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Children with brain injuries can suffer additional trauma in the classroom from a lack of understanding. A teacher who knows what to look for can make all the difference.

Acquired Brain Injury in the Classroom Promoting Awareness

By Sheila Bennett, Dawn Good and Dawn Zinga

Eric was an enthusiastic student who worked to his full potential. During the December holidays, he and his mother were in a motor vehicle collision on Highway 401 while returning from a day of skiing. Once back in school, Eric was irritable, distracted, refused to participate in group activities and his academic performance changed noticeably for the worse.

His Grade 4 teacher felt that Eric was affected by his mother's remaining in hospital throughout the remainder of the term.

In Grade 5, Eric's teacher told the family that Eric was unmotivated and refused to apply himself. They agreed that the stress of the accident and the trauma of his mother's near death had emotionally scarred Eric and affected his behaviour. They agreed to get him some counselling and to address his behavioural dysfunction.

In fact, Eric is one of an estimated 27,000 students in Ontario with an acquired brain injury (ABI). Some are diagnosed by the medical community; others are never diagnosed. In the classroom, such students are mistakenly seen as behavioural and motivational problems.

Teachers were never told that Eric had sustained a brain injury in a car accident. Because he suffered a "closed head" injury and he did not present any overt physical disfigurement or disability - he could walk and talk - Eric's teachers had no way of recognizing the signs on their own.

Often Undiagnosed
It is important for teachers to be aware that an ABI is a medical diagnosis made by a trained medical professional. Often the diagnosis of ABI is made available to teachers, but other times it is not. Many children may be undiagnosed as ABI. Bearing this in mind, teachers' observations and involvement with the student can provide vital information and support systems to promote the child's adjustment and academic success in an educational setting.

How can educators be alerted to the possibility of acquired brain injury in the classroom? Children with ABI may experience cognitive problems such as deficiencies in memory, attention, concentration or problems with language or overall intellectual functioning, behavioural and social problems such as acting out, impulsiveness, inattention or irritability, and/or physical neurological problems such as dysthymia, slowed motor skills and impaired gait or balance, depending on the location and the extent of the injury.

All of these symptoms can have a severe impact in the classroom. The emotional scars cannot be ignored either. Isolation, rejection, failure, inability to accomplish and inability to do what they used to do all can take their toll on the student as well.

The effects of ABI can change as a child develops. An injury that occurred when the child was in Grade 1 may seem to have little impact on the child's behaviour and academic performance. However, that same child may display difficulties in Grade 6 when she develops higher level cognitive processing abilities such as abstract thought and problem solving.

Children with ABI are often more distracted and become frustrated in the classroom which frequently results in acting out. If a child demonstrates a change in behaviour and starts having trouble with tasks they showed evidence of handling well previously, the root of the problem may be an acquired brain injury.

How to Help
What can educators do to assist students with ABI in the classroom? Students with ABI benefit from consistent routines and clear expectations. They may need assistance with organization and staying on task. These students often tire cognitively as well as physically and become frustrated. Minimizing distractions and allowing students opportunities to rest as needed helps them cope more effectively and may minimize acting out.

Students often need more time to complete assignments and tests. Information processing difficulties and memory impairment make it difficult for students with ABI to follow complex directions and to consolidate new skills.

Educators can address these difficulties by giving directions one step at a time or by providing written directions. Offering a wide range of opportunities to practice new skills helps with consolidation. It is also important to ensure that students have learned a new skill by working through examples with them before providing opportunities to practice the new skill individually. With the introduction of some of these simple procedures, both classroom performance and the child's future can dramatically improve.

If you have a student with ABI in your classroom or would like further information, you can contact the Ontario Brain Injury Association at 1-800-263-5404 or the Educating Educators about Acquired Brain Injury project at 905-688-5550, ext. 3556. Over the next two years, this project will be providing resource binders for educators, in-service training sessions and a resource web site.

Dawn Good is an associate professor of psychology at Brock University and the director of Brock's neuroscience program. Sheila Bennett is an assistant professor at the Faculty of Education at Brock University and a veteran classroom teacher specializing in research and teaching on special needs. Dawn Zinga is a PhD candidate at the Ontario Institute for Studies in Education of the University of Toronto.