How Does TBI Differ for Those Injured as Children?

How does TBI differ for those injured as children?

The effects of TBI on children differ in several ways from the effects on an injured adult:

• Because the child’s brain is still developing, injury may alter the course of development of the brain and its functions. It is not clear whether this works in the child's favor. Because the child's brain is less "set" than the adult's, its plasticity offers hope that damaged tissue and areas of deficit will be bypassed in the child’s brain by other parts taking over for these areas that no longer work well. Recent research, however, suggests that this may not be the case.
• After a brain injury, previously learned information, which provides important building blocks for subsequent learning, is retained and used. However, in very young children, these building blocks are relatively few, handicapping them as learners in comparison to similarly brain-injured older children or adults, who have larger foundations of intact information.
• The effects of the TBI on the child may not be seen directly after injury, but only become apparent in the child’s life when, during the course of the child’s development, affected skills are called upon. For example, problems in abstract thinking may not be evident until the child with a TBI reaches an age when abstract thinking enters the realm of possibility for any child at that developmental level. Because of this lag in the emergence of problems, the cause of the problems (the TBI) may not be identified. Frequently, such problems are dealt with inappropriately as if they are due to learning disabilities or emotional causes. This misperception by teachers, parents, and others can devastate the child, because the strategies used to help a child with TBI are different from those used to address similar problems that stem from other causes. A child will suffer in two ways: feeling diminished or confused because no one knows what is really wrong, and being damaged as a learner because no one can nurture learning based on understanding his or her real needs.

What should schools know about helping children with TBI?

We spent several years (under the auspices of a New York State-funded project) providing training on TBI to more than 10,000 educators in all districts and schools in New York City. The focus was on three key aspects of addressing the education needs of children who have experienced a TBI:

• Identifying the children — both those who have been hospitalized and the many more who have not, who are often unknown to their schools as children with a TBI.
• Assessing educational needs of these children appropriately — implying a shift in the assessment paradigm to one that includes a clear focus on defining cognitive challenges in terms that classroom educators can run with.
• Modifying classrooms to fit the needs of children with TBI — which typically means modifying classrooms to better teach all children.

As a result of this work, training modules broadly useful in educational settings were developed. The major ideas that were developed and shared with New York City educators, have been published in Students with Traumatic Brain Injury: Identification, Assessment, and Classroom Accommodations.

The staff at Mount Sinai provides technical assistance to educators who wish to initiate a program to better identify, assess and meet the classroom needs of the large number of children in schools today who have identified or unidentified TBI. After consulting with the interested party, a plan is developed to implement a program suitable for that educational site. The plan describes the activities constituting the program and, if relevant, may cover the purchase of training materials, technical assistance to "train the trainers," travel, and continuing technical assistance to support implementation of the planned program.

If you are interested in obtaining more information about technical assistance, please e-mail Dr. Wayne Gordon at wayne.gordon@mssm.edu or Dr. Mary Hibbard at mary.hibbard@mssm.edu who together lead the effort to help educators address the needs of students with TBI.