Julie M. Bowen

Childhood traumatic brain injury: neuropsychological status at the time of hospital discharge

The present study examined the status at the time of hospital discharge of 22 children who had sustained moderate to severe closed head injuries. Despite an average length of stay of 46 days, on average the children performed significantly below normal on cognitive, memory, and motor tests. The children who did the worst were those who sustained their injuries riding in a vehicle, as opposed to being hit by a vehicle while walking or riding a bicycle. No reliable associations were found between neuroimaging data and cognitive measures; however, children whose scans showed more diffuse severe injury (e.g. white matter hemorrhages) performed more poorly than those who did not. Of further importance were detailed morphometric analyses of tissue quantity and ventricular volume that showed significantly increased ventricle to brain ratios (VBR) over a 3 to 4 week period following injury.

What is a Good Intervention

What makes a good school-based intervention for students with behavioral, academic, or social difficulties? First, it is important to understand what an intervention is and what it is not. For the purposes of this book, interventions are not counseling or non-directive psychotherapies. There are places for these approaches in a school setting, however, their overall effectiveness for behavior problems, social skills deficits, and academic problems are less robust (Stage & Quiroz, 1997; Weiss, Catron, Harris, & Phung, 1999; Weisz, Weiss, Alicke, & Klotz, 1987). Our definition of an intervention is: the systematic application of research-validated procedures to change behaviors through either teaching new skills or through the manipulation of antecedents and consequences. It is important that any procedure implemented with students has been research-validated and published in a peer reviewed professional journal. This process insures that the intervention has been implemented with integrity and its’ effectiveness has been demonstrated using an acceptable research design and outcome measures. Most of the interventions reviewed in this book are either single subject or group research designs. Having the procedure “peer reviewed”, means that objective experts in the field have reviewed the intervention research study and found its’ methodology to be acceptable and the procedure effective in changing behaviors.

Students with Behavior Problems

This book is about interventions for students with behavior problems—problems that are pervasive and present a considerable challenge to educators in preschool, elementary, and secondary classrooms across the United States. It is not necessary for educators to have extensive training in psychology or psychiatry to identify and experience the impact of a student with a behavior disorder in their classrooms. In fact, educators are often the first to recognize and seek assistance for children with significant behavior problems (which is typically a phone call home or referral to the school psychologist). These students usually stand out in class after the first few days of school! Acquiring a knowledge base and understanding of the causes and development of behavioral problems will assist educators and parents in intervening more effectively with these difficult students.

Classroom Basics—Preventing Problems Before They Begin

There are some important differences between classrooms characterized by productive learning environments and high levels of student engagement and classrooms with frequent disruptions and chaotic transitions, where teachers spend an excessive amount of time responding to unproductive student behavior. The difference is due to Classroom Basics—those teacher behaviors that lead directly to well-managed classrooms. Classroom Basics are methods of proactive classroom management that emphasize prevention of behavior problems by planning for and encouraging appropriate behavior, maintaining high levels of student participation, and reducing opportunities for student disruptions. Research evidence gathered over the past few decades suggests that successful teaching is not just responding to problems after they occur, but proactive planning for appropriate behavior— preventing problems before they begin (Gettinger, 1988). Using Classroom Basics will not prevent every problem from occurring, nor will it result in every child becoming a model student. Following Classroom Basics will, however, minimize occurrences of discipline problems, and help create a positive learning environment.

Interventions for Academic Problems

The interventions in this chapter are designed to enhance academic skills in the areas of reading, written language, spelling, math, and organization skills. Many students with behavior problems also exhibit low academic skills and poor academic performance—either because their behavior has interfered with the learning of new skills, because they have learning disabilities, or both. Without basic academic skills, these students are destined for failure. Early identification of students who are at-risk for academic difficulties and behavioral problems and providing strategic intervention to address these problems is particularly important in helping them to achieve a successful school outcome.

Interventions for Social Skills

Social development is inextricably linked to a student’s school success and his or her long-term social acceptance and adjustment. While most children develop social skills by observing the real-life modeling of parents, siblings, extended family, and teachers, as well as daily interactions with their peers; children with behavioral problems often have not developed or do not satisfactorily demonstrate these important skills. In fact, inability to establish and maintain satisfactory peer and teacher relationships is a key defining characteristic of behaviorally disordered children—unfortunately resulting in profound implications throughout their lives. Many students with attention problems, oppositional or defiant behaviors, aggressive behaviors, or those who annoy and bother other students are disliked or rejected by their peers. In addition, students with learning disabilities, autistic disorders, or internalizing disorders are sometimes teased by peers and may have significant difficulties making and keeping friends.

Interventions for Behavior Problems

Several effective techniques are presented in this chapter that educators can use with an individual student, with a small group of students, or with an entire classroom. While many students learn and flourish in a well-structured classroom and do not require specific or intensive intervention to behave appropriately, students with behavior problems and/or emotional disabilities will require more support and may require more extrinsic motivation to develop appropriate academic, social, and compliant behaviors. The goal of these interventions is not simply behavior management or using rewards to control behavior, rather it is to help students improve behavior and develop internal motivation to succeed. Based on the definition of the term intervention described in Chapter 2, the research-validated procedures presented in this chapter include methods of teaching new skills, and/or manipulation of antecedents and consequences. They include a range of effective or combination of effective positive interventions such as group contingencies, self-management, differential reinforcement, token economies, peer tutoring, as well as some mild reductive techniques such as response-cost and time-out from reinforcement. A complete list of behavioral intervention terms, definitions, examples, and cautions for each are provided in Appendix B. When selecting an intervention, it is always important to try the most direct or simple approach first. When classroom disruption is the result of only one or two student’s misbehavior, the most appropriate intervention may be an individual intervention. When several students are misbehaving, class-wide interventions or group contingencies may be more effective. Most of the following interventions can be adapted for use with an individual student, a few students, or with the entire class.

School-wide Positive Behavioral Intervention and Support

School-based interventions may be much more effective when incorporated as part of a milieu in which the majority of children and adults within an entire school are working together to create a proactive, positive environment, while reducing the opportunities and conditions that trigger behavior problems. A program in which the school responds proactively and consistently to provide effective behavioral support to all teachers and students is referred to as a school-wide intervention, or positive behavior intervention and support program. A school-wide intervention plan should be an essential component of the primary goal of schooling—to ensure all students achieve academic success and receive instruction in a school environment conducive to learning.