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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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At times, students fail to apply recently acquired social skills and relapse into behaviors that are problematic for self and others. These relapses often occur when experiencing other symptoms of brain trauma, i.e., fatigue, irritability, anxiety, depression, headache. Time-outs are often helpful in removing the student from environmental events contributing to the symptomatic behavior, particularly when the student is excessively stimulated by academic and physical stimuli. Other strategies used to reduce inappropriate behaviors include (a) planned ignoring of the inappropriate behavior until such time as the student is able to apply behavioral control, and (b) reinforcing alternative, more acceptable behaviors that can occur at the same time as the negative behavior. In addition, verbal and physical cueing can often prompt the student to the more appropriate social behavior.

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Cognitive strategies are often introduced to treatment as the child becomes more able to use cognitive and memory skills needed to self-monitor and self-modify social behavior. Indeed, self-monitoring alone has been shown to produce reactive effects leading to behavioral change (Kanfer and Gaelick-Buys, 1991). By drawing the student's attention to his or her behavior, the child with TBI can often redirect behavior in a more socially appropriate direction. Individual counseling that focuses on social problem solving often assists the student's ability to formulate appropriate goals, generate alternative solutions, identify the consequences of these solutions, choose a good solution, implement a plan and evaluate the results. Often times, students with TBI have difficulty reading the social cues of others and understanding the social context in which the social cues were delivered. In this manner, cognitive strategies often develop student abilities to engage in active-reflective listening for purposes of identifying content, affect and context of delivered messages.

Cognitive strategies help students to use prepared scripts when facing a perplexing and confusing situation. In this manner, prepared scripts allow students to get through difficult situations, while buying time to discuss the manifestations of that situation within an individual counseling relationship. Anxiety management strategies are introduced to assist the student's ability to recognize and identify sources of anxiety, while relaxation strategies are taught to improve the student's ability to modulate the debilitative effects of anxiety.

Some students benefit from structured didactic class activities. Numerous commercially prepared programs are available, including Elliot's and Gresham's (1991) The Social Skills Intervention Guide, McGinnis's and Goldstein's (1984) Skillstreaming series, and Stephens's (1992) Social Skills in the Classroom. These classroom programs provide opportunities for students to develop and practice emerging social skills, with repeated rehearsal to strengthen these skills through use of scripts and multiple role-plays.

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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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