Question
Why is there a significant undercounting of children with moderate to severe traumatic brain injuries (TBI) in schools, and what factors contribute to this discrepancy?
Answer
The significant undercounting of children with moderate to severe traumatic brain injuries (TBI) in schools can be attributed to several factors. Primarily, standardized language and cognitive testing often fails to capture the deficits experienced by these children. Although they may perform adequately on developmental language tests or neuropsychological assessments in controlled environments, these tests do not reflect their real-world challenges. In classrooms and social situations, these children often struggle despite appearing physically recovered, which contributes to the "invisibility" of their injuries.
Physical recovery from a TBI typically precedes cognitive, communication, and language recovery. This leads to situations where children seem physically fine, but they face significant difficulties in academic and social settings. The discrepancy arises because the observable signs of a TBI can be subtle, leading educators and peers to overlook the ongoing cognitive and communicative challenges these children face.
Furthermore, the impact of a TBI can evolve as children grow older. While initial recovery may seem successful, new cognitive and academic difficulties can emerge over time as developmental demands increase. This delayed manifestation of deficits can further contribute to the underreporting and misunderstanding of the long-term effects of TBIs in the school environment.
This Ask the Expert is an edited excerpt from the course Students with Brain Injury: Implementing Curriculum-Based Assessment and Intervention presented by Jennifer Lundine, PhD CCC-SLP, BC-ANCDS.
