Students with traumatic brain injury (TBI) can suffer from cognitive and behavioral impairments that make learning challenging.

When a child returns to school, a speech-language pathologist (SLP) can work with the child, family, and teachers to determine cognitive-communicative strengths and challenges.

A SLP can help create a plan including strategies and suggestions for the classroom to make return to school a success.

Areas of Difficulty, Suggested Modifications

Below is a list of areas that may prove difficult for a child who is suffering from a TBI.

Click a link to view behaviors associated with the area of difficulty and potential modifications that may help the student overcome these difficulties.

• Attention
• Memory
• Learning new concepts
• Starting work or projects
• Organization
• Thought flexibility
• Abstract thought
• Reasoning and problem solving
• Information processing
• Judgment
• Social skills
• Overstimulation and emotional control
• Awareness of deficits

Attention

Behaviors

• Off-task behavior
• Easily distracted in classroom

Modifications

• Use a signal between student and teacher or peer to bring individual back to the task at hand
• Seat the child away from the source of distraction and close to the front of the room
• Shorten the assignments

Memory

Behaviors

• Difficulty following directions
• Frequently breaking the rules
• Denial of bad behavior
• Inability to recall previous actions
• Difficulty remembering homework assignments
• Difficulty learning or memorizing new information

Modifications

• Encourage a peer companion to assist the student with following classroom rules
• Maintain a structured environment with consistent expectations
• Offer the student a simplified planner
• Provide a visual schedule

Learning New Concepts

Behaviors

• Difficulty learning or memorizing new information

Modifications

• Frequently review materials
• Devise a cueing systems (cards, notes, mnemonic devices)
• Present well-organized information and materials to the student
• Offer tutoring to the student
• Assist with note taking

Starting Projects

Behaviors

• Difficulty beginning work assignments
• No initiation of peer interaction
• Lack of motivation
• Passive approach to all activities

Modifications

• Use a watch or timer alarm to cue student to initiate
• Use a script for student (What should I be doing now?)
• Signal between the teacher and the student to start a task
• Peer model or partner

Organization

Behaviors

• Inability to adjust to changes in schedules or lessons
• Writing assignments that wander or seem directionless
• Difficulty keeping up with tests and assignments

Modifications

• Provide child with an activity or daily planner
• Offer visual organizers, outlines, and note cards to organize writing assignments

Thought Flexibility

Behaviors

• Difficulty coping with changes in routine
• Getting ‘stuck’ on one thought or behavior
• Inability to generate more than one possible solution

Modifications

• Prepare for changes in routine in language consistent with the cognitive level of student
• Redirect inappropriate or incorrect behaviors

Abstract Thought

Behaviors

• Inability to determine thoughts behind casual comments
• Feeling hurt by sarcasm and joking
• Difficulty understanding figures of speech or abstract concepts
• Difficulty with peer-to-peer interaction

Modifications

• Use concrete language
• Offer clear explanations
• Limit joking

Reasoning and Problem Solving

Behaviors

• Difficulty drawing conclusions
• Inability to figure out and apply rules in problem-solving activities
• Difficulty with production and fluency of thought
• Inability to learn from trial and error
• Poor decisions about behavior and friends

Modifications

• Create Structured situations
• Provide Written rules
• Provide concrete explanations
• Offer visual descriptions or explanations
• Pre-discuss situations

Information Processing

Behaviors

• Delayed response to teacher's questions
• Increased time required to complete assignments

Modifications

• Give adequate time for student to answer questions or complete assignments
• Provide information in multiple modalities (e.g., auditory, written, and visual)

Judgment

Behaviors

• Poor decisions about behavior and friends
• Telling stories not based on facts

Modifications

• Rehearse scripts and routines for handling situations
• Offer peer counseling
• Journal past activities to guide student's recollection of fact

Social Skills

Behaviors

• Violation of others’ personal space
• Unable to read body language and social cues

Modifications

• Provide contextualized cueing (e.g. at lunch or recess) to assist student during interactions
• Rehearse scripts for interacting with others
• Provide opportunities for success
• Offer peer modeling of appropriate behavior
• Role play social interactions

Overstimulation and Emotional Control

Behaviors

• Difficulty functioning in lunchroom or gym (for example, behavioral outburst)
• Irritability in classroom during class activities
• Emotional reactions (anger, sadness) out of proportion to situations

Modifications

• Avoid situations of overstimulation
• Devise a routine for identifying anxiety and escaping stressful situations

Awareness of Deficits

Behaviors

• Limited insight into own abilities and behaviors
• Denial of problems and needs for assistance

Modifications

• Provide education about strengths/weakness in supportive environment
• Offer counseling for cases of psychological denial
• Analyze and discuss performance on difficulty tasks