Under-Identification of Students with Long Term Disability from Moderate to Severe TBI: Analysis of Causes and Potential Remedies
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Published:
Nov 19, 2019
Keywords:
traumatic brain injury, learning difficulties, special education identification categories
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Abstract
Traumatic Brain Injury (TBI) is a special education eligibility category under the Individuals with Disabilities Education Act (IDEA). Unlike other special education categories (e.g., autism, specific learning disabilities), relatively few students with TBI are identified for special education nationwide compared to the known prevalence of TBI. Discrepanies between TBI hospitalization data, estimates of long-term disability due to TBI, and the number of students identified under the TBI category were analyzed. Only 33% of students projected to have moderate to severe TBI were represented in state child counts using the IDEA TBI category. Possible explanations for these discrepancies were explored, including that students with TBI are not referred for special education services, students are served under other special education categories, communications between medical systems-school systems are limited, and that students may not manifest difficulty until years after injury. Potential solutions to improve TBI identification for special education services are presented.
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How to Cite
Nagele, D. A., Hooper, S. R., Hildebrant, K., McCart, M., Dettmer, J., & Glang, A. (2019). Under-Identification of Students with Long Term Disability from Moderate to Severe TBI:: Analysis of Causes and Potential Remedies. Research, Advocacy, and Practice for Complex and Chronic Conditions, 38(1), 10–25. https://doi.org/10.14434/pders.v38i1.26850
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Implications and Strategies for Practitioners
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References
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Rivara, F. P., Vavilala, M. S., & Durbin, D. (2012). Persistence of disability 24 to 36 months after pediatric traumatic brain injury: A cohort study. Journal of Neurotrauma, 29(15), 2499-2504.
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Schwab KA, Ivins B, Cramer G, Johnson, W. Sluss-Tiller, M., Kiley, K., Lux, W. Warden, D. . Screening for traumatic brain injury in troops returning from deployment in Afghanistan and Iraq: initial investigation of the usefulness of a short screening tool for traumatic brain injury. Journal of Head Trauma Rehabilitation, 22(6), 377-389.
Taylor, C.A., Bell, J.M., Breiding, M.J., & Xu, L. (2017). Traumatic brain injury–related emergency department visits, hospitalizations, and deaths — United States, 2007 and 2013. MMWR Surveillance Summary, 66(SS-9), 1–16. Retrieved from http://dx.doi.org/10.15585/mmwr.ss6609a1
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Todis, B., Author, & Fabry, M. A. (1997). Family-school-child: A qualitative study of the school experiences of students with ABI. in Students with Acquired Brain Injury: The School’s Response (pp 33-72). Baltimore, MD: Paul H. Brookes.
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U.S. Department of Education. (2013). IDEA Part B Child Count and Educational Environments. Retrieved from https://www2.ed.gov/programs/osepidea/618-data/state-level-data-files/index.html
Yeates, K.O., Armstrong, K., & Janusz, J., (2005). Long-term attention problems in children with traumatic brain injury. Journal of American Academy Children Adolescent Psychiatry, 44(6), 574-584.
Zaloshnja, E., Miller, T., Langlois, J. A., & Selassie, A. W. (2008). Prevalence of long‐term disability from traumatic brain injury in the civilian population of the United States, 2005.
Journal of Head Trauma Rehabilitation, 23(6), 394-400.
Barlow, K. M., Crawford, S., Stevenson, A., Sandhu, S. S., Belanger, F., & Dewey, D. (2010). Epidemiology of post-concussion syndrome in pediatric mild traumatic brain injury. Pediatrics, 126(2), e374-e381. www.pediatrics.org/cgi/doi/10.1542/peds.2009-0925
Beauchamp, M., Catroppa, C., Godfrey, C., Morse S., Rosenfeld, J.V., & Anderson, V. (2011). Selective changes in executive functioning ten years after severe childhood traumatic brain injury. Developmental Neuropsychology, 36(5), 578-595.
Bogner, J.A., & Corrigan, J.D. (2009). Reliability and validity of the OSU TBI identification method with prisoners. Journal of Head Trauma Rehabilitation, 24(6), 279–291.
Cantor, J.B., Gordon, W.A., Schwartz, M.E., Charatz, H.J., Ashman, T.A., & Abramowitz, S. (2004). Child and parent responses to a brain injury screening questionnaire. Archives of Physical Medicine & Rehabilitation, 85(4 Suppl 2), S54-60.
Davies, S. (2016). School-based traumatic brain injury and concussion management program. Psychology in the Schools, 53(6), 567-582.
Author, Daunhauer, L., Detmar-Hanna, D., & Sample, P.L. (2007). Putting brain injury on the radar: exploratory reliability and validity analyses of the screening tool for identification of acquired brain in- jury in school-aged children. Journal of Head Trauma Rehabilitation. 22(6), 339–349.
Author, Ettel, D., Author, & McAvoy, K., (2014). Building statewide infrastructure for
effective educational services for students with TBI: Promising practices and recommendations. Journal of Head Trauma Rehabilitation, 29(3), 224–232.
Ewing-Cobbs, L., Prasad, M. R., Kramer, L., Cox Jr, C.S., Baumgartner, J., Fletcher, S.,…Swank, P. (2006). Late intellectual and academic outcomes following traumatic brain injury sustained during early childhood. Journal of Neurosurgery: Pediatrics, 105(4), 287-296.
Forness, S., Freeman, S., Paparella, T., Kauffman, J. & Walker, H. (2012). Special education implications of poinet and cumulative prevalence for children with emotional or behavioral disorders. Journal of Emotional and Behavioral Disorders, 20(1), 4-18.
Gerrard-Morris, A., Taylor, H.G., & Yeates, K.O. (2010). Cognitive development after traumatic brain injury in young children. Journal of the International Neuropsychological Society, 16(1), 157-168.
Author, Todis, B., Sublette, P., Eagan-Brown, B., & Vaccaro, M. (2010). Professional development in TBI for educators: The importance of context. Journal of Head Trauma Rehabilitation., 25(6), 426–432.
Author, Ettel, D., & Todis, B. (2015). Services and supports for students with traumatic brain injury: Survey of state educational agencies. Exceptionality, 23(4), 211-224.
Greene, N. H., Kernic, M. A., Vavilala, M. S., & Rivara, F. P. (2014). Variation in pediatric traumatic brain injury outcomes in the United States. Archives of Physical Medicine and Rehabilitation, 95(6), 1148-1155.
Hawley, C. A. (2004). Behaviour and school performance after brain injury. Brain Injury, 18(7), 645–659. https://doi.org/10.1080/02699050310001646189
Individuals with Disabilities Education Act of 2004, (IDEA) Pub. L. 101-476, Section 300.7.
Iverson GL, Langlois JA, McCrea MA, Kelly JP. Challenges associated with postdeployment screening for mild traumatic brain injury in military personnel. Clinical Neuropsychology. 2009;23(8):1299–1314.
Kurowski, B.G., Taylor, H.G., Yeates, K.O., Walz, N.C., Stancin, T., & Wade, S.L. (2011). Caregiver ratings of long-term executive dysfunction and attention problems after early childhood traumatic brain injury: Family functioning is important, Archives of PM&R, 3(9), 836-845.
Li, L., & Liu, J. (2013). The effect of pediatric traumatic brain injury on behavioral outcomes: Systematic review. Developmental Medicine & Child Neurology, 55(1), 37–45.
Limond, J., Dorris, L., & McMillan, T. M. (2009). Quality of life in children with acquired brain injury: Parent perspectives 1–5 years after injury. Brain Injury, 23(7-8), 617–622.
Massachusetts Department of Elementary and Special Education, 2018. Retrieved from http://www.doe.mass.edu/sped/links/brain.html
Moser, R. S., Schatz, P., & Jordan, B. D. (2005). Prolonged effects of concussion in high school athletes. Neurosurgery, 57(2), 300–306.
Myers RK; Eagan-Brown BL; Conway AT; Author; Vaccaro MJ; Kendi S; Zonfrillo MR. (2018) Examining a statewide educational consulting program for pediatric brain injury. Clinical Pediatrics; 57(6):645-655.
National Center for Injury Prevention and Control (2003). Report to congress on mild traumatic brain injury in the United States: Steps to prevent a serious public health problem. Atlanta, GA: Centers for Disease Control and Prevention.
Ohio Brain Injury Program & Brain Injury Advisory Committee (2018). 2017 Biennial Report on the Incidence of Traumatic Brain Injury in Ohio, Ohio State University, Wexner Medical Center, page 16.
Prasad, M. R., Swank, P. R., & Ewing-Cobbs, L. (2017). Long-term school outcomes of children and adolescents with traumatic brain injury. Journal of Head Trauma Rehabilitation, 32(1), E24-E32.
Rivara, F. P., Koepsell, T. D., & Wang, J. (2012). Incidence of disability among children 12 months after traumatic brain injury. American Journal of Public Health, 102(11), 2074-2079.
Rivara, F. P., Vavilala, M. S., & Durbin, D. (2012). Persistence of disability 24 to 36 months after pediatric traumatic brain injury: A cohort study. Journal of Neurotrauma, 29(15), 2499-2504.
Ryan, N. P., Catroppa, C., Godfrey, C., Noble-Haeusslein, L. J., Shultz, S.R., O’Brein, T.j., … Semple, B.D. (2016). Social dysfunction after pediatric traumatic brain injury: A translational perspective. Neurosci Biobehav Rev, 64, 196–214. https://doi.org/10.1016/j.neubiorev.2016.02.020
Schwab KA, Ivins B, Cramer G, Johnson, W. Sluss-Tiller, M., Kiley, K., Lux, W. Warden, D. . Screening for traumatic brain injury in troops returning from deployment in Afghanistan and Iraq: initial investigation of the usefulness of a short screening tool for traumatic brain injury. Journal of Head Trauma Rehabilitation, 22(6), 377-389.
Taylor, C.A., Bell, J.M., Breiding, M.J., & Xu, L. (2017). Traumatic brain injury–related emergency department visits, hospitalizations, and deaths — United States, 2007 and 2013. MMWR Surveillance Summary, 66(SS-9), 1–16. Retrieved from http://dx.doi.org/10.15585/mmwr.ss6609a1
Todis, B., Author, & Author. (2018). Hospital to school transition following Traumatic Brain Injury: A qualitative longitudinal study. NeuroRehabilitation, 42, 3, 269-276.
Todis, B., & Author. (2008). Redefining success: Results of a qualitative study of postsecondary transition outcomes for youth with traumatic brain injury. Journal of Head Trauma Rehabilitation, 23(4), 252-263.
Todis, B., Author, & Fabry, M. A. (1997). Family-school-child: A qualitative study of the school experiences of students with ABI. in Students with Acquired Brain Injury: The School’s Response (pp 33-72). Baltimore, MD: Paul H. Brookes.
U.S. Census Bureau, American Fact Finder. (2013). Population estimates. Retrieved from http://factfinder.census.gov
U.S. Department of Education. (2013). IDEA Part B Child Count and Educational Environments. Retrieved from https://www2.ed.gov/programs/osepidea/618-data/state-level-data-files/index.html
Yeates, K.O., Armstrong, K., & Janusz, J., (2005). Long-term attention problems in children with traumatic brain injury. Journal of American Academy Children Adolescent Psychiatry, 44(6), 574-584.
Zaloshnja, E., Miller, T., Langlois, J. A., & Selassie, A. W. (2008). Prevalence of long‐term disability from traumatic brain injury in the civilian population of the United States, 2005.
Journal of Head Trauma Rehabilitation, 23(6), 394-400.