic independence increase substantially (Glang et al., 2019).<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Research indicates that students with TBI often require explicit instruction in compensatory strategies and environmental modifications to successfully navigate academic settings (Davies et al., 2020). Deficits in metacognitive awareness may prevent students from independently recognizing when they need assistance or which strategies might be helpful, necessitating ongoing adult support and monitoring.<\/p>\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Behavioral and Emotional Regulation<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Impairments in behavioral and emotional regulation are among the most challenging adaptive behavior deficits following pediatric TBI. Students may exhibit increased impulsivity, emotional lability, difficulty managing frustration, reduced behavioral inhibition, and challenges with transitioning between activities or adapting to changes in routine (Treble-Barna et al., 2020). These difficulties can manifest as disruptive classroom behaviors, conflict with peers and adults, and reduced capacity to benefit from typical behavioral management approaches.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Narad et al. (2019) found that children who sustained TBI were at significantly elevated risk for developing behavioral and emotional problems, with approximately 25-50% experiencing clinically significant symptoms. These behavioral and emotional challenges directly impact students&#8217; ability to function adaptively within the structured school environment and can strain relationships with teachers, peers, and family members.<\/p>\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Safety Awareness and Judgment<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">TBI can impair students&#8217; safety awareness and judgment, creating concerns about their ability to navigate school and community environments independently (Gagner et al., 2018). Students may demonstrate reduced awareness of potential hazards, impulsive decision-making that places them at risk, and difficulty learning from previous mistakes or consequences. This is particularly concerning for adolescents who are typically developing increasing independence and may not recognize their own vulnerabilities.<\/p>\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Long-Term Adaptive Functioning Outcomes<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Longitudinal research indicates that adaptive behavior deficits following pediatric TBI often persist or even emerge years after the initial injury, particularly as environmental demands increase and the scaffolding provided in early recovery phases is withdrawn (Anderson et al., 2021). The concept of &#8220;growing into deficits&#8221; describes how children with TBI may appear to recover initially but then demonstrate increasing difficulties as they fail to acquire new skills at the expected rate or struggle to meet age-appropriate expectations for independence.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Wade et al. (2019) emphasized that adaptive functioning outcomes are influenced not only by injury severity but also by family functioning, socioeconomic status, access to rehabilitation services, and the quality of school-based support. Students from disadvantaged backgrounds or those with limited access to specialized services face heightened risk for poor long-term adaptive outcomes.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Ewing-Cobbs et al. (2018) found that children with severe TBI demonstrated persistent deficits in adaptive functioning across communication, daily living skills, and socialization domains even several years post-injury. These findings underscore the chronic nature of adaptive impairments following significant brain injury during childhood.<\/p>\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Developmental Considerations<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">The impact of TBI on adaptive behaviors varies significantly based on the child&#8217;s age at injury. Younger children may be at particular risk of long-term adaptive difficulties due to disruptions in foundational skill development, while adolescents face challenges related to increasing expectations for independence and more complex social navigation (Beauchamp et al., 2019). Ryan et al. (2018) emphasized that injury during critical developmental periods can have cascading effects on subsequent skill acquisition across multiple domains.<\/p>\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>School-Based Assessment and Monitoring<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Regular assessment of adaptive functioning is essential for students with TBI, as deficits may not be immediately apparent or may emerge over time as demands increase (Glang et al., 2019). Standardized measures of adaptive behavior, combined with functional observation and input from multiple informants, provide critical data for educational planning and intervention development (Keenan et al., 2018)..<\/p>\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Conclusion<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Traumatic brain injury during the school years can have devastating and long-lasting effects on adaptive behaviors across multiple domains of functioning. The impact extends beyond academic skills to encompass the practical, social, and behavioral competencies essential for independence and quality of life. Understanding these challenges and implementing comprehensive, individualized support systems within educational settings is critical for helping students with TBI reach their full potential and successfully transition to adulthood.<\/p>\n<hr \/>\n<h2>Susan\u2019s Story<\/h2>\n<p>Susan was 7 years old when she was hit by a car while riding her bike. She broke her arm and leg. She also hit her head very hard. The doctors say she sustained a traumatic brain injury. When she came home from the hospital, she needed lots of help, but now she looks fine.<\/p>\n<p>In fact, that\u2019s part of the problem, especially at school. Her friends and teachers think her brain has healed because her broken bones have. But there are changes in Susan that are hard to understand. It takes Susan longer to do things. She has trouble remembering things. She can\u2019t always find the words she wants to use. Reading is hard for her now. It\u2019s going to take time for people to really understand the changes they see in her and how best to meet her learning needs.<\/p>\n<p>(Center for Parent Information and Resources, 2015)<\/p>\n<hr \/>\n<h3><strong>Interventions and Strategies<\/strong><\/h3>\n<p>Go to your primary reading for this section of the summary: Bowen, J. (2018),\u00a0<em>Classroom Interventions for Students with Traumatic Brain Injury<\/em> from <a href=\"https:\/\/www.brainline.org\/article\/classroom-interventions-students-traumatic-brain-injuries\" target=\"_blank\" rel=\"noopener\">https:\/\/www.brainline.org\/article\/classroom-interventions-students-traumatic-brain-injuries\u00a0<\/a><\/p>\n<ul>\n<li>Include strategies for <strong>structuring the school environment (and<\/strong><strong>\u00a0classroom <\/strong><strong><strong>accommodations)\u00a0<\/strong>and <strong>specialized teaching strategies<\/strong><\/strong><\/li>\n<\/ul>\n<hr \/>\n<p>The following text is an excerpt from:<\/p>\n<p>DeMatteo CA, Randall S, Lin C-YA, and Claridge EA (2019). What Comes First: Return to School or Return to Activity for Youth After Concussion? Maybe We Don&#8217;t Have to Choose.<\/p>\n<h3><strong>Concussion<\/strong><\/h3>\n<p>Concussions have become an epidemic in children and youth. The number of reported head injuries in Emergency Departments among youth playing sport has increased in the past decade by over 40%. The symptoms of concussions can often interfere with participation and performance in home, school, and community activities. The current consensus for standard concussion management is the six-stage Berlin Return to Play recommendations. This statement and much of the literature now suggest a more conservative approach to the management of children\/youth with concussion. It is, however, still unclear as to what \u201cmore conservative\u201d entails. When they are symptomatic, children and youth are advised to rest for 48 hours, then gradually resume regular activity with incremental increases in physical and cognitive activity within symptom tolerance. Depression and anxiety may result as a secondary sequelae if youth are socially isolated and removed from normal activity and participation for prolonged periods of time. Prolonged rest can lengthen recovery time and contribute to deconditioning. Protocols for children must contain a balance of activity and rest to promote physical, emotional, and cognitive recovery.<\/p>\n<p>Both Return to School (RTS) and Return to Activity\/Play \u00a0(RTA) protocols for pediatric concussion management should be conservative and individualized. A number of protocols guiding families and youth through progressive recovery steps for safe Return to School (RTS) and Return to Activity\/Play (RTA) have now been developed, are widely accepted, and are important aspects of pediatric concussion management.<\/p>\n<p><strong>Download Return to School Guidelines <\/strong><a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2019.00792\/full#supplementary-material\">https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2019.00792\/full#supplementary-material<\/a><\/p>\n<p>Youth return to school faster than they return to play in spite of the self-reported, school-related symptoms they experience while moving through the protocols. Youth can progress simultaneously through the RTS and RTA protocols during the early stages 1\u20133. Considering the number of youth having school difficulties post-concussion, full contact sport, stage 6, of RTA, should be delayed until full and successful reintegration back to school has been achieved. In light of the\u00a0<span style=\"margin: 0px;padding: 0px\"><strong>wide variability in recovery<\/strong>, determining how to resume participation in activities despite ongoing symptoms remains<\/span>\u00a0a challenge for each individual child. There is much to be learned, with further research needed in this area<\/p>\n<p>*Research sample mean age of the research is \u201c46% male, 13 yrs. of age.<\/p>\n<p>(DeMatteo, Randall, and Lin, 2019)\u00a0 The Full article and references can be accessed at: <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2019.00792\/full#h14\">https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2019.00792\/full#h14<\/a><\/p>\n<hr \/>\n<h3><strong>Assistive Technology<\/strong><\/h3>\n<p>Assistive technology offers powerful support for students with traumatic brain injury (TBI) who struggle with memory and organizational challenges. These tools can compensate for cognitive difficulties and help students succeed academically and independently.<\/p>\n<p>Focus specifically on AT for memory and organization.\u00a0 Two critical areas affect learning and day-to-day life.<\/p>\n<div data-test-render-count=\"1\">\n<div class=\"group\">\n<div data-is-streaming=\"false\" class=\"group relative pb-3\">\n<div class=\"font-claude-response relative leading-[1.65rem] [&amp;_pre&gt;div]:bg-bg-000\/50 [&amp;_pre&gt;div]:border-0.5 [&amp;_pre&gt;div]:border-border-400 [&amp;_.ignore-pre-bg&gt;div]:bg-transparent [&amp;_.standard-markdown_:is(p,blockquote,h1,h2,h3,h4,h5,h6)]:pl-2 [&amp;_.standard-markdown_:is(p,blockquote,ul,ol,h1,h2,h3,h4,h5,h6)]:pr-8 [&amp;_.progressive-markdown_:is(p,blockquote,h1,h2,h3,h4,h5,h6)]:pl-2 [&amp;_.progressive-markdown_:is(p,blockquote,ul,ol,h1,h2,h3,h4,h5,h6)]:pr-8\">\n<div>\n<div class=\"standard-markdown grid-cols-1 grid gap-4 [&amp;_&gt;_*]:min-w-0 standard-markdown\">\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Memory Support<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Students with TBI often experience difficulties with short-term memory, working memory, and prospective memory (remembering to do things in the future). Technology can serve as an external memory system:<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Digital reminders and alerts<\/strong> are perhaps the most fundamental tool. Smartphones, smartwatches, and tablets can provide auditory or vibration alerts for class transitions, assignment deadlines, medication schedules, or therapy appointments. Apps like Google Calendar or specialized tools designed for cognitive support can send repeated notifications until acknowledged.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Voice recording applications<\/strong> allow students to record lectures, instructions, or their own verbal notes, which they can replay as needed. This reduces the cognitive load of trying to remember everything in real-time and allows students to focus on understanding during class.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Note-taking apps with audio sync<\/strong> (like Notability or OneNote) let students take minimal notes while recording, then tap any written word to hear what was said at that moment. This creates a multimedia memory aid that&#8217;s far more accessible than traditional notes.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Memory notebooks or apps<\/strong> can store important information students need frequently\u2014locker combinations, class schedules, teacher names, or step-by-step procedures for recurring tasks. Digital versions offer search functionality that makes retrieval faster than flipping through pages.<\/p>\n<p class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\"><strong>Organization Support<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">TBI often disrupts executive functioning, making it difficult to plan, prioritize, sequence tasks, and manage time. Assistive technology can provide external structure:<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Task management apps<\/strong> break down complex assignments into manageable steps with individual deadlines. Apps like Todoist or specialized educational planners can use visual cues, color-coding, and priority rankings to help students see what needs attention first. Some apps use gamification elements that provide positive reinforcement for task completion.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Digital planners and organizational systems<\/strong> offer advantages over paper planners\u2014they can&#8217;t be lost as easily, provide automatic backup, and integrate with reminder systems. Visual schedules with pictures or icons can help students who process visual information more easily than text.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Cloud-based file organization<\/strong> (Google Drive, Dropbox, OneDrive) ensures students can access their work from any device and reduces the risk of losing important documents. These systems also allow for shared folders with teachers or support staff who can help monitor the organization.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Graphic organizers and mind-mapping software<\/strong> help students structure their thoughts for writing assignments or studying. Tools like Inspiration or digital whiteboards provide templates that guide students through brainstorming, outlining, and organizing information hierarchically.<\/p>\n<h4 class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Integrated Benefits<\/h4>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">What makes assistive technology particularly effective is how these tools work together. A student might receive a reminder about an assignment, access their task list to see the broken-down steps, listen to a recorded lecture for information, and use a graphic organizer to structure their response\u2014all supported by technology that compensates for their specific cognitive challenges.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">The key is individualized assessment and training. Not every student with TBI needs the same tools, and successful implementation requires teaching students how to use the technology consistently until it becomes habitual. When properly matched to a student&#8217;s needs and integrated into their routine, assistive technology can dramatically improve academic performance and independence, allowing students to demonstrate their knowledge despite memory and organizational impairments.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"flex justify-start\" role=\"group\" aria-label=\"Message actions\">\n<div class=\"text-text-300\">\n<div class=\"text-text-300 flex items-stretch justify-between\">\n<div class=\"w-fit\" data-state=\"closed\">\n<div class=\"relative text-text-500 group-hover\/btn:text-text-100\">\n<div class=\"flex items-center justify-center transition-all opacity-100 scale-100\"><\/div>\n<div class=\"flex items-center justify-center absolute top-0 left-0 transition-all opacity-0 scale-50\">(<span>Ownsworth et all, 2023)<\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div>\n<hr \/>\n<\/div>\n<h3><strong>Related Service Providers<\/strong><\/h3>\n<div>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Children with traumatic brain injury (TBI) who qualify for special education services under IDEA can access a comprehensive range of related service providers, as TBI often affects multiple areas of functioning. The specific services depend on the individual child&#8217;s needs as determined by their IEP team.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Highly relevant service providers for students with TBI:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Speech-language pathologists are frequently essential for students with TBI, as these injuries commonly affect language processing, word retrieval, verbal expression, and pragmatic language skills (understanding social cues, conversation skills, humor). They may also address cognitive-communication difficulties like organization, sequencing, and problem-solving through language.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Occupational therapists help students rebuild or compensate for lost fine motor skills, visual-motor integration, handwriting abilities, and executive functioning skills needed for academic tasks. They&#8217;re particularly important for addressing cognitive effects of TBI like attention, memory, organization, and planning. OTs also work on sensory processing issues and fatigue management, which are common after brain injury.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Physical therapists support students who have motor impairments, balance difficulties, coordination problems, or mobility challenges resulting from their TBI. They help with safe navigation of the school environment and may recommend adaptive equipment.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">School psychologists and counselors provide crucial support for the emotional and behavioral changes that often follow TBI. Students may experience personality changes, mood swings, depression, anxiety, irritability, or difficulty with social relationships. These providers offer counseling, behavioral interventions, and strategies for emotional regulation.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Additional specialized services:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">School nurses play a particularly important role for students with TBI who may have seizure disorders, require medication management, need monitoring for post-concussion symptoms, or have other medical needs requiring oversight during the school day.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Vision specialists or teachers of the visually impaired may be needed if the TBI resulted in visual impairments, visual processing difficulties, or visual field defects that affect learning.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Assistive technology specialists can be critical, as many students with TBI benefit from technology supports like voice-to-text software, organizational apps, memory aids, audiobooks, or modified computer access to compensate for cognitive, motor, or sensory changes.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Orientation and mobility specialists might work with students who have visual-spatial difficulties or physical mobility challenges, navigating the school environment.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Important considerations for TBI:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">The needs of students with TBI can change significantly over time, especially in the months and years following the injury. Recovery patterns vary widely, so IEP teams should regularly reassess services and adjust support as the student progresses or as new challenges emerge. Some students show remarkable recovery while others have persistent difficulties.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">TBI can affect seemingly unrelated areas &#8211; a student might have physical recovery but struggle with subtle cognitive changes affecting memory, processing speed, attention, or executive functions. Related services should address the full scope of impact, not just the most visible effects.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Coordination among service providers is particularly important for students with TBI, as their challenges often overlap multiple domains and require an integrated approach to support their return to successful learning.<\/p>\n<\/div>\n<hr \/>\n<p><strong>Optional Extended Learning \/ Teacher Resources<\/strong><\/p>\n<ul>\n<li>From the Wisconsin Department of Public Instruction, <a href=\"https:\/\/dpi.wi.gov\/sites\/default\/files\/imce\/sped\/pdf\/tbi-mildtchrbroc.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Mild Brain Injury Brochure for Educators<\/a><\/li>\n<li style=\"font-weight: 400\">Colorado Dept. of Education, (2012). Brain Injury in Children and Youth: A Manual for Educators. Retrieved from \u00a0<a href=\"http:\/\/www.cde.state.co.us\/cdesped\/tbi_manual_braininjury\">http:\/\/www.cde.state.co.us\/cdesped\/tbi_manual_braininjury<\/a><\/li>\n<li>Brain Injury Association of VA (2013).\u00a0<a href=\"http:\/\/www.doe.virginia.gov\/special_ed\/disabilities\/traumatic_brain_injury\/brain_injury_schools.pdf\" target=\"_blank\" rel=\"noopener\">Brain Injury and the\u00a0<\/a>S<a href=\"http:\/\/www.doe.virginia.gov\/special_ed\/disabilities\/traumatic_brain_injury\/brain_injury_schools.pdf\" target=\"_blank\" rel=\"noopener\">chools: A Guide for Educators<\/a>, Ch.\u00a0B &amp; C, Educational Implications. Retrieved from <a href=\"http:\/\/www.doe.virginia.gov\/special_ed\/disabilities\/traumatic_brain_injury\/brain_injury_schools.pdf\">http:\/\/www.doe.virginia.gov\/special_ed\/disabilities\/traumatic_brain_injury\/brain_injury_schools.pd<\/a><\/li>\n<\/ul>\n<hr \/>\n<p>References<\/p>\n<p>Anderson, V., Spencer-Smith, M. M., Coleman, L., Anderson, P. J., Greenham, M., Jacobs, R., Lee, K. J., &amp; Leventer, R. J. (2021). Predicting neurocognitive and behavioral outcome after early brain insult. <em>Developmental Medicine &amp; Child Neurology<\/em>, <em>63<\/em>(3), 329-336. <a href=\"https:\/\/doi.org\/10.1111\/dmcn.14749\">https:\/\/doi.org\/10.1111\/dmcn.14749<\/a><\/p>\n<p>Beauchamp, M. H., Vera-Estay, E., Morasse, F., Julien, J., &amp; Dooley, J. J. (2019). Sociomoral reasoning and behavior in children with traumatic brain injury. <em>Developmental Neurorehabilitation<\/em>, <em>22<\/em>(5), 301-310. <a href=\"https:\/\/doi.org\/10.1080\/17518423.2018.1500519\">https:\/\/doi.org\/10.1080\/17518423.2018.1500519<\/a><\/p>\n<p><span>Bowen, J. M. (2008).<\/span><span>\u00a0<\/span><em>Classroom Interventions\u00a0for\u00a0Students With Traumatic Brain Injuries, Preventing School Failure<\/em><span>: posted on brainline.org,<\/span><a class=\"external\" href=\"https:\/\/www.brainline.org\/article\/classroom-interventions-students-traumatic-brain-injuries\" target=\"_blank\" rel=\"noopener\"><span> https:\/\/www.brainline.org\/article\/classroom-interventions-students-traumatic-brain-injuries\u00a0<\/span><\/a><\/p>\n<p><span>Brainline, (n.d.)\u00a0<em>Using External Aids to Compensate for Memory and Organization Post-TBI<\/em><strong>.<\/strong>\u00a0from\u00a0<\/span><a class=\"external\" href=\"https:\/\/www.brainline.org\/article\/using-external-aids-compensate-memory-and-organizational-problems-post-tbi\" target=\"_blank\" rel=\"noopener\"><span>https:\/\/www.brainline.org\/article\/using-external-aids-compensate-memory-and-organizational-problems-post-tbi<\/span><\/a><\/p>\n<p>Center for Parent Information and Resources (2015), <em>Traumatic Brain Injury, <\/em>from <a href=\"https:\/\/www.parentcenterhub.org\/tbi\/\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.parentcenterhub.org\/tbi\/<\/a> public domain<\/p>\n<p>Davies, S. C., Shultz, E. L., &amp; Glang, A. (2020). Traumatic brain injury facts and stats: What educators need to know. <em>TEACHING Exceptional Children<\/em>, <em>52<\/em>(6), 368-370. <a href=\"https:\/\/doi.org\/10.1177\/0040059920927060\">https:\/\/doi.org\/10.1177\/0040059920927060<\/a><\/p>\n<p><span style=\"font-size: 1em\">DeMatteo CA, Randall S, Lin C-YA, and Claridge EA (2019).\u00a0<\/span><a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2019.00792\/full#h14\" target=\"_blank\" style=\"font-size: 1em\" rel=\"noopener\">What Comes First: Return to School or Return to Activity for Youth After Concussion?<\/a><a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2019.00792\/full#h14\" target=\"_blank\" rel=\"noopener\">\u00a0Maybe We Don&#8217;t Have to Choose<\/a>.\u00a0Front. Neurol.\u00a010:792. doi: 10.3389\/fneur.2019.00792 This is an open-access article distributed under the terms of the\u00a0<a href=\"http:\/\/creativecommons.org\/licenses\/by\/4.0\/\" target=\"_blank\" rel=\"noopener noreferrer\">Creative Commons Attribution License (CC BY)<\/a>.<\/p>\n<p>Ewing-Cobbs, L., Johnson, C. P., Juranek, J., DeMaster, D., Prasad, M., Duque, G., Kramer, L., Cox, C. S., &amp; Swank, P. R. (2018). Longitudinal diffusion tensor imaging after pediatric traumatic brain injury: Impact of age at injury and time since injury on pathway integrity. <em>Human Brain Mapping<\/em>, <em>37<\/em>(11), 3929-3945. <a href=\"https:\/\/doi.org\/10.1002\/hbm.23286\">https:\/\/doi.org\/10.1002\/hbm.23286<\/a><\/p>\n<p>Gagner, C., Landry-Roy, C., Lain\u00e9, F., Beauchamp, M. H., &amp; Bernier, A. (2018). Traumatic brain injury and its consequences for the development of self-regulation: Implications for interventions focused on social competence. <em>Frontiers in Psychology<\/em>, <em>9<\/em>, 2325. <a href=\"https:\/\/doi.org\/10.3389\/fpsyg.2018.02325\">https:\/\/doi.org\/10.3389\/fpsyg.2018.02325<\/a><\/p>\n<p>Glang, A., Todis, B., Sublette, P., Eagan Brown, B., &amp; Vaccaro, M. (2019). Professional development in TBI for educators: The importance of context. <em>Journal of Head Trauma Rehabilitation<\/em>, <em>25<\/em>(6), 426-432. <a href=\"https:\/\/doi.org\/10.1097\/HTR.0b013e3181fb8f45\">https:\/\/doi.org\/10.1097\/HTR.0b013e3181fb8f45<\/a><\/p>\n<p>Jones, K., Marquez de la Plata, C., Wilde, E. A., Hanten, G. R., Scheibel, R. S., Yallampalli, R., Chapman, S. B., &amp; Levin, H. S. (2019). Profiles of executive and memory function following pediatric traumatic brain injury. <em>Developmental Neuropsychology<\/em>, <em>44<\/em>(5), 393-413. <a href=\"https:\/\/doi.org\/10.1080\/87565641.2019.1635606\">https:\/\/doi.org\/10.1080\/87565641.2019.1635606<\/a><\/p>\n<p>Keenan, H. T., Clark, A. E., Holubkov, R., Cox, C. S., &amp; Ewing-Cobbs, L. (2018). Psychosocial and executive function recovery trajectories one year after pediatric traumatic brain injury: The influence of age and injury severity. <em>Journal of Neurotrauma<\/em>, <em>35<\/em>(2), 286-296. <a href=\"https:\/\/doi.org\/10.1089\/neu.2017.5265\">https:\/\/doi.org\/10.1089\/neu.2017.5265<\/a><\/p>\n<p>K\u00f6nigs, M., Engenhorst, P. J., &amp; Oosterlaan, J. (2018). Intelligence after traumatic brain injury: Meta-analysis of outcomes and prognosis. <em>European Journal of Neurology<\/em>, <em>23<\/em>(1), 21-29. <a href=\"https:\/\/doi.org\/10.1111\/ene.12719\">https:\/\/doi.org\/10.1111\/ene.12719<\/a><\/p>\n<p>Narad, M. E., Kennelly, M., Zhang, N., Wade, S. L., Yeates, K. O., Taylor, H. G., Stancin, T., &amp; Kirkwood, M. W. (2018). Secondary attention-deficit\/hyperactivity disorder in children and adolescents 5 to 10 years after traumatic brain injury. <em>JAMA Pediatrics<\/em>, <em>172<\/em>(5), 437-443. <a href=\"https:\/\/doi.org\/10.1001\/jamapediatrics.2017.5746\">https:\/\/doi.org\/10.1001\/jamapediatrics.2017.5746<\/a><\/p>\n<p>Narad, M. E., Minich, N., Taylor, H. G., Kirkwood, M. W., Brown, T. M., Stancin, T., &amp; Wade, S. L. (2019). Effects of family environment on behavioral and emotional outcomes in children and adolescents with traumatic brain injury. <em>Journal of Developmental &amp; Behavioral Pediatrics<\/em>, <em>40<\/em>(5), 376-384. <a href=\"https:\/\/doi.org\/10.1097\/DBP.0000000000000674\">https:\/\/doi.org\/10.1097\/DBP.0000000000000674<\/a><\/p>\n<p><span>Ownsworth T, Mitchell J, Griffin J, Bell R, Gibson E, Shirota C. Electronic Assistive Technology to Support Memory Function After Traumatic Brain Injury: A Systematic Review of Efficacy and User Perspectives. J Neurotrauma. 2023 Aug;40(15-16):1533-1556. doi: 10.1089\/neu.2022.0434. Epub 2023 May 3. PMID: 36792919.<\/span><\/p>\n<p>Ryan, N. P., Catroppa, C., Godfrey, C., Cooper, J. M., Hearps, S., Beauchamp, M. H., Yeates, K. O., &amp; Anderson, V. (2021). Longitudinal outcome and recovery of social problems after pediatric traumatic brain injury (TBI): Contribution of brain insult and family environment. <em>International Journal of Developmental Neuroscience<\/em>, <em>49<\/em>, 23-30. <a href=\"https:\/\/doi.org\/10.1016\/j.ijdevneu.2015.12.004\">https:\/\/doi.org\/10.1016\/j.ijdevneu.2015.12.004<\/a><\/p>\n<p>Schalock, R. L., Luckasson, R., &amp; Tass\u00e9, M. J. (2021). An overview of intellectual disability: Definition, diagnosis, classification, and systems of supports (12th ed.). <em>American Journal on Intellectual and Developmental Disabilities<\/em>, <em>126<\/em>(6), 439-442. <a href=\"https:\/\/doi.org\/10.1352\/1944-7558-126.6.439\">https:\/\/doi.org\/10.1352\/1944-7558-126.6.439<\/a><\/p>\n<p>Schmidt, A. T., Hanten, G. R., Li, X., Orsten, K. D., &amp; Levin, H. S. (2020). Emotion recognition following pediatric traumatic brain injury: Longitudinal analysis of emotional prosody and facial emotion recognition. <em>Neuropsychologia<\/em>, <em>48<\/em>(10), 2869-2877. <a href=\"https:\/\/doi.org\/10.1016\/j.neuropsychologia.2010.05.029\">https:\/\/doi.org\/10.1016\/j.neuropsychologia.2010.05.029<\/a><\/p>\n<p>Treble-Barna, A., Zang, H., Zhang, N., Taylor, H. G., Yeates, K. O., &amp; Wade, S. L. (2020). Long-term neuropsychological profiles and their role as mediators of adaptive functioning after traumatic brain injury in early childhood. <em>Journal of Neurotrauma<\/em>, <em>34<\/em>(2), 353-362. <a href=\"https:\/\/doi.org\/10.1089\/neu.2016.4476\">https:\/\/doi.org\/10.1089\/neu.2016.4476<\/a><\/p>\n<p>Vanderlind, W.M.; Demers, L.A.; Engelson, G.; Fowler, R.C.; McCart, M.<em> Back to School: Academic Functioning and Educational Needs among Youth with Acquired Brain Injury.<\/em> <em>Children <\/em><strong>2022<\/strong>, <em>9<\/em>, 1321. <a href=\"https:\/\/doi.org\/10.3390\/children9091321\">https:\/\/doi.org\/10.3390\/<\/a> children9091321\u00a0 Creative Commons Attribution (CC BY) license<\/p>\n<p>Wade, S. L., Cassedy, A., Shultz, E. L., Zang, H., Zhang, N., Kirkwood, M. W., Stancin, T., Yeates, K. O., &amp; Taylor, H. G. (2019). Randomized clinical trial of online parent training for behavior problems after early brain injury. <em>Journal of the American Academy of Child &amp; Adolescent Psychiatry<\/em>, <em>58<\/em>(9), 887-896. <a href=\"https:\/\/doi.org\/10.1016\/j.jaac.2018.12.023\">https:\/\/doi.org\/10.1016\/j.jaac.2018.12.023<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>There is a wealth of important information on Brainline under the &#8220;Children with TBI&#8221; and &#8220;Teens with TBI&#8221; tabs. In this one-week module, these readings are optional. Do bookmark these resources for future reading<\/p>\n<hr \/>\n<p>Updated 1\/12\/2026<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"author":11,"menu_order":25,"template":"","meta":{"pb_show_title":"","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[49],"contributor":[],"license":[],"class_list":["post-69","chapter","type-chapter","status-publish","hentry","chapter-type-numberless"],"part":21,"_links":{"self":[{"href":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/wp-json\/pressbooks\/v2\/chapters\/69","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/wp-json\/wp\/v2\/users\/11"}],"version-history":[{"count":31,"href":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/wp-json\/pressbooks\/v2\/chapters\/69\/revisions"}],"predecessor-version":[{"id":470,"href":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/wp-json\/pressbooks\/v2\/chapters\/69\/revisions\/470"}],"part":[{"href":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/wp-json\/pressbooks\/v2\/parts\/21"}],"metadata":[{"href":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/wp-json\/pressbooks\/v2\/chapters\/69\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/wp-json\/wp\/v2\/media?parent=69"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/wp-json\/pressbooks\/v2\/chapter-type?post=69"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/wp-json\/wp\/v2\/contributor?post=69"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.usnh.edu\/understandingandsupportinglearnerswithdisabilities\/wp-json\/wp\/v2\/license?post=69"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}