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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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Observational assessment. Principles of applied behavioral analysis are often used when assessing the social behaviors of children with TB I (Horton, 1994). This strategy of assessment assumes that behavior is best explained by the antecedents that precede and the consequences that follow that behavior. In this regard, the antecedents and consequences of problematic, inappropriate social behavior become the targets of therapeutic intervention. Generally, applied behavior analysis involves: (a) identifying and describing the problem behavior: (b) measuring the frequency, intensity and duration of the behavior; and (c) identifying the antecedents and consequences that maintain the behavior and the function of that behavior.

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In this manner, the observational assessment of social behavior in the classroom looks at factors within the student's environment that contribute to the challenging behaviors (Haynes & O'Brian, 2000). For many children with TBI, physical factors affect social-emotional functioning, including (a) the number of children in the class, (b) activity level within the classroom, (c) amount of available physical space, and (d) the intensity of light and noise. Often times, behavioral difficulties are time dependent, with some children showing difficulties early in the school day, while other children showing difficulties as they become more fatigued later in the day. The social behavior of the child may depend upon academic expectations of a specific setting, with some maladaptive behaviors noted in classes that are more academically or socially demanding. Or, quality and appropriateness of social behavior may depend upon the amount of instructional and social support available during the classroom period. As noted, variability of behavior is often noticed. Therefore, periodic observational assessments in a variety of classroom environments will assist the staff in identifying those specific factors that either contribute to or modulate social and emotional difficulties experienced by TBI students.

Intervention. The purpose of classroom intervention is to assist the child in reducing inappropriate social behaviors associated with the traumatic brain injury and increasing the appropriate social behaviors as the child progresses through Stage 3 of the recovery process. In this regard, the child's incremental progress can be assisted by both the recovery of brain function as well as adaptations made to the environment. Principles of cognitivism and behavioral modification are often used to assist the recovery process.

A variety of strategies are commonly used to develop and increase useful and appropriate social behaviors (Wollcott, Lash & Pearson, 1995). Reinforcement of positive behaviors commonly utilizes a combination of primary and secondary reinforcers, with tangible reinforcers having a rich fixed ratio reinforcement schedule to establish new behaviors, and social reinforcers having a variable reinforcement schedule to maintain socially appropriate behaviors. Many times, it is necessary to reinforce the small steps of improved behavior that successively approximates the desirable behavior. with such shaping of behavior carried out as a long-term intervention strategy. Modeling appropriate social behaviors, either as a live or videotaped presentation, can be useful for students capable of observational and imitative learning. Prompting and cueing socially appropriate behavior assists students in carrying out previously acquired behaviors, with combinations of verbal and physical prompts reduced as the student gains skills needed to maintain appropriate behavior. Contracting with students to maintain recently acquired behaviors helps to generalize behaviors over time and setting. Reinforcement delivered through multiple exemplars (viz., teacher, counselor, parent) can assist the transfer of social skills to new settings.

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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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