This month's question and answer is a double hitter! See below

The theme for this month is Traumatic Brain Injury(TBI). I have received two letters about behavior in children who have experienced a TBI. I am grouping them together although the first thing that should be said about TBI is that it is not a discrete diagnosis. The injury can be to any part of the brain, of a non-specified degree of severity, occur at any age, and have a wide range of anomalies. Sometimes, the term “acquired brain injury” is used to include open- or closed-head injuries (TBI) and non traumatic brain injuries that are the results of strokes, infections, or noxious products taken into the body.

It is a unique disorder in the special education arena because the children who experience a TBI were, for the most part, previously typical in their development, and the change occurs suddenly. Thus, the emotional impact of a TBI, both on the child and his or her family, is a part of the picture. Most children (and adults) have some behavior problems and cognitive changes are also frequent. Attention, memory, and judgment are often affected. Just as there are no “typical” TBIs, there is no typical intervention.

Question 1:

I have a son who is 22 years old. He was in accident in 1996 after which he was diagnosed with TBI. He is on a great deal of medication for depression, seizures, compulsive behavior. His behavior is completely out of control. His IQ is around 14 yrs. He is now taking money, forging my checks, making long distance calls =$2200.00, thought the calls were free. He is addicted to POT! Its like he will do what ever just to feel accepted, and that has been a bad influence. His physician. prescribed all meds, we meet for 1 on 1, but he seems to be getting worse. But with him being of legal age I can't just take him to hospital in which he has spent a lot of time for psychological problems. He had the medical testing early, the psychological again last year. Do you think a repeat in medical examination may be help full, as in MRI etc.? I do not know where to start. Feeling very stressed, tired, helpless. He needs guidance on how to survive and interact with society in the right way. Any advice would be greatly appreciated.

Thank You for taking your time to read this,

Alisa R. Mullis

I have an 11 yr. old child who suffered from TBI on the right side of the brain 5 years ago. Academically, he's very good in math and science but he has problems in reading comprehension and writing. He also has some problems with social skills such as not easy to make friends, preferring to be alone, being passive in class and not initiating things. He also forgets things such as not turning in the homework that he already completes. We have an educational specialist referred by one psychologist coming home to help him with writing for about 1 year, but I don't see any improvement. Where can we get information to look for educational therapists, who can we contact for help and what should we do to help him improving in social skills, in writing and reading comprehension as well as his forgetfulness and his withdrawn behavior at school?

Thank you,

V. Nguyen

Answer 1:

Dear Ms. Mullis,

I totally understand your feeling of not knowing where to start. And it is very common for young people who experience a TBI to be immature and to have problems with self esteem but knowing that doesn’t make it any easier for their families or themselves.

Your son clearly needs help, but the medical needs of individuals with TBI require specialists, and you are looking for a program that has a team approach to look at the psychological, medical and functional needs that your son has. Your son might benefit from medication for depression but because of his injury, a psychiatrist with experience in treating people with TBI will know which medications are safe and effective for him.

I don’t know where you live but there are centers in various parts of the country that specialize in treating people with TBIs. In Northern California, there is the Santa Clara Valley Medical Center. If you are not in this area, I am sure that they can direct you to a center nearer you. Try them at 408 885-5000 or http://www.sccgov.org/portal/site/vmc/
www.biausa.org (Brain Injury Association) 1800 444-6443 see TBI Challenge (v.5 #4 2001) by Carolyn Roccio about finding a suitable counselor in the community mental health.

Also, check out these web sites:

http://main.uab.edu/tbi/show.asp?durki=50770 Managing Behavioral Problems after a Traumatic Brain Injury by Tom Novak and the site http://main.uab.edu/tbi has many other resources

http://www.nichcy.org/pubs/factshe/fs18txt.htm#whatis – clear fact sheet

http://www.tbiguide.com/ TBI Survival Guide by Dr. Glen Johnson – a free and informative book on-line

http://www.neuro.pmr.vcu.edu/material/Article%20Reprints/Article%20reprints.htm Free articles dealing with psychological issues for people with TBI

Dear Ms. Nguyen,

Thanks for your letter. Some of the behaviors and abilities you describe are typical of children who have experienced a TBI. ( Take a look at this article:

http://www.brainevaluation.com/articles/traumaticchildren.html Traumatic Brain Injury in Children and Adolescents). That means that there are strategies that can help him, that some of these things may improve over time, and also that everyone must recognize that some of these things are going to remain challenging. I think hiring an Educational Therapist is an option, and that some of his difficulties can be addressed by his special education IEP team.

It’s hard to offer blanket interventions for big areas such as social skills or reading comprehension with so little information. I would suggest that for his forgetfulness that you and his school team use schedules and check-off sheets.

1. Provide an individual schedule of his day that he can keep with him at all times. Teaching him to use and follow a written schedule may be a life long accommodation. His schedule should include the written words of each activity in his day, including break times between classes. He can check off each class or activity as it is completed.
   
2. Use “within activity” schedules (or embedded schedules) to help your son complete the work assigned to him independently. Within each activity listed on his daily schedule, write an activity checklist that outlines the specific assignments. For example, when it is time for math on his schedule, his checklist would list such things as a page number and the problems assigned as well as how much time he has to complete the work. Teaching him to use these embedded schedules will help reduce the times he needs to be reminded what to do next. It will also remove the “I forgot” excuse!

re: an Educational Therapist; there are various levels. You want one who meets the qualifications of Board Certified. Beware : There are people who use the title, but lack the training. To locate one, complete the form available at www.aetonline.org (under parents) and the association will send you up to 3 names of certified Educational Therapists in your area.