TBI Affects Student Executive Skills by Teresa Sacchi Armstrong, M.A.

TBI AFFECTS STUDENT EXECUTIVE SKILLS

by Theresa Sacchi Armstrong, M.A.

Frontal lobe injuries can affect executive functions in students after TBI

Children who have had a brain injury often struggle with executive skills in school. These are high-level cognitive functions which cue the use of other mental functions. We can think of the executive functions as conductors of a mental ability orchestra. Anatomically, we know that these functions correlate with the frontal lobes of the brain, specifically the prefrontal cortex, which often is injured during the coup-contra-coup type of injury that is seen after a motor vehicle accident, or shaken baby syndrome.

Is the student with executive deficits eligible for special education?

The Individuals with Disabilities Education Act (IDEA) governs how states and public agencies provide early intervention, special education, and related services to children with disabilities. The two pronged eligibility for receiving services requires:

1) that the child has a disability (defined in idea by one of the 14 disabling categories), and

2) that the disability has an educational impact on the child’s educational performance.

At this time, poor executive functioning skills alone will not deem a child eligible to receive special education services. If the child has a documented disability, such as a traumatic brain injury, they may receive support for their executive functioning limitations depending on district policies. However, in some school districts, special education teachers are still trained to write annual goals only in academic skill areas and will not address executive dysfunction. However, children with disabilities may receive supports and accommodations now for poor executive functioning skills. They often do within special education classrooms, team taught general education classrooms, and other classes often named study skills, personal professional development, and so forth.

What if my child does not quality for special education under TBI?

Those children with acquired brain injuries who do not qualify for special education through the TBI category, (i.e. those who may be diagnosed with ADHD secondary to an ABI whose educational performance is not thought to be impacted), often receive accommodations and modifications through a 504 plan. They usually receive accommodations such as use of a graphic organizer, more time on tests, preferential seating, etc. Neither of the above solutions provides much in the way of help for children experiencing executive skill dysfunction secondary to ABI.

A better structured approach and universal design in lesson planning for all children in the general educational environment is needed to support children. Teachers seldom know what is really going to help an individual child, because they have not first ascertained the extent or specific area of executive dysfunction through a thorough assessment.

One approach does not fit all students after brain injury

Each child is different, one that struggles with initiation of  a task, might be able to sustain attention to the task, another child might not be able to organize a task, but might be able to shift attention and hold information in working memory long enough to manipulate work involved in that task. The best attempts by teachers and districts seem to be a “checklist”, provided to teachers and parents, listing modifications and supports that may help a child with executive dysfunction achieve more academic success. However, this one size fits all approach also causes frustration for parents and teachers. As teachers, we often hear a child angrily state, “I don’t need that!” One approach for all is not the intervention called for either.

Lesson plans can support students in class and with homework

All children need a better structured general educational environment to enhance their performance, especially those with poorly developed executive functioning skills. Solid lesson planning and concrete directions for follow through on extension activities (such as homework or group work in or out of class), are necessary and will help all students complete these activities in their teacher’s absence.

The lesson plan design should incorporate and consider the support children have at home to structure, plan and organize their projects and homework. Therefore, the teacher should think about how and if the students will be planning and organizing homework and projects out of class on their own and if they have been adequately equipped to follow those activities through until completion. “Parents may not have the time or organizational skills to help with homework, or conflict between parent and child around this issue may preclude their help” (Dawson, 2010).

Some questions to guide a teacher when planning out of class projects and homework might include:

  • Was the instruction provided sufficient to expect accurate completion by a student at home?
  • Is the expectation of the quantity of work to be completed in one sitting at home reasonable?
  • Does the student possess the executive skills to organize his/her own work at home, or will they need help?

 A final thought

Of course some children with ABI present more intense executive dysfunction needs, and those children will require interventions that specifically target individual training toward improving the executive skills after a thorough executive skill assessment is conducted.

References:

Dawson, P. (2010). Executive Skills in Children and Adolescents.New York:Guilford Press.

About the Author

Theresa Sacchi Armstrong is Research Associate in the Graduate School of Education and Human Development at The George Washington University. For information on building schools’ capacity to serve students with brain injuries, learn about the Master’s Degree Program with Teacher Licensure email Ms. Armstrong at tjsacchi@gwu.edu.

Recommended Reading

Instructional Tool Kit on Brain Injury for Educators

By Stephen Bruce, M.Ed., Roberta DePompei. Ph.D., Marilyn Lash, M.S.W., Katherine Kimes, Ed.D., D., Sue Pearson, M.A., Ron Savage, Ed.D., Lisa Selznick Gurdin, M.S., Janet Tyler, Ph.D., Gary Wolcott, M.Ed.

Four manuals for educators, therapists and parents show how to identify students with brain injuries in school, address cognitive and behavioral challenges in the classroom, and develop educational programs with supports and accommodations at home and in school. They are full of practical educational and compensatory strategies with examples on teaching students with acquired brain injury.

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