Information for Counselors and parents on how to help students who have TBI (traumatic brain injury) when they return to school after being home or hospitalized. Many supports are needed for students and they may require an IEP or 504 to put accommodations or modifications into place. A special education advocate might be helpful if the school is difficult about providing support. Find out more information at https://www.specialmomadvocate.com/returning-school-tbi/

1. Returning to School After TBI
What School Counselors Need to Know
presented by Bonnie Landau

2. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
What is a TBI?
 TBI = Traumatic Brain Injury
 Insult to the brain that causes damage
 Can have internal or external cause
ABI: acquired brain injury
TBI: traumatic brain injury
MTBI: mild traumatic brain injury (concussion)
 No two injuries are alike

3. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Statistics about TBI
 Such a severe problem CDC created Heads Up program
 Leading cause of death and disability in children 0-18
 Incidence
 475,000 ER visits for child-related TBIs each year
 1 in 500 children 0-18 will require hospitalization for a TBI
 Twice as likely for boys than girls
 75% of TBIs are mild
 1/3 of TBI survivors will suffer more than one TBI
 Child abuse causes 60% of head injuries for children 0-3
 Long-term effects
 26% have long-term issues from the TBI
 mTBI symptoms most often attributed to something else.
 Children diagnosed with ADHD 1.8x more likely to have history of
concussion
 30% of students with vision impairment have history of TBI
Source: CDC http://www.cdc.gov/TraumaticBrainInjury/ and http://www.headinjuryctr-stl.org/statistics.html

4. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Statistics about Concussions
 At least 10% of all HS athletes will suffer concussions
 71% male, 29% female
 Bicycling is greatest risk
 More kids ride bikes than play football
 52% because kids don’t wear helmets!!
 Football is 2nd greatest
 1 player in every game will have some form of concussion
 4-20% of HS football players per season sustain a concussion
 11-33% of HS football players will have more than 1 concussion in the same
season
 50% of HS football players will have at least one concussion over 4 years.
 Second or more concussions – symptoms twice as long.
 Rate of concussions has doubled in last 10 years
Source: http://www.momsteam.com/health-safety/concussion-rates-high-school-sports

5. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Most Frequent Cause by Age
Age (years) 0-2 2-4 4-7 8-13 14-18
Abuse/neglect X X
Falls X X
Playground accidents X
Pedestrian hit by a car X
Bike rider hit by a car X X
Sports X X
Car Accidents X

6. How TBI Effects School
What School Counselors Need to Know

7. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Cognitive Effects of TBI
 Attention
 Executive Function
 Memory difficulties
 Processing difficulties
 Learning disabilities
 Confusion

8. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Physical Effects of TBI
 Headaches
 Nausea and/or vomiting
 Fatigue & Reduced Stamina
 Balance/coordination
 Vision problems
 Eye-tracking, convergence, fixation
 Photophobia
 Sleep disturbance
 Auditory issues
 Auditory processing disorder (45%)
 Hyperacusis
 Tinnitus
 Seizure disorder

9. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Personality Changes from TBI – Big One!
 Impulsiveness
 Short-tempered
 Easily frustrated
 Social dis-inhibition
 Irritability
 Aggression
 Anxiety

10. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Mental illness 4x more likely
 PTSD (33%)
 Depressive disorder (40-50%)
 Generalized Anxiety Disorder
 Increases risk of post-concussive syndrome
 ODD (oppositional defiance disorder)
 OCD (obsessive compulsive disorder)
 Bipolar disorder
 Substance abuse
 Increased risk of suicide

11. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Social Effects of TBI
 Communication difficulties
 Inappropriate actions
 Easily misunderstands
 Easily misled
 Easily frustrated

12. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Developmental Difficulties
 Brain injury may not be evident until child
reaches an age where more difficult tasks
are expected.
 Especially true for children injured <4

13. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Christopher Nowinski, athlete
 Post-concussive syndrome

14. Social Challenges After TBI
Biggest issue for TBI survivors

15. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
How TBI Effects Social Skills
 Social issues much greater than cognitive
issues
 Depression issues exacerbate social skills
problems
 Communication skills severely effected
 TBI survivors have a shrinking social
support group – they need MORE support!

16. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Communication Difficulties
 Speech problems
 Social cue misinterpretation
 Interpersonal difficulties
 Inappropriate verbalization
 Problem solving difficulties
 Lack of empathy

17. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Losing Old Friends
 92% of TBI survivors have a change in
friendship circles
 Personality & communication changes can cause
old friends to leave
 Old Friends may not understand changes in
behavior
 Old friends may be embarrassed to be seen with
TBI survivor

18. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Self-awareness therapy helps
 Come up with a plan for a situation
 Implement the plan
 Review result and provide feedback
 Problem solve new options
 Re-implement new option and evaluate
outcome

19. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Dr. Mariann Young, psychologist
 How to deal with friends falling away after TBI

20. After the Injury
What Schools Should Do to Help

21. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Transition Meetings
 Assign a resource coordinator for the
student
 Pre-meeting to get update on medical
condition
 Assessments and 504/IEP meeting
 Plan review every term
 Remember that entire family is in extreme
emotional distress

22. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Assessment
 Evaluate current function
 Develop profile of strengths and needs
 Develop intervention plan
 Services
 Accommodations
 Behavioral support
 Response to Intervention Protocol (RTI)
 Educate student, parent/guardian and
teachers about plan

23. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Educate Staff
 Understanding TBI
 85% of teachers have had no TBI training
 Parents become source of information, listen to
them
 Understand which behaviors can be caused by TBI
 Help parents understand what services or
accommodations are available
 Do not call them truant
Source: Oregon Dept. of Education

24. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Emotional Support
 Check in with student regularly
 Consider regular meetings to review
progress or issues
 Note patterns in problems that come up
 Work together to find solutions

25. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Britt Payton, athlete
 2nd impact syndrome

26. What Parents Want You To Know
For all people who work with kids with TBI

27. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
It is an invisible disability
 Don’t assume all is okay because the child
looks “normal”
 Child is mentally different even if physically
the same
 Child struggles with their new self and
mourns loss of old self

28. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Provide strong emotional support
 Child is emotionally fragile
 Their life has been turned upside down
 Many changes will come as they return to school
 Social environment change is huge
 Consider intervention for old friends – HUGE!
 Provide ongoing support group for TBI survivor
 Create peer support network
 Help child learn coping strategies for new
difficulties (like sensory overload)
 Help the child learn to self-advocate

29. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Create a Quiet Space
 A place the child can go when over
stimulated
 Quiet room
 Dim lighting
 Few if any people
 Permission to use whenever necessary

30. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
Listen to the parents
 They are probably TBI experts
 They know their child best
 They talk with other parents and know
about positive solutions
 They are going through their own inner
turmoil and are easily agitated
 Offer the parents resources if you know of
any

31. Thank you!
Bonnie Landau Weed

32. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU
References
 Anderson, V., Beauchamp, M.H., Yeates, K.O., Crossley, L., Hearps, S., Catroppa, C (2013).
Social Competence at 6 Months Following Childhood Traumatic Brain Injury. Journal of the
International Neuropsychological Society. 19(5), 539-550. doi:
10.1017/S1355617712001543.
 Bay, E. H., Blow, A. J., & Yan, X. (2012). Interpersonal relatedness and psychological
functioning following traumatic brain injury: Implications for marital and family therapists.
Journal of Marital and Family Therapy, 38 (3), 556-567.
 Brain Injury Association of America (2014). Mild Brain Injury. Retrieved from
http://www.biausa.org/mild-brain-injury.htm
 Centers for Disease Control (2014). Traumatic Brain Injury. Retrieved from
http://www.cdc.gov/concussion/
 The Center for Head Injury Services (2014). Brain Injury Statistics. Retrieved from
http://www.headinjuryctr-stl.org/statistics.html
 Henderson, D. A., & Thompson, C. L. (2011). Counseling With Children With Disabilities. In
L. Schreiber-Ganster (Ed.), Counseling Children (pp.693-716). Belmont, CA: Brooks/Cole
 National Institute of Neurological Disorders and Stroke (2014). Traumatic brain injury: Hope
through research. Retrieved from http://www.ninds.nih.gov/disorders/tbi/tbi.htm