Assisting Students With a Traumatic Brain Injury in School Interventions

Abstract

French

Traumatic brain injury (TBI) in children and adolescents can significantly affect their lives and educational needs. Deficits are often exhibited in areas such as attention, concentration, memory, executive function, emotional regulation, and behavioral functioning, but specific outcomes are not particular to any one child or adolescent with a TBI. Therefore, educators must provide specific interventions to accommodate the needs of each individual student with a TBI. This article, first, addresses the definition of TBI in the schools and provides an overview of TBI including causes, classifications, and the primary areas of head injury. Second, the article presents recommendations and suggestions for school interventions for children and adolescents with TBI.

Keywords

traumatic brain injury pediatric TBI classification of TBI school interventions

There is an increasing awareness of Traumatic Brain Injury (TBI) in our society. The most recent statistics on students with TBI provided by the National Center for Education Statistics (NCES), which addresses the 2007-2008 school year, cite the number of students served by special education with TBI at 25,000 (NCES, 2010). This means that since the reauthorization of the Individuals with Disabilities Education Improvement Act (IDEIA) in 2004, 0.4% of children aged 3 to 21 served by special education have been classified as students with TBI. In addition, the number of students affected by undiagnosed or unreported TBI is unknown (Dykeman, 2009).

The IDEIA, which guides the definition of TBI in the schools, takes into account students’ levels of neuropsychological functioning after a TBI in regard to their educational needs. The educational definition of TBI per the United States Code of Federal Regulations is as follows:

an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child’s educational performance. Traumatic brain injury applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. Traumatic brain injury does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma (Assistance to States for the Education of Children with Disabilities, 2004).

As evidenced by the above educational definition, there are many possible outcomes of a TBI in children, which can affect their school experiences and school performance. School psychologists must understand the causes and outcomes of pediatric TBI, the specific needs of those students affected, and strategies to increase their potential for success in school. Based on the noted deficits exhibited in areas such as attention, concentration, memory, executive function, emotional regulation, and behavioral functioning, a neuropsychological approach seems warranted for the understanding and guiding of potential interventions in pediatric TBI. Earlier work by Dalby and Obrzut (1991) and Farmer and Peterson (1995) as well as more recent work by Allen, Thaler, Donohue, and Mayfield (2010), Donders and Janke (2008), Galbiati et al., (2009), and Newsome et al., (2008), support this view.

Overview of TBI

TBI, or head injury, is a medical condition that occurs when an external force or trauma (usually an accident) causes injury to the scalp, skull, or brain, which can range from a minor bump on the skull to serious brain injuries (Heller, 2010). Researchers estimate that more than one million people sustain brain injuries per year (Centers for Disease Control and Prevention [CDC], 2010; Havey, 2002; Jantz & Coulter, 2007) and that TBI is the leading cause of death for persons aged 1 to 45 years (Ewing-Cobbs, Levin, & Fletcher, 1998). The CDC (2010) estimates that the leading causes of TBIs in the overall American population include falls (35.2%), motor vehicle accidents (17.3%), being struck in the head (16.5%), physical assault (10%), and unknown causes (21%). Motor vehicle traffic accidents account for the most deaths due to TBI.

There are two classifications of TBI: open-head and closed-head injuries (e.g., Farmer & Peterson, 1995; Semrud-Clikeman, Kutz, & Strassner, 2005). Open-head injuries occur when an object, such as a bullet, knife, or other blunt object, penetrates the scalp or skull. In these cases, brain damage is usually localized to where the penetrating object affected the brain tissue. Resulting impairments are related to the specific function of the area of the brain that was damaged. Closed-head injuries occur when the scalp or skull is not penetrated but the external force affects the underlying brain tissue. According to Hooper and Baglio (2001), approximately 90% of brain injuries are the result of closed-head injuries. There are two origins of closed-head TBIs: direct contact forces and inertial forces (Farmer & Peterson, 1995). Direct contact forces occur when an object strikes the head, resulting in an inward compression of the skull and brain damage at the point of impact. Furthermore, the brain could be forced against the side of the skull opposite the point of impact, which causes additional damage. Direct force damage is usually localized to the specific areas of the brain that were struck or affected. Inertial forces occur when the brain is moving in an accelerated manner but then decelerates at impact, as with motor vehicle accidents. Inertial forces cause injuries that are more global because the entire brain continues to move forward after the impact, which damages many areas of the tissue.

Medical practitioners consider a TBI to be medically significant when there is an altered level of consciousness, the duration of posttraumatic amnesia is greater than 5 min, and there is physical evidence of injury based on neurodiagnostic measures such as magnetic resonance imagery (MRI) or computer tomography (CT; Bigler, 2007; Farmer & Peterson, 1995; Semrud-Clikeman, Kutz, & Strassner, 2005). To measure an individual’s level of consciousness, and thereby categorize the severity of TBI into mild, moderate, or severe diagnoses, medical practitioners use the Glasgow Coma Scale (GCS; Teasdale & Jennett, 1974). The GCS is a rating scale that measures eye opening response, motor response, and verbal response. A diagnosis of severe TBI is reflected by a GCS score of 8 or less; moderate TBI ranges from 9 to 12; and mild TBI ranges from 13 to 15 on the scale. According to the CDC (2010), about 75% of TBIs that occur each year are considered mild cases. The medical field will diagnose a coma when the patient is unable to open his or her eyes, unable to follow commands, and cannot utter any recognizable words (Farmer & Peterson, 1995). CT scans and MRIs are historically the most common diagnostic tools used to detect physical evidence of injury to the brain (Zimmerman & Bilaniuk, 1989). Today, technological developments have led to devices such as functional magnetic resonance imaging (fMRI) studies, which allow for functional neuroimaging that produces more informed results of brain activation patterns (Kramer et al., 2008). The literature clearly suggests that the frontal and temporal lobes are the most susceptible to injury (e.g., Bigler, 2007; Semrud-Clikeman et al., 2005). These injuries are caused by rapid acceleration, deceleration, or other trauma that grate and/or deform these lobes of the brain. As such, injury to the frontal-temporal area is assumed to be the cause of cognitive and neurobehavioral symptoms of TBI, such as attention, concentration, memory, executive function, and emotional regulation (Bigler, 2007). These neurobehavioral symptoms will manifest in scores on cognitive tests or measures and can have a direct impact on academic functioning.

Academic Functioning and the Need for Special Education Services

Children and adolescents with TBI can exhibit deficits in their academic performance in the areas of language, reading, arithmetic calculation, writing, and spelling (Levin, Ewing-Cobbs, & Eisenberg, 1995). It may be difficult for educators to assess or predict academic functioning after TBI as standardized testing often finds average abilities paired with poor performance in the classroom on daily tasks (Semrud-Clikeman et al., 2005). Furthermore, academic assessments usually only assess the retention and recall of previously learned material, which may remain intact after a TBI (Farmer & Peterson, 1995). Educators must be aware that achievement tests tap preinjury skills as opposed to postinjury potential. For example, Arroyos-Jurado, Thaler, Donohue, and Mayfield (2006) found that parent ratings of their child’s premorbid school achievement, using the Pediatric Behavior Scale (PBS; Lindgren & Koeppl, 1987), were the best predictors used to determine their child’s academic performance 6 to 8 years postinjury. Premorbid ability was not a statistically significant predictor of achievement within those six to eight years after the injury. The higher the child’s parent-rated ability was pre-injury, the higher his or her achievement was 6 to 8 years later. The study also found that children and adolescents’ achievement improved as they got older. These findings differ from previously reported research that used other child-based factors to predict future achievement (e.g., Rivara et al., 1994).

Despite their often average academic functioning, many children and adolescents with a TBI receive some type of special education services when they return to school. Studies have found that up to three fourths of children with severe TBI were retained in a grade or received special education services (Ewing-Cobbs et al., 1998). A study by Miller and Donders (2003) found that 43% of their sample of 69 children with TBI was receiving special education services in the forms of teacher consultant and resource room services at 12 months postinjury. At 24 months postinjury, 38% of the children were receiving the same services. In almost all cases, the qualification for eligibility for special education services was under the “physical and otherwise health impaired” category because the state where the investigation was conducted did not yet have a separate TBI special education classification. In this study, predicting the need for special education services was determined by the participants’ scores on the California Verbal Learning Test–Children’s Version (CVLT-C; Delis, Kramer, Kaplan, & Ober, 1994). In particular, children who received a T-score of less than 45 on the CVLT-C during the initial postinjury assessment were 8 to 13 times more likely to qualify for special education 12 to 24 months later. The predictive power of the CVLT-C probably relates to the fact that learning and consolidation of new information is an increasingly important requirement as children mature and progress through their academic career (Miller & Donders, 2003).

Children and adolescents with TBI often exhibit psychosocial or behavioral problems that stem from a decreased ability to self-monitor and self-regulate their daily activities and social interactions (Farmer & Peterson, 1995), which parents and teachers need to acknowledge. These emotional and behavioral problems can affect peer relationships and impede academic progress. Problems can manifest in ways such as difficulty remaining focused on academic tasks, developing positive peer or teacher interactions, accepting their limitations, maintaining a consistent mood, controlling anger, accurately remembering events, accepting responsibility for their actions, saying things without thinking about consequences, waiting to begin working, appearing to be apathetic, being reluctant to engage in activities, and engaging in incongruent emotional responses (Jantz & Coulter, 2007).

Lastly, problems with attentional capacity and/or attentional control can have a serious impact on a child’s performance in the classroom. For example, children with a TBI may show decreased on-task behavior, disorganization, difficulty shifting from one activity to another, variable performance from day to day on similar tasks, and trouble with identifying key points in a reading passage or lecture (Farmer & Peterson, 1995).

Given the nature and scope of the deficits experienced by children and adolescents with TBI in the school setting, it is important that school psychologists assist these students by providing appropriate interventions. The spectrum of TBI is immense, ranging from a mild sport concussion to the child who has experienced a catastrophic outcome. The literature on TBIs has often argued to separate the mild from the moderate to severe TBIs because of the significant differences in outcomes (Babikian & Arsanow, 2009; McCauley et al., 2012). However, research on interventions for students with a TBI generally does not discern between the different levels of TBI severity. Therefore, the interventions presented below could potentially apply to any student with a TBI who has behavioral or academic difficulties in school postinjury.

Assisting Students With a TBI in School Interventions

Outcomes of a TBI manifest differently from individual to individual; therefore, no set of interventions exists particular to students with a TBI. However, the research suggests several intervention strategies to assist students with a TBI after they have returned to school. As a part of the special education evaluation, the special education team should use a Functional Behavioral Assessment (FBA). An FBA will assist the team to examine, measure, and treat many deficits associated with a TBI (Bowen, 2005; Dykeman, 2009). As the FBA is most revealing of deficits regarding behavioral changes (Bowen, 2005), interventions for behavioral changes will be discussed first. Specific information regarding the target behavior is obtained to assist the special education team in choosing an effective intervention plan (Bowen, 2005). The FBA is used to determine the setting in which the behavior occurs, as well as the antecedents and consequences of the behavior (Bowen, 2005; Dykeman, 2009). Unique interventions are available if it was determined that a specific setting or environment contributed to the unwanted behavior. For example, the team may consider different school options such as homebound instruction, gradual increase in school attendance, changes in class schedules, a quiet and simplified classroom, predictable and consistent classroom routines (Bowen, 2005), a shortened day or work periods, rest periods, and preferential seating (Szekeres & Meserve, 1994).

Bowen (2005) aligned suggested interventions with four specific cognitive impairments, attention, memory, organization, and writing and information processing speed, and divided these interventions into two categories: external aids and teaching/learning strategies. For cognitive impairments, several interventions from both categories are provided. For example, using a timer to focus attention and the use of earplugs are potential external aids to assist with attention impairment. Simple and direct instruction, rest periods, and a slow pace of instruction are some teaching/learning strategies that are also supportive of students with attention impairments. External aids to assist students experiencing memory impairments include the use of checklists and appointment calendars, while some teaching/learning strategies helpful for the same impairment are teaching the use of visual imagery and breaking each task into steps, teaching each step separately. Checklists, planners, and graphic organizers are beneficial external aids for students with organizational deficits. Reviewing daily routines and peer buddies are teaching/learning strategies to assist with organization. Finally, for impairments of writing and information processing speed, external aids include assigning a peer note taker and using assistive devices, such as a word processor, and teaching/learning strategies focus on mastery of critical information while reducing the amount of required written work. Bowen (2005) provides further examples in both categories for each of these impairments.

Many of the interventions the literature suggests to assist students who exhibit behavioral changes following a TBI are also useful in assisting other potential TBI impairments. For example, like students presenting with unwanted behaviors, a student experiencing attention deficits following a TBI may benefit from preferential seating and a quiet, simplified classroom (Bowen, 2005). Additionally, basic reinforcement strategies can manage appropriate social behaviors. According to Dykeman (2003), such strategies include the utilization of primary and secondary reinforcers, reinforcement of successive approximations of appropriate behavior, modeling, prompting and cueing, creating behavior contracts, reinforcing acceptable replacement behaviors, and reinforcement delivered by a variety of important adult role models. At times, using time-outs and planned ignoring can reduce inappropriate behaviors.

School personnel can also utilize cognitive strategies with a student with a TBI to increase acceptable behavior. Cognitive strategies are useful when a student with a TBI is able to use cognitive and memory skills that are necessary to self-monitor and self-modify social behavior (Dykeman, 2003). Examples of cognitive interventions include self-monitoring, individual or group cognitive therapy, using scripts, anxiety management strategies, and structured didactic activities that focus on social skills in the classroom. Davies, Jones, and Rafoth (2010) studied the effects of a self-monitoring intervention on teacher’s direct behavior recordings of their students with a TBI. The teachers used direct behavior recordings that briefly measured the frequency, duration, or intensity of a behavior during predetermined intervals in the students’ natural environments while the students completed self-ratings of their behavior. The self-monitoring treatment included child self-ratings, matching self-ratings to teacher ratings, and teacher feedback. Results of this study suggested that the self-monitoring intervention was associated with improved class work and behavior in addition to increased accuracy in self-monitoring skills among all 3 participants.

Feeney and Yvlisaker (2003, 2006, 2008) evaluated the effectiveness of a support-oriented behavioral, cognitive, and executive system intervention aimed at improving the behavioral self-regulation and academic performance of children with severe and challenging behavior after a TBI. They used a combination of behavioral, cognitive, executive function, and communication-focused interventions with antecedent-focused and positive behavior support procedures in the children’s classrooms. Prior to the intervention, the researchers conducted an FBA on each participant. The intervention procedures of the studies included the following classroom procedures:

Daily routine: Negotiation and choice. Daily routines were analyzed with decisions about the minimum amount of work the student was expected to accomplish as well as achieving their goals, was discussed with the student.

Behavioral momentum: The plan included relatively easy tasks with a guaranteed high level of reinforcement before difficult work was introduced. If possible, a student-preferred activity preceded each mandated activity.

Reduction of errors: Instructional personnel were trained to provide sufficient modeling and assistance so that the students would experience few errors, which historically evoked negative behavior and interfered with learning.

Escape communication: The FBA indicated that most occurrences of challenging behavior served to communicate a need to escape a task or place. Therefore, the students were taught positive communication alternatives as replacement behaviors (e.g., “I need a break”).

Adult communication style: Instructional assistants were trained to (a) increase their frequency of supportive and reinforcing interactions with the students, (b) anticipate students’ difficulties and offer assistance or model escape phrases, and (c) avoid “nagging” (as perceived by the students).

Graphic advance organizers: Due to significant organizational impairment, the students were provided with photographic cues. The photos were placed in small binders and the students carried the binders with them throughout the day.

Goal-plan-do-review routine: The students were given a graphic “map” that represented the general sequence of activities from an executive function perspective: goal (i.e., “What are you trying to accomplish?”), identification of difficulty level (i.e., “Is this going to be hard or easy?”), plan (i.e., “How do you plan to get this done? What do you need? What are the steps? How long will this take?”), review (i.e., “What were you trying to accomplish? How did it work out? What worked for you? What did not work? What was easy? What was difficult?”). The interactions with staff were brief and collaborative.

Consequence procedures: Antecedent control procedures resulted in the students’ successful performance as well as praise from staff. When the students engaged in targeted negative behaviors, staff responded with a verbal prompt (“you’re not ready to . . .”) and removed the activity materials. Staff then told the students they could return to the activity when they were “ready” and then said, “I’ll know when you’re ready when you are sitting in your chair.” Students were also reminded of the other supports that were available to them. When the student was ready, staff returned the student to the activity.

With all three of Feeney and Ylvisaker’s (2003, 2006, 2008) studies, the intervention was successful in decreasing the frequency and intensity of challenging behaviors while the amount of work completed increased.

Conclusion

Pediatric TBI can have major effects on the operation of the young brain. It is important for educators to know the severity of a child or adolescent’s TBI to better predict potential deficits that may arise. Typically, those young people who experience mild TBI fare the best while those with moderate or severe TBI display the most amount of difficulty in multiple domains. To best understand and plan for their return to school postinjury, children and adolescents should receive neuropsychological assessments both soon after the injury as well as follow-up evaluations to determine if progress is being made. In the initial assessment, the young person’s parents or caretakers should be interviewed to gather as much data as possible in regard to their child’s preinjury levels of functioning. Oftentimes, the parents’ assessments of their child’s preinjury status are the best predictors of future performance. Knowing this information will inform the school psychologist and special education team in regard to how to best plan for the student’s education. School psychologists should also closely monitor a student with a TBI’s school progress after the injury and be prepared to make necessary adjustments to his or her education plan to offer the most appropriate education to the student postinjury.

When problems in school arise for a student with a TBI, an FBA should be completed to better inform future educational planning for that student. The information gathered from an FBA will guide educators in choosing the most appropriate school interventions for students of this population. Tailoring individual education plans for students with a TBI to be successful in school is a necessary part of the process since the neuropsychological outcomes of these students can vary greatly.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Bios

Erin M. Aldrich, EdS, is an advanced PhD student in the school psychology program at the University of Arizona. Her current research interest is in understanding the neuropsychological effects of traumatic brain injury as experienced by children and adolescents and in implementing evidence-based school interventions with this clinical population.

John E. Obrzut, PhD, is professor emeritus of school psychology in the Department of Disability and Psychoeducational Studies, College of Education, at the University of Arizona. His research interest is in developmental neuropsychology, with a specific focus on clinical populations.

References

Allen

D. N.

Thaler

N. S.

Donohue

Mayfield

(2010). WISC-IV profiles in children with traumatic brain injury: Similarities to and differences from the WISC-III. Psychological Assessment, 22, 57-64. doi:10.1037/a0016056

Arroyos-Jurado

Paulsen

J. S.

Ehly

Max

J. E.

(2006). Traumatic brain injury in children and adolescents: Academic and intellectual outcomes following injury. Exceptionality, 14, 125-140. doi:10.1207/s15327035ex1403_2

Assistance to States for the Education of Children with Disabilities, 34 C.F.R. pt. 300, 2004.

Babikian

Arsanow

(2009). Neurocognitive outcomes and recovery after pediatric TBI: Meta-analytic review of the literature. Neuropsychology, 23, 283-296. doi:10.1037/a0015268

Bigler

E. D.

(2007). Anterior and middle cranial fossa in traumatic brain injury: Relevant neuroanatomy and neuropathology in the study of neuropsychological outcome. Neuropsychology, 21, 515-531. doi:10.1037/0894-4105.21.5.515

Bowen

J. M.

(2005). Classroom interventions for students with traumatic brain injuries. Preventing School Failure, 49, 34-41. doi:10.3200/PSFL.49.4.34-41

Centers for Disease Control and Prevention. (2010). Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths, 2002-2006. Injury prevention and control: Traumatic brain injury. Retrieved from http://www.cdc.gov/traumaticbraininjury/tbi_ed.html

Dalby

P. R.

Obrzut

J. E.

(1991). Epidemiologic characteristics and sequelae of closed head- injured children and adolescents: A review. Developmental Neuropsychology, 7, 35-68. doi:10.1080/87565649109540476

Davies

S. C.

Jones

K. M.

Rafoth

M. A.

(2010). Effects of a self-monitoring intervention on children with traumatic brain injury. Journal of Applied School Psychology, 26, 308-326.

10.

Delis

D. C.

Kramer

J. H.

Kaplan

Ober

B. A.

(1994). California Verbal Learning Test—Children’s Version. San Antonio, TX: Psychological Corporation.

11.

Donders

Janke

(2008). Criterion validity of the Wechsler Intelligence Scale for Children—Fourth Edition after pediatric traumatic brain injury. Journal of the International Neuropsychological Society, 14, 651-655. doi:10.1017/S1355617708080752

12.

Dykeman

B. F.

(2003). School-based interventions for treating social adjustment difficulties in children with traumatic brain injury. Journal of Instructional Psychology, 30, 225-230.

13.

Dykeman

B. F.

(2009). Response to intervention: the functional assessment of children returning to school with traumatic brain injury. Education, 130, 295-300.

14.

Ewing-Cobbs

Fletcher

J. M.

Levin

H. S.

Iovino

Miner

M. E.

(1998). Academic achievement and academic placement following head injury in children: Educational implications. Journal of Clinical and Experimental Neuropsychology, 20, 769-781. doi:10.1076/jcen.20.6.769.1109

15.

Farmer

J. E.

Peterson

(1995). Pediatric traumatic brain injury: Promoting successful school reentry. School Psychology Review, 24, 230.

16.

Feeney

Ylvisaker

(2003). Context-sensitive behavioral supports for young children with TBI: Short-term effects and long-term outcomes. Journal of Head Trauma Rehabilitation, 18, 33-51. doi:10.1097/00001199-200301000-00006

17.

Feeney

Ylvisaker

(2006). Context-sensitive cognitive-behavioral supports for young children with TBI: A replication study. Brain Injury, 20, 629-645. doi:10.1080/02699050600744194

18.

Feeney

Ylvisaker

(2008). Context-sensitive cognitive-behavioral supports for young children with TBI: A second replication study. Journal of Positive Behavior Interventions, 10, 115-128. doi:10.1177/1098300707312540

19.

Galbiati

Recla

Pastore

Liscio

Bardoni

Castelli

Strazzer

(2009). Attention remediation following traumatic brain injury in childhood and adolescence. Neuropsychology, 23, 40-49. doi:10.1037/a0013409

20.

Havey

J. M.

(2002). Best practices in working with students with traumatic brain injury. In Thomas

Grimes

(Eds.), Best practices in school psychology IV (pp. 1433-1445). Washington, DC: National Association of School Psychologists.

21.

Heller

J. L.

(2010). Head injury. Medline Plus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000028.htm

22.

Hooper

S. R.

Baglio

(2001). Children and adolescents experiencing traumatic brain injury. In Hughes

J. N.

LaGreca

A. M.

Conoley

J. C.

(Eds.), Handbook of psychological services for children and adolescents (pp. 267-283).

23.

Individuals with Disabilities Education Improvement Act, 20 U.S.C. 1400, 2004.

24.

Jantz

P. B.

Coulter

G. A.

(2007). Child and adolescent traumatic brain injury: Academic, behavioural, and social consequences in the classroom. Support for Learning, 22, 84-89. doi:10.1111/j.1467-9604.2007.00452.x

25.

Kramer

M. E.

Chiu

C.-Y. P.

Walz

N. C.

Holland

S. K.

Yuan

Karunanayaka

Wade

S. I.

(2008). Long-term neural processing of attention following early childhood traumatic brain injury: fMRI and neurobehavioral outcomes. Journal of the International Neuropsychological Society, 14, 424-435. doi:10.1017/S1355617708080545

26.

Levin

H. S.

Ewing-Cobbs

Eisenberg

H. M.

(1995). Neurobehavioral outcome of pediatric closed head injury. In Broman

Michel

M. E.

(Eds.), Traumatic head injury in children (pp. 70-94). New York, NY: Oxford University Press.

27.

Lindgren

S. D.

Koeppl

G. K.

(1987). Assessing child behavior problems in a medical setting: Development of the pediatric behavior scale. Advances in Behavioral Assessment of Children and Families, 3, 57-90.

28.

McCauley

S. R.

Wilde

E. A.

Anderson

V. A.

Bedell

Beers

S. R.

Campbell

T. F.

Chapman

S. B.

. . . Yeates

K. O.

(2012). Recommendations for the use of common outcome measures in pediatric traumatic brain injury research. Journal of Neurotrauma, 29, 678-705. doi:10.1089/neu.2011.1838

29.

Miller

L. J.

Donders

(2003). Prediction of educational outcome after pediatric traumatic brain injury. Rehabilitation Psychology, 48, 237-241. doi:10.1037/0090-5550.48.4.237

30.

Newsome

M. R.

Steinberg

J. L.

Scheibel

R. S.

Troyanskaya

Chu

Hanten

. . . Levin

H. S.

(2008). Effects of traumatic brain injury on working memory-related brain activation in adolescents. Neuropsychology, 22, 419-425. doi:10.1037/0894-4105.22.4.419

31.

Rivara

J. B.

Jaffe

K. M.

Polissar

N. L.

Fay

G. C.

Martin

K. M.

Shurtleff

H. A.

Liao

(1994). Family functioning and children’s academic performance and behavior problems in the year following traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 75, 369-379. doi:10.1016/0003-9993(94)90157-0

32.

Semrud-Clikeman

Kutz

Strassner

(2005). Providing neuropsychological services to learners with traumatic brain injuries. In D’Amato

R.C.

Fletcher-Janzen

Reynolds

C. R.

(Eds.), Handbook of School Neuropsychology (pp. 425-443). Hoboken, NJ: John Wiley.

33.

Szekeres

S. F.

Meserve

N. F.

(1994). Collaborative intervention in schools after traumatic brain injury. Topics in Language Disorders, 15, 21-36.

34.

Teasdale

Jennett

(1974). Assessment of coma and impaired consciousness. Lancet, 2, 81-84. doi:10.1016/S0140-6736(74)91639

35.

Zimmerman

R. A.

Bilaniuk

L. T.

(1989). CT and MR: Diagnosis and evolution of head injury, stroke, and brain tumors. Neuropsychology, 3, 191-230.