Education post-TBI
HOW WILL THE BRAIN INJURY AFFECT MY CHILD AT SCHOOL?
WHAT INFORMATION WILL THE SCHOOL NEED?
LAWS THAT AFFECT YOUR CHILD'S EDUCATION
DEVELOPING AN INDIVIDUAL EDUCATION PLAN (IEP)
READING RESOURCES FOR FAMILIES
HOW WILL THE
BRAIN INJURY AFFECT MY CHILD AT SCHOOL?
Parents ask,
"When will my child be able to go to school?"
"How will the brain injury affect my child's education?"
"Will my child need special help at school?"
Leaving the hospital or rehabilitation program is a big step in your child's recovery. Even though your child may still need outpatient therapies or follow-up care, the medical crisis is behind you.
Some of the changes caused by your child's brain injury may be obvious; others may be less visible. Some may be temporary; others may last for a long time. It is even possible that some changes from the brain injury may not show up for months or even years. As time passes, it can be hard to sort out changes that are part of growing up and those that are related to the injury.
Unlike hospital and rehabilitation staff who have special training and programs for children with brain injuries, most school teachers have little experiences in this area. This means that careful planning must be done for your child's return to school.
Many parents have commented that their child's physical recovery was so quick that it seemed "miraculous." Physical progress over the first year is usually quite rapid and can give a child the appearance of being fully recovered. This can give educators and parents a false sense of a complete and quick recovery.
Over time, many parents find that the cognitive (or thinking) recovery is slower and these changes can make it harder for the child to learn at school. Control over behavior is also slower to improve and relationships with teachers, classmates, family members, and friends are often affected.
Changes in how a child thinks, learns, and behaves after a brain injury can be so minor that they are hardly noticeable. However, changes can also be so great that the child seems like a "different person." Between these two extremes are many children - each of them with a unique personality and abilities that have been touched in some way by the brain injury.
CAUTION! Schools are more familiar with students with mental
retardation, autism and birth related conditions. The needs of a
student with a traumatic brain injury are different. You may need to
educate them about traumatic brain injury.
The list below includes changes that are common among children with brain injuries as they return to school. Not all will be seen in every child. They may even vary each day or over time. Other people and activities may affect them as well.
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tires easily and needs extra rest |
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has trouble with memory and is forgetful |
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needs help starting and finishing tasks |
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has trouble concentrating |
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has trouble following directions |
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is irritable and short tempered |
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hits others, breaks rules, speaks out of turn |
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is easily distracted |
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acts on impulse |
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acts younger than their age |
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can't seem to get organized |
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doesn't fit in with classmates |
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makes embarrassing comments |
Suggestions
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share this list with rehabilitation staff and discuss the areas that affect your child |
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develop a plan with the rehabilitation staff to prepare school staff |
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learn strategies from rehabilitation staff to respond to any changes in your child, especially changes in behavior, emotions and memory. |
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contact parent support groups to discuss coping strategies |
Information provided from the "Traumatic Brain Injury in Children and Teens: A National Guide for Families" by the Dartmouth Medical School and the New Hampshire EMSC Project.
WHAT INFORMATION WILL THE SCHOOL NEED?
The basic question is, "How will this brain injury affect my child in school?" There is no easy answer to this. It is different for each child because each brain injury is different. Let your child's teacher and school know that your child has had a brain injury as soon as possible. Keep them updated on his/her progress. They need to know:
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the date your child was injured |
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the cause of the injury |
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how long he/she will be in the hospital or rehabilitation program |
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when your child will return to school |
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how the brain injury has affected him/her |
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special needs that your child has as the result of a brain injury |
Your child may now take medication, which he/she did not take before the brain injury. The school will need information about your child's medications. In large schools the school nurse or other health professional will administer or directly supervise the administration of medication to your child. In small schools, a health professional may not always be present. Identify the person responsible for giving medication to your child each day. Also identify another person who will give your child his/her medication if the first person is not at school. Make sure everyone understands:
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name of the medication(s) |
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amount to be given |
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schedule for giving it |
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any side effects of the medication |
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what to do if there is a missed dose |
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any allergies your child has to medications |
If your child has developed a seizure disorder as a result of his/her brain injury, the school will need information about the seizures. Both you and the school staff should develop a plan for handling in-school seizures. Make sure the appropriate school staff knows about your child's seizure medication and the type of seizure your child has. Your child's friends may be concerned about your child's seizures. Tell them about your child's seizures and what they can do to help their friend. Consider getting a medical alert bracelet or necklace for your child.
Schools and rehabilitation programs often have different expectations about what students need, what resources are available, how much services will cost, and who will pay for them. So it is important that people from the school and rehabilitation staff get together as soon as possible to begin planning before your child is discharged from the hospital and goes home.
Rehabilitation staff can advise school staff about your child's:
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brain injury |
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therapies for rehabilitation |
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expectations for recovery |
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need for changes or accommodations |
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strengths and abilities |
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difficulties and weaknesses |
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planned discharge data |
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need for special help to learn |
School staff can advise rehabilitation staff about you child's:
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previous educational abilities, interests and grades |
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any prior learning or behavioral difficulties at school |
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classroom schedule and activities during a regular school day |
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special resources and programs at school |
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referral and application process for special education |
By sharing this information, rehabilitation and school staff can work with you to figure out if your child will need:
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special educational services or programs for learning |
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physical, occupational or speech therapies at school |
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special transportation to and from school |
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adjustments in scheduling activities |
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changes in the physical setup of your child's classroom |
Information provided from the "Traumatic Brain Injury in Children and Teens: A National Guide for Families" by the Dartmouth Medical School and the New Hampshire EMSC Project.
"Special" refers to specially designed instruction. There are also "related services" that can help your child learn and function in school. These related services include:
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school health services |
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occupational therapy |
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audiology (hearing services) |
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social work services |
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psychological and neuropsychological services |
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communication devices and special equipment (assistive technology) |
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physical therapy |
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speech therapy |
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counseling |
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recreational programs |
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transportation |
Information provided from the "Traumatic Brain Injury in Children and Teens: A National Guide for Families" by the Dartmouth Medical School and the New Hampshire EMSC Project.
A neuropsychologist is a psychologist who has specialized in the relationships between the brain and behavior. Neuropsychologists have special training to evaluate how an injury to the brain affects your child's ability to learn, communicate, plan, organize, and relate to others. Evaluations usually involve several tests, including games, puzzles and responses to words and images. These give the examiner information about how the different parts of the brain function when challenged to reason, analyze, store and recall information. The selection of tests will depend on your child's age, the difficulties reported by the rehabilitation team, questions from the school staff, and your concerns. A neuropsychologist experienced in evaluating children and adolescents will be familiar with which tests are valid and useful for students with brain injuries.
Suggestions
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Talk with your child's doctor about having a neuropsychologist evaluate your child while in the rehabilitation hospital. |
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Involve the neuropsychologist in providing information to the evaluation team at your child's school. |
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Ask the neuropsychologist to send a written report to the school. |
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Keep a copy of this report as a baseline. |
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Ask the neuropsychologist to include teaching strategies to help your child learn. |
The neuropsychologist in the rehabilitation hospital may or may not be able to follow your child after discharge. If you look for one closer to your child's school and community, be sure the person has experience with children that age, has worked with schools, will interpret test results clearly, can give practical suggestions for teachers, and provides follow-up to school staff.
Once your child returns to school, the special education team may want to use a psychologist employed or contracted by the school rather than a neuropsychologist to evaluate your child's progress. However, standard tests used by school psychologists to evaluate learning difficulties of other students with disabilities may not be helpful or appropriate in evaluating the effects of a brain injury. Many intelligence and achievement tests measure primarily what the child has learned in the past. Students who have had brain injuries often do not lose the knowledge they had prior to injury. Thus, test scores on previously learned material such as vocabulary, general information and social comprehension often show scores in the average range. This can be a misleading picture of the student's ability to learn new information.
After your child returns to school, you and the teachers may have questions about how the brain injury has affected your child's learning and behavior. A neuropsychological evaluation within the first year after your child was injured can help track progress and difficulties in special areas. This may be done by the same neuropsychologist who evaluated your child in the rehabilitation program. If it is a different person, then it is important to have the earlier reports available to compare test results and track your child's progress over time.
Explore a referral for a neuropsychological evaluation when your child:
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has had a moderate to severe brain injury |
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has sustained a mild traumatic brain injury and is having trouble with attention, learning, behavior or emotions. |
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is showing changes in behavior at school that are not understood |
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is having major difficulties learning and his grades are dropping |
Information provided from the "Traumatic Brain Injury in Children and Teens: A National Guide for Families" by the Dartmouth Medical School and the New Hampshire EMSC Project.
LAWS THAT AFFECT YOUR CHILD'S EDUCATION
There is a federal law on education called the Individuals with Disabilities Education Act (IDEA). Original legislation was enacted in 1975 and it has been amended many times since then. The most recent amendment to IDEA occurred in 1997 and is Public Law 105-17. The law lays out the process for schools and parents to follow in planning and providing special education and related services to infants, toddlers, and children with disabilities and other conditions that affect learning. Every state also has a law for education which matches the federal guidelines under IDEA. Some states even provide additional services.
The IDEA law has a special category for traumatic brain injury. It is very important to use the code or category "traumatic brain injury" for your child and to avoid general labels such as "other health impaired."
The category of traumatic brain injury helps schools:
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identify students with special needs as a result of brain injuries |
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recognize that students with brain injuries have unique needs |
To learn about the IDEA law:
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Set up a meeting with the principal or special education director |
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Get the handbook or manual that describes the education law for your state. |
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Talk with your child's doctor and rehabilitation team and ask if your child should be referred for special education services. |
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Go to special education workshops for parents of children with disabilities. |
Your child may be eligible for services and accommodations under another federal law called the Rehabilitation Act. Section 504 of the Rehabilitation Act prohibits the discrimination against persons with disabilities by school districts and ensures access to a free, appropriate public education. If your child has a handicapping condition that limits a major activity, special accommodations to his educational program are required.
Some examples of potential 504 handicapping conditions not generally covered under the IDEA are:
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temporary medical conditions due to illness or accident |
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behavioral difficulties |
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attention deficit disorder |
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asthma, allergies, diabetes, heart disease |
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tuberculosis, HIV |
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drug and alcohol addiction |
A child with a disability is considered handicapped and is protected under Section 504. However, a child considered handicapped under Section 504 may not be disabled under IDEA. In other words, a child does not need to be enrolled in special education to be eligible for services under Section 504.
Information provided from the "Traumatic Brain Injury in Children and Teens: A National Guide for Families" by the Dartmouth Medical School and the New Hampshire EMSC Project.
DEVELOPING AN INDIVIDUAL EDUCATION PLAN
Once the school team approves your child's application for special education, and educational plan will be put together. Although different states have different names for this, the federal law calls it an Individualized Education Plan (IEP).
This is a contract between you and the school for your child's education. You have final approval of this plan before the school can put in into action. So it is very important for you to be involved in developing this plan. The IEP is a legal document used to plan, monitor and evaluate your child's progress. The IEP must include:
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your child's current level of educational ability |
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goals and short-term objectives for the year |
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educational services needed to meet those goals and objectives |
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plan for how your child will be part of regular classroom programs |
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dates to begin services |
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how your child's program will be evaluated |
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schedule for checking progress and making needed changes |
Think about why, when and if you want to include your child in all or part of the IEP meeting. Consider your child's ability to participate, be part of the planning, and ability to hear feedback and answer questions. Weigh how your child's presence will contribute or limit discussions.
Many schools are in the habit of doing IEP's only once a year. However, the IEP of a student with a brain injury should be reviewed monthly after first returning to school. You may later want to set up reviews every 3-4 months. This is because the needs of a student with a brain injury change especially in the first year after the injury.
Setting up IEP meetings involves a lot of time and work by school staff. Insist on frequent meetings because they are the key to monitoring services, identifying changing needs, spotting problems and delays, putting together effective educational plans and committing resources.
The goals and objectives written on the IEP should include not only what your child needs to learn but how your child will learn. Once an IEP is written, it must be followed by school staff. Any changes require the consent of the school team. As a parent, you have the right to request a review or revision of the IEP at any time.
Information provided from the "Traumatic Brain Injury in Children and Teens: A National Guide for Families" by the Dartmouth Medical School and the New Hampshire EMSC Project.
READING RESOURCES FOR FAMILIES
When Your Child Goes to School After an Injury
By Marilyn Lash, M.S.W. (1992).
Published by Exceptional Parent, Dept ML, P.O. Box 8045, Brick NJ 08723.
(800) 535-1910
Signs and Strategies for Educating Students with Brain Injuries: A Practical Guide for Teachers and Schools
By Gary F. Wolcott, M.Ed., Marilyn Lash, M.S.W., Sue Pearson, M.A> (1995). Published by HDI Publishers, P.O. Box 131401, Houston, TX 77219. (800) 321-7037
Students with Aquired Brain Injury: The School's Response
Edited by Ann Glang, George Singer, and Bonnie Todis (1997).
Published by Paul H. Brookes Publishing Co., PO Box 10624, Baltimore, Maryland 21285-0624. (410) 337-9580.
An Educator's Manual: What Educators Need to Know about Students with Brain Injury
Edited by Ronald C. Savage, Ed.D., and Gary6 F. Wolcott, M.Ed. (1994). Published by PRO-Ed, 8700 Shoal Creek Blvd, Austin, TX 78757-6897. (512) 451-3246
Educational Dimensions of Acquired Brain Injury
Edited by Ronald C. Savage, Ed.D. and Gary F. Wolcott, M.Ed. (1994). Published by PRO-Ed, 8700 Shoal Creek Blvd, Austin, TX 78757-6897.
(512) 451-3246
Traumatic Head Injury in Children and Adolescents: A sourcebook for Teachers and Other School Personnel
By Mary P. Mira, Bonnie Tucker and Janet S. Tyler, (1992).
Published by PRO-Ed, 8700 Shoal Creek Blvd, Austin TX 78757-6897.
(512) 451-3246
Pediatric Traumatic Brain Injury: Proactive Intervention
By Jean Blosser, Ed.D. and Roberta DePompei, Ph.D., (1994). Published by Singular Publishing Group, Inc., 4284 41st Street, San Diego, CA 92105-1197.
When Your Teenager is Injured: Preparing for Work and Adulthood
By Marilyn Lash, M.S.W., (1998). Published by Research and Training Center in Rehabilitation and Childhood Trauma, New England Medical Center, Boston, MA. Call (603) 569-3826 to order.
Myths and Facts: When Your Child has a Brain Injury
By Marilyn Lash, M.S.W., (1998). Published by Lash and Associates, 22 Keewaydin Road, Wolfeboro, NH 03894
Call (603) 569-3826 to order.
Back to School After a Moderate to Severe Brain Injury
By Roberta DePompei, Jean Blosser, Ron Savage, Marilyn Lash, (1998).
Published by Lash and Associates, 22 Keewaydin Road, Wolfeboro, NH 03894
Call (603) 569-3826 to order.
Special Education:IEP Checklist for a Student with a Brain Injury
By Roberta DePompei, Jean Blosser, Ron Savage, Marilyn Lash, (1998)
Published by Lash and Associates, 22 Keewaydin Road, Wolfeboro, NH 03894
Call (603) 569-3826 to order.
Neuropsychology and School: Understanding Hopw a Brain Injury Affects a Student's Behavior
By Marilyn Lash and Ron Savage, (1998). Published by Lash and Associates, 22 Keewaydin Road, Wolfeboro, NH 03894
Call (603) 569-3826 to order.
ELVIN The Elephant Who Forgets
By Heather Snyder and Illustrated by Susan Beebe, (1998).
Published by Lash and Associates, 22 Keewaydin Road, Wolfeboro, NH 03894
Call (603) 569-3826 to order
Information provided from the "Traumatic Brain Injury in Children and Teens: A National Guide for Families" by the Dartmouth Medical School and the New Hampshire EMSC Project.
