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School-based interventions for treating social adjustment difficulties in children with traumatic brain injury

Journal of Instructional Psychology, Sept, 2003 by Bruce F. Dykeman

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Despite the developmental nature of symptom presentation, the specificity of symptoms often depends upon location and severity of brain injury (Rourke, Bakker, Fisk & Strang, 1983). The effects of brain trauma often relate to functions subserved by the specific area of brain damage. Closed head injuries often have diffuse effects, which may impact a number of cognitive, social and emotional functions. Despite such variability, both open head and closed head injuries often result in social skills difficulties. In some cases, social skills deficits may be long lasting, whereas in other cases, the injured child can reacquire skills needed in establishing and maintaining social relationships.

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Recovery process. The course of recovery for the brain-injured child varies according the site and extent of injury: however, the recovery typically involves three stages (Corbett & Ross-Thomson, 1996). Stage 1 of recovery process often includes displays of agitation, impulsivity, and confusion. Often, the child shows impaired efficiency of information processing. This stage is usually apparent in the rehabilitation setting, but can also occur in the schools. Children in Stage 2 of recovery process often show intolerance for stimulation, with a denial of cognitive disability and with increasing behavioral demands placed upon the teachers and caregivers. Often, the child displays disinhibition and may emit behaviors that seem inappropriate and immature. Children in Stage 3 of the recovery process begin to show an increased understanding of the nature and type of cognitive and social deficits associated with the brain injury along with an increased understanding of the lasting nature of these deficits. Consequently, children in the third stage often become susceptible to anxiety, depression, frustration. and anger.

At each stage of the recovery process, the child with brain injury experiences some deficits of cognitive and social-emotional functioning that were not apparent at pre-injury. Cognitive impairments may include difficulties on tasks requiring attention, memory, organization and problems solving. Emotional impairments may include apathy, irritability, anxiety, fearfulness and depression. Social impairments may include withdrawal, anger and aggression. The degree of intervention needed depends, in part, upon the stage of recovery, with more advanced recovery requiring less intensity of support. In most cases, however, interventions that target specific aspects of disability assist the child's reintegration into the school environment.

In addition to the location and severity of brain injury, the course of recovery is also influenced by the environmental support provided during recovery process (Horton, 1994). In some cases, the child may exhibit little change in behavior. For other children, there may be an exacerbation of problematic pre-injury behaviors. Yet, in other cases, the child may display marked changes in behavior that were seldom, if ever, noticed at pre-injury. Consequently, an observational assessment of social behavior in the school provides a contemporary and meaningful supplement to assessments from rehabilitation personnel.

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School-based interventions for treating social adjustment difficulties in children with traumatic brain injury

Journal of Instructional Psychology, Sept, 2003 by Bruce F. Dykeman

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