TBI: The Stealthy School Stressor Traumatic brain injury effects can take longer to manifest and overcome in children, but SLPs can help identify and procure services for these students. School Matters
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School Matters  |   December 01, 2015
TBI: The Stealthy School Stressor
Author Notes
  • Angela Hein Ciccia, PhD, CCC-SLP, is an assistant professor in the Department of Psychological Sciences at Case Western Reserve University. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders, and editor of the SIG’s Perspectives publication. angela.ciccia@case.edu
    Angela Hein Ciccia, PhD, CCC-SLP, is an assistant professor in the Department of Psychological Sciences at Case Western Reserve University. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders, and editor of the SIG’s Perspectives publication. angela.ciccia@case.edu×
Article Information
School-Based Settings / Attention, Memory & Executive Functions / Traumatic Brain Injury / School Matters
School Matters   |   December 01, 2015
TBI: The Stealthy School Stressor
The ASHA Leader, December 2015, Vol. 20, 36-37. doi:10.1044/leader.SCM.20122015.36
The ASHA Leader, December 2015, Vol. 20, 36-37. doi:10.1044/leader.SCM.20122015.36
Did you know traumatic brain injury (TBI) causes more childhood disabilities and deaths than any other injury? In addition, the Centers for Disease Control and Prevention reports that children and adolescents experience the greatest number of TBI-related emergency room visits of any age group. TBI frequently goes unreported, however, because children with mild injuries often receive care at places other than emergency rooms—such as pediatricians’ offices. Occasionally they receive no formal care.
For those who go to the hospital, the school might get notified, but this communication usually occurs only for those with significant TBIs requiring a long hospital stay. Many children return to school without any coordination among their medical team, family and school.
Regardless of severity, TBI after-effects last longer in children—the brain’s plasticity is outweighed by continuing development that might yield issues years after the injury. In addition, the recovery pathway is different from that of adults, because it generally takes children longer to return to or approach pre-injury function.
Children’s time in medical care is often short for TBI—usually just an emergency room visit or brief hospital admission—but they often experience lingering challenges. They can suffer setbacks in numerous cognitive functions such as attention, information processing, learning, recall, impulse control and emotional regulation.
Increasing documentation on these longer-term effects prompted a movement to consider TBI a chronic condition. Although they receive different amounts and types of medical care, children with TBI return to school and continue in the education system through young adulthood. However, studies estimate that as many as 60 percent of these children with TBI don’t receive additional educational supports.
In her 2007 book, “Executive Function in Education,” Lynn Meltzer writes, “Academic success is now increasingly dependent on a student’s ability to plan their time, organize and prioritize information, distinguish main ideas from details, monitor their progress, and reflect on their work.”
A child with TBI finds all of these skills incredibly challenging, and for some of them, it’s the first time they ever struggled in school. In addition, families might not understand that a child needs extra support or know what types of help the school offers.
So what does this mean? Children dealing with long-term cognitive-communication effects of TBI attend our schools, regardless of whether or not the school knows about the injury.
These effects influence many facets of their education, including short-term performance at school, long-term academic potential and long-term functional outcome after high school graduation.

Children dealing with long-term cognitive-communication effects of TBI attend our schools, regardless of whether or not the school knows about the injury.

If school speech-language pathologists gets involved in assisting these students from the initial “return to learn” process, they can greatly influence outcomes. SLPs can also help implement an IEP, response to intervention or a 504 education plan.
School SLPs bring critical abilities to the team in several ways. You can:
  • Provide one-to-one intervention for ongoing cognitive-communication challenges.

  • Offer structured, evidenced-based cognitive-communication group treatment that supports carryover.

  • Monitor cognitive-communication skill development and the effect of ongoing cognitive-communication challenges for academic performance.

  • Provide education and training to school faculty and staff on long-term effects of TBI.

  • Build awareness that many children are at risk for TBI across activities—not just athletes playing sports.

Several comprehensive resources provide more details about identifying and treating students with TBI. Start by checking the Centers for Disease Control and Prevention’s Heads Up program and The Center on Brain Injury Research & Training. Both sites provide excellent information.
In addition, you can:
  • Contact the director of speech-language pathology services at your local hospitals and find out what protocols they follow when a child gets treated for TBI. They might also offer options for providing additional support as students return to school.

  • Identify and contact the coordinators for the concussion clinics in your area to find out about return-to-learn recommendations and ways your school can support these transitions.

  • Visit the Brain Injury Association of America to find your state group and familiarize yourself with available resources.

  • Shadow hospital or concussion-clinic SLPs to gain up-to-date, hands-on experience with different types and severity of TBIs.

  • Meet with the school nurse, physical education teacher and sports coaches in your school to review current policies for kids who experience TBI at school or during sports practices or games. Also, talk about ways to identify students who suffer injuries outside of school.

A school-based SLP can’t successfully support a student with TBI alone. Successful interventions require active involvement from the primary classroom teacher, physical education teacher, school psychologist, school nurse, before- and after-care programs, parents and caregivers, and coaches. School teams also should communicate with members of the child’s medical team, such as the pediatrician and/or neurologist. Supporting a child with TBI requires all these players to work together in that child’s best interests.
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December 2015
Volume 20, Issue 12