Siân Rees outlines some of the key issues facing the pupil returning to school with an acquired brain injury.
Going back to school after a brain injury is a great milestone in recovery, but it is at this point, when learning can no longer be individually tailored, that the difficulties of the brain-injured child are compounded. The pupil may sit quietly in the classroom, appearing to act like the “average” child but underneath there are significant differences and teachers have to work hard to maximise their learning potential. Alternatively, the teacher may know very clearly that this young person has gone through a lot recently, as they can see the child is easily fatigued, irritable and has difficulties attending to the most simple tasks. Thankfully, brain injury is relatively rare, but this mean that frequently children with severe brain injuries return to schools where there is no specialist knowledge about the educational effects of their injury.
The returning pupil may look just the same as they did previously. Staff, students and parents are relieved to see them returning, but do not realise that this is where the big changes will be noticed. While in hospital or during the rehabilitation period, the young person generally accepts that they need to “wake up their brain” again, but now they think they are back to normal, and will not ask for help. They are unaware that their whole way of thinking has changed.
Timing the return to school
The timing of school re-entry is an important variable for a successful return to school. Pupils must be able to function adequately in the classroom, responding to instruction, attending to simultaneous input in various modalities and work unassisted for 30 minutes. The ability to retain and understand information, reason and express ideas, plan and monitor their own performance are also required in the classroom, but the extent to which these are necessary depends on the age of the young person. It is unlikely that young people with acquired brain injury (ABI) will be able to operate fully in these areas and here the skill of the teacher in differentiating the curriculum to cope with these difficulties comes into play.
Difficulties associated with ABI
The returning pupil will probably arrive with a number of assessments by different professionals. While these are of great use in ascertaining the young person’s abilities, they may not show the whole picture. Formal measures of ability are administered in highly controlled settings; after ABI they may overestimate the actual level of functioning in the classroom, where demands and distractions are greater.
American statistics show that the majority of children with brain injuries experience educational difficulties. Problems are frequently in comprehension and problem-solving; it is possible for most brain-injured youngsters to regain all of the knowledge which they had before the injury, but new learning is difficult. However, most children also experience subtle changes in how they learn, but this varies from pupil to pupil. Commonly, young people experience changes in communication skills, where word retrieval difficulties and slowed speech are common. Motor functioning difficulties could include tremors when under pressure, while memory and attention difficulties are among the more lasting and pervasive of the consequences of injury. Children sometimes not only can’t remember what they have been taught, they cannot remember having been taught it. This also affects other aspects of school life, such as remembering the location of classrooms or how to move through a lunch queue. There may be changes in behaviour and personality, especially as young people with ABI are frequently unable to make judgements about appropriate behaviour and tend to be disinhibited, saying or doing the first thing which comes to mind.
The child’s needs will evolve and change as the learner progresses. For some children with ABI, a more structured learning environment may be required for continued progress to be made. There are also key behaviours which may be readily misinterpreted by school personnel not familiar with ABI; children with expressive difficulties may not be able to explain concepts which they readily understand and may then be considered to be at a lower academic level than they really are. It is important that teachers find other ways for children to show what they understand other than by using words. After ABI, many young people experience a slowing of their ability to think and will need extra time in class, homework, tests and exams to truly show what they can do.
Non-academic considerations
When planning for a return to school, it must be remembered that it is not only teachers who come into contact with the youngster. School meal supervisors, caretakers and secretaries also need to know about the returning pupil, as they may be the first on the scene when the young person needs help.
School can be a very confusing place after an ABI; transport to and from school, class changes, conflicting demands of as many as eight different teachers during the day in some secondary schools, the need to remember security codes, PE routines, lunch queues, and countless interpersonal encounters during the day all mean that there is a lot to take in. Children with an ABI have difficulty in sorting and prioritising stimuli and such a range as this may be a barrier to successful re-entry. Too much stimulation can cause the young person to become very tired and a phased return to school is always recommended. Once the young person shows they can manage, the time may be extended. It is also recommended that there should be a quiet room where the pupil with ABI can go to have time out and rest, even for ten minutes.
The process of reintegration into school must match the needs of the individual; every child differs in their character, injury and response to the injury. Children can grow into difficulties which are not obvious on return to school. This is especially so as children move from primary to secondary education and the demands made on them change significantly. Teachers should be aware that delayed onset of problems is possible.
Behaviour
Unlike “typical” pupils, a child with ABI cannot understand, remember or respond to rewards and punishments. Distraction or time out does not work in the long run, because the student does not attach markers to stored representations of an event, so they cannot use it to guide future action. Instead, teachers should look for an approach which eliminates provocation and supports the pupil to avoid frustration and build self-esteem, especially before attempting a difficult task. Positive alternatives should be taught, including communication skills, giving choices and control to the student at appropriate times, and helping the student to recognise pressure points and leave the situation before trouble arises.
Training
Students with ABI often need the support of outside agencies. It is widely recognised that therapy works best when it is integrated into the pupil’s daily routine. The management of ABI often necessitates approaches which run counter to conventional wisdom and the continued support of a specialist teacher is recommended both for initial training and in order to monitor progress, watching for the delayed onset of any difficulties. We should not view school re-entry as complete once the pupil is back in school full-time; the process will continue until they leave the school and carry on once they enter the next one.
Author: Siân Rees
Siân Rees
Dr Siân Rees is a specialist teacher at The SHIPS Project, a charitable project supporting young people who have sustained an acquired brain injury through accident or illness in their educational placement.
www.shipsproject.org.uk
