Under-Identification of Students with Long Term Disability from Moderate to Severe TBI:

Traumatic brain injury (TBI) has historically been considered a low-incidence disability in public education, and yet estimates indicate that nearly 145,000 children in the United States aged 0–19 are currently living with long-lasting, significant alterations in social, behavioral, physical, and cognitive functioning from a TBI. Comparing this number with the total number of students receiving special education services under the TBI eligibility category found only 26,371 students across all grades. Thus, it appears that a large number of students with significant disability following TBI are not being served under the TBI category, and raises the possibility that many students are not being identified and/or effectively served by educational practitioners in the public-school system. This paper examined the discrepancy between the number of students expected to experience disability using hospitalization data for Nagele, Hooper, Hildebrant, McCart, Dettmer, and Glang moderate-severe TBI and the number of students who receive special education services under the TBI eligibility category. On average, the number of students actually identified nationally under the Special Education TBI category is only 32% of the students who have moderate-severe TBI across the country. Possible reasons for this discrepancy are explored, including lack of awareness about TBI as a disability, lack of communication between hospital and school, under-reporting of injuries by parents, a narrow definition of TBI that excludes other forms of acquired brain injury, and students with TBI receiving services under alternate disability categories. Recommendations are offered for providing staff training on brain injury, increasing parent awareness of TBI, increasing identification of brain injury in students through screening, and program evaluation of school brain injury protocols.

[1]  M. Zonfrillo,et al.  Examining a Statewide Educational Consulting Program for Pediatric Brain Injury , 2018, Clinical pediatrics.

[2]  Likang Xu,et al.  Traumatic Brain Injury–Related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2007 and 2013 , 2017, Morbidity and mortality weekly report. Surveillance summaries.

[3]  S. Davies School-Based Traumatic Brain Injury and Concussion Management Program. , 2016 .

[4]  S. Shultz,et al.  Social dysfunction after pediatric traumatic brain injury: A translational perspective , 2016, Neuroscience & Biobehavioral Reviews.

[5]  B. Todis,et al.  Services and Supports for Students with Traumatic Brain Injury: Survey of State Educational Agencies , 2015 .

[6]  Mary A. Kernic,et al.  Variation in pediatric traumatic brain injury outcomes in the United States. , 2014, Archives of physical medicine and rehabilitation.

[7]  A. Glang,et al.  Building Statewide Infrastructure for Effective Educational Services for Students With TBI: Promising Practices and Recommendations , 2014, The Journal of head trauma rehabilitation.

[8]  Jianghong Liu,et al.  The effect of pediatric traumatic brain injury on behavioral outcomes: a systematic review , 2013, Developmental medicine and child neurology.

[9]  T. Koepsell,et al.  Persistence of disability 24 to 36 months after pediatric traumatic brain injury: a cohort study. , 2012, Journal of neurotrauma.

[10]  Frederick P Rivara,et al.  Incidence of disability among children 12 months after traumatic brain injury. , 2012, American journal of public health.

[11]  S. Forness,et al.  Special Education Implications of Point and Cumulative Prevalence for Children With Emotional or Behavioral Disorders , 2012 .

[12]  H. Taylor,et al.  Caregiver Ratings of Long‐term Executive Dysfunction and Attention Problems After Early Childhood Traumatic Brain Injury: Family Functioning Is Important , 2011, PM & R : the journal of injury, function, and rehabilitation.

[13]  J. Rosenfeld,et al.  Selective Changes in Executive Functioning Ten Years After Severe Childhood Traumatic Brain Injury , 2011, Developmental neuropsychology.

[14]  B. Todis,et al.  Professional Development in TBI for Educators: The Importance of Context , 2010, The Journal of head trauma rehabilitation.

[15]  J. Kelly,et al.  Challenges Associated with Post-Deployment Screening for Mild Traumatic Brain Injury in Military Personnel , 2009, The Clinical neuropsychologist.

[16]  N. Minich,et al.  Cognitive development after traumatic brain injury in young children , 2009, Journal of the International Neuropsychological Society.

[17]  T. McMillan,et al.  Quality of life in children with acquired brain injury: Parent perspectives 1–5 years after injury , 2009, Brain injury.

[18]  B. Todis,et al.  Redefining Success: Results of a Qualitative Study of Postsecondary Transition Outcomes for Youth With Traumatic Brain Injury , 2008, The Journal of head trauma rehabilitation.

[19]  L. Daunhauer,et al.  Putting Brain Injury on the Radar: Exploratory Reliability and Validity Analyses of the Screening Tool for Identification of Acquired Brain Injury in School‐Aged Children , 2007, The Journal of head trauma rehabilitation.

[20]  D. Warden,et al.  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 , 2007, The Journal of head trauma rehabilitation.

[21]  Linda Ewing-Cobbs,et al.  Late intellectual and academic outcomes following traumatic brain injury sustained during early childhood. , 2006, Journal of neurosurgery.

[22]  B. Jordan,et al.  Prolonged Effects of Concussion in High School Athletes , 2005, Neurosurgery.

[23]  D. Drotar,et al.  Long-term attention problems in children with traumatic brain injury. , 2005, Journal of the American Academy of Child and Adolescent Psychiatry.

[24]  C. Hawley Behaviour and school performance after brain injury , 2004, Brain injury.

[25]  T. Ashman,et al.  Child and parent responses to a brain injury screening questionnaire. , 2004, Archives of physical medicine and rehabilitation.

[26]  S. Hooper,et al.  A call for implementing preferred practices for brain injury screening in youth to improve transition. , 2018, NeuroRehabilitation.

[27]  L. Ewing-Cobbs,et al.  Long-Term School Outcomes of Children and Adolescents With Traumatic Brain Injury , 2017, The Journal of head trauma rehabilitation.

[28]  T. Stockdale,et al.  Population estimates. , 2004, Health statistics quarterly.