Welcome to the TBI-HELP Live Chat

Today's topic is: "Traumatic Brain Injury in Pediatric Neuropsychology"

Our Guest is: Dr. Tamar Martin, Rehabilitation Counseling, Hunter College


[19:02:37] Mod: Welcome everyone! Tonight we are very happy to have Dr. Tamar Martin as our guest speaker. Tonight Dr. Martin's topic will be Traumatic Brain Injury in Pediatric Neuropsychology. Welcome Dr. Martin!
[19:13:19] Mod: Since children and young adults have a rough and tumble life- how do we know if that recent fall or the crash of uniforms on the football field may have caused some form of TBI?
[19:23:50] drtamarmartin: There are three things to pay attention to: the first if if the child suffers a loss of consciousness.. Then, changes in behavior and thinking (cognitive changes) are often seen by family, friends, and teachers although often they don't know why.. Finally, if these occur, I advise a referral for an assessment to document cognitive changes noted..
[19:26:22] Mod: What are the challenges faced by our educational system for students with BI?
[19:27:11] drtamarmartin: Students with BI are often mis- or undiagnosed because the injury is not known by the school, especially if it is considered a "mild" BI.  These children often start to experience difficulties with new learning and a decrease in grades. Often, educators assume this is because the child has become "lazy" or unmotivated..
[19:28:46] Mod: Why is it difficult to identify students with BI?
[19:29:49] drtamarmartin: There are 5 major reasons why children with BI are unidentified. 1. They are placed in classrooms for children with LD or ED.. The more traditional approaches to assessment do not address the cognitive changes the child experiences and therefore, these deficits remain unknown. Often, the changes post BI do not occur for months or years until the child is challenged to perform in a more demanding way (for example, memorize more complex information). By then, people do not connect the memory impairment with a BI from years before. Children with BI often retain old learning - in other words, what they have learned prior to the injury, they retain. It is the new learning that is difficult, but educators expect the children to perform as they once had.
[19:34:21] drtamarmartin: Finallly, even if a child with BI is identified, the services are usually the same as those for children with LD and therefore, do not address the specific cognitive challenges of children with BI..
[19:34:43] Mod: Would a child who suffered a TBI enter a mainstream classroom environment?
[19:36:24] drtamarmartin: Yes, the child with a BI can enter a mainstream setting. The classroom setting needed by a child depends on his or her specific learning needs. Just because a child has a BI, does not mean s/he should not attend general ed. Specifically, under Section 504 , children with BI can receive classroom modifications in genral ed. and do not require an IEP..
[19:36:40] Mod: Rail: Once we know a child has a BI, what can we do?
[19:37:14] Mod: <just sitting here>
[19:37:37] drtamarmartin: Once you know the child has suffered a BI, it is important to seek the services of a neuropsychologist who specializes in children to obtain an assessment so appropriate recommendations for educational planning can be made..
[19:38:15] Mod: How do children with BI differ from adults with BI?
[19:39:55] drtamarmartin: Children with BI differ from adult because the child's brain is not yet fully developed. Therefore, the damage at a younger age also effects the way the brain functions may develop. For example, the frontal lobes are not fully developed until adolescence. This is the area of the brain responsible for "executive functions". These children will often have problems with organization, planning, shifting from one task to other, etc..
[19:40:20] Mod: Syd: Are there any statistics that tell us how many children have had moderate BI and went undiagnosed?
[19:41:20] drtamarmartin: There have been studies of children in special education setting that ask about prior BI, but to date it is difficult to determine an exact number. We do know that some studies showed that 15% of students in ED classes have a history of BI..
[19:42:19] Mod: Do children with brain injury have a better chance of recovering than adults based on the theory of plasticity?
[19:43:41] drtamarmartin: I don't believe that is considered a "true" theory. We still do not know how much recovery one can expect - it is very individualized. But, I have seen that children suffer tremendously because they have not yet acquired the skills they need as adults and often struggle despite compensatory strategies..
[19:43:59] Mod: How long should a child who has sustained a brain injury be monitored for?
[19:45:03] drtamarmartin: A child with a brain injury needs to be monitored throughout their education. Things learned by the teachers one year can be passed on to the next so the same "mistakes" are not made. Also, children change over time - new problems may arise..
[19:45:30] Mod: What type of services are available for families with a child who has sustained a brain injury?
[19:46:55] drtamarmartin: That is an excellent question. There are very few services for families - there are few specialists who understand the specific need of families with a child with BI. It is best to contact your local or state brain injury program or a local hospital with a rehabilitation unit. Or, contact this website!
[19:47:23] Mod: Rail: What about the emotional and behavioral challenges following a BI; Especially with the adolescent?
[19:49:48] drtamarmartin: This is a very demanding area. These children are experiencing all the "typical" changes in adolescence, plus those as a result of the injury. In older children, we often see depression (loss of interest), sadness, feelings of worthlessness, anxiety, and, also very important, changes in self-esteem. I recommend counseling, but again, with a counselor or psychologist knowledgeable about BI..
[19:50:16] Mod: Rail: What are the "cognitive" challenges for students with BI?
[19:51:40] drtamarmartin: The most common cognitive challenges for students with BI include the following areas: attention and concentration, memory, information processing, executive functioning, and communication..
[19:55:19] Mod: What counseling strategies have been effective in your work with students with BI?
[19:57:14] drtamarmartin: There are counseling strategies that are NOT effective: we have found that peer mediation, dealing consequences to a unwanted behavior, and, of course, criticism don't work. What has been effective are proactive interventions, working with the student to identify the triggers for a certain response, and empowering the student to remove him or herself from a stressful environment. It should be emphasized that it helps to have counseling with the family and teachers as well so all are on the same page..
[19:57:27] Mod: On the cognitive front-are there any good diagnostic measures of cognitive progress/process that can be related to "normal" results to assist in spotting the BI results in elementary and middle school ages?
[19:58:45] drtamarmartin: There are several excellent measures (or tests) available to help us learn about a BI. However, if you do not have a history of an injury, you can not use BI as a diagnosis.
[19:59:33] Mod: What role do parents have in developing a treatment plan for a child that has recently sustained a brain injury?
[20:01:18] drtamarmartin: Parents play a significant role in working together with the professional in developing a treatment plan. Firstly, parents will have valuable information about "what works" and what doesn't at home which can also be implemented at school, with friends, etc. Unless all of the people involved with the child are included in the planning, the "best" plan will fail..
[20:02:59] Mod: What are the greatest hindrances of a child returning to "normal" functioning?
[20:04:19] drtamarmartin: I often hear that the most difficult issues faced by children with BI are not that their peers don't understand or accept them, but the change they see in themselves (the "before and after") following the BI is the most painful aspect and a hurdle that they (and the parents) struggle with the most.
[20:05:38] drtamarmartin: Of course, the cognitive impairments - memory deficits, communication problems, may hinder a child in learing, but these can be addressed when the community is willing..
[20:06:56] Mod: What can we do to help children?
[20:08:07] drtamarmartin: We have to first educate our educators about BI! Unless our teachers and other school staff know what to look for, can we hope to help these children.
[20:08:30] Mod: Well I see that our time is up. I would like to thank Dr. Martin for providing us with a very informative session and hope that she returns sometime in the future. Thank you and good night!
[20:08:46] drtamarmartin: Thank you