Tuesday, January 10, 2017

School outcomes with traumatic brain injury.

Prasad MR, Swank PR, Ewing-Cobbs L. Long-Term School Outcomes of Children and
Adolescents With Traumatic Brain Injury. J Head Trauma Rehabil. 2017
To better understand the impact of age at injury, severity of injury, and time since injury on long-term school outcomes of children with traumatic brain injury (TBI).
Four groups of children: complicated mild/moderate TBI (n = 23), severe TBI (n = 56), orthopedic injury (n = 35), and healthy controls (n = 42). Children with TBI were either 2 years postinjury or 6 years postinjury.
Cross-sectional design.
School records as well as parental ratings of functional academic skills and school competency.
Children with severe TBI had consistently high usage of school services and low school competency ratings than children with orthopedic injuries and healthy controls. In contrast, children with complicated-mild/moderate TBI were significantly more likely to receive school support services and have lower competence ratings at 6 years than at 2 years postinjury. Students injured at younger ages had lower functional academic skill ratings than those injured at older ages.
These findings highlight the increasing academic challenges faced over time by students with complicated-mild/moderate TBI and the vulnerability of younger children to poorer development of functional academic skills.

From the article:

The results of this cross-sectional study highlight the long-term educational challenges facing children with TBI. As predicted, we found that children with TBI have higher rates of school support services than students with orthopedic injuries and healthy comparison children. Students with severe TBI had high rates of educational support services, regardless of age at injury or time since injury. An unexpected finding was the disparity in the provision of educational services between students with complicated-mild/moderate and severe TBI. Children with complicated-mild/moderate TBI were less likely to receive educational services at 2 years postinjury than children with severe TBI; however, those assessed at an average of 6 years postinjury had comparable levels of educational services to students with severe TBI at the same time point. That is, the complicated-mild/moderate TBI group that was further from injury had much higher rates of school-based services than those who were 2 years postinjury. Data regarding school services mirror parental ratings of school competency and academic performance metrics such as grades and retention. Parental ratings of school competency were significantly related to time since injury for children with complicated-mild/moderate TBI; the cohort that was assessed at the later time point had lower competency than those assessed at 2 years postinjury.

For children with complicated-mild/moderate TBI, educational issues may be increasingly evident as they age and more demands are placed upon them. These findings are consistent with previous studies that have found that children with TBI are at high risk for falling further behind their peers as they age. The lower rates of educational support services for children with complicated-mild/moderate TBI at 2 years postinjury raises concerns about underidentification of educational needs for students with less severe TBI.

Based on previous research indicating younger children are more vulnerable to the deleterious effects of TBI, we predicted that children injured at younger ages would have greater educational services than children injured at older ages. We found that younger age at injury was associated with placement in a self-contained classroom, which is an educational setting for children with significant disabilities who cannot be appropriately educated in a less restrictive regular classroom setting. Younger age at injury was associated with lower functional academic skills based on parental ratings of basic reading, writing, and math skills.

Previous studies have found generally favorable recovery of basic academic skills on standardized tests but poor school outcomes, such as grade retention and poor grades. Although academic performance may decline over time, de novo placements in special education occur infrequently after the first year postinjury. Therefore, inadequate monitoring of children's academic progress during the first several years after injury represents a barrier to accessing appropriate supports. The longer the interval between the injury and identification of academic problems, the less likely that educational and medical providers will connect the TBI to the academic difficulties and initiate services to which the child may be eligible under federal statutes.

In studies, such as this one and those by Taylor et al, Glang et al, and Rivara et al, the high rates of school support services for students with TBI are contrary to the view that TBI is a low-incidence disability in school settings  Participants in this study were enrolled in longitudinal studies of outcome from TBI in children. As part of their participation in those studies, the parents received interval reports about their child's functioning and recommendations for services or accommodations at school. These reports may have aided parents in identifying their child's educational needs and provided a means by which they could advocate for educational services. Therefore, it is likely that this study may overestimate educational services typically provided to students with TBI. Most families do not have the benefit of ongoing contact with healthcare professionals who are knowledgeable about TBI. Schools rely primarily on parental information regarding TBI and often do not receive information from healthcare providers about the long-term effects of TBI on the child's cognitive, social, and academic functioning. Most parents are not well informed about the possible long-term sequelae of TBI and as such, do not advocate for services for their children until the child experiences academic failure or social rejection. Educating parents about the long-term impairments experienced by children with TBI often falls to healthcare professionals, such as pediatricians. The low rates of special education services for students with TBI relative to the fairly high incidence  suggest that healthcare providers may be unfamiliar with the long-term sequelae of TBI and the educational rights of students with TBI.

Courtesy of:  https://www.mdlinx.com/neurology/medical-news-article/2017/01/09/children-school-outcomes-special-education-traumatic/7004219/?category=latest&page_id=6

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