Mild Traumatic Brain Injury in Childhood: Injury Outcomes, Teacher Perspectives and Educating Educators
Case, R. J. L. (2014). Mild Traumatic Brain Injury in Childhood: Injury Outcomes, Teacher Perspectives and Educating Educators (Thesis, Doctor of Philosophy (PhD)). University of Waikato, Hamilton, New Zealand. Retrieved from http://hdl.handle.net/10289/8786
Permanent Research Commons link: http://hdl.handle.net/10289/8786
Paediatric mild traumatic brain injury (mTBI) has the potential to impact on a wide range of developmental functions in childhood. However, the relationship between mTBI and persistent developmental difficulties is controversial, with some suggestion that children’s post-injury difficulties may actually predate the injury. Regardless of cause, however, mTBI seems to be associated with developmental impairment in childhood that may impact on academic performance and overall school functioning. In spite of the high prevalence of mTBI amongst young people, educators and school services may not be aware of the implications of such injuries and how post-concussive symptoms should be managed in educational settings. It seems that the conflicting findings regarding mTBI outcomes in childhood may contribute to a lack of knowledge amongst educators about how to manage mTBI and associated difficulties in primary-school-aged students. There is a need to further clarify the existence and nature of developmental impairments after paediatric mTBI and consider their implications in educational settings. Furthermore, there is a need to understand more regarding the capacities of educators to address issues that may arise as a result of such impairments and consider how teaching practices in this area can be enhanced. In Study 1, the emotional, behavioural, social, intellectual, neuropsychological (comprised of memory, attention, and executive function) and academic functioning of 41 children who had sustained mTBI 14-months prior was investigated. The findings of those assessments were compared with those from a non-injured cohort of children matched on age, gender, ethnicity and school decile. Assessment measures included the Strengths and Difficulties Questionnaire (SDQ) as a measure of emotional, behavioural and social functioning, the Behavior Rating Inventory of Executive Function (BRIEF) as a measure of executive function, Woodcock Johnson Tests of Cognitive Abilities (WJ III COG) and CNS Vital Signs (CNSVS) as measures of global neuropsychological functioning, a short-form version of the Wechsler Intelligence Scale for Children (WISC-IV) as a measure of intelligence, the brief battery of the Woodcock Johnson Tests of Academic Achievement (WJ III ACH) as measure of academic achievement, and a teacher questionnaire regarding school functioning. Information obtained from parents and teachers regarding pre-injury diagnoses and learning problems did not reveal significant premorbid difficulties amongst the clinical group. The results of Study 1 showed that children who have sustained mTBI demonstrate higher rates of emotional and behavioural problems than those in a matched cohort, while executive function and social functioning was found to be similar across the two groups. Children with mTBI evidence significantly lower intellectual functioning and academic achievement, and are more likely to demonstrate learning disorders. Given the developmental impairments identified in the sample and the possible implications of such difficulties in school settings, it was considered important to evaluate teachers’ perceptions of childhood TBI and how such impairments might be managed at school. Study 2 looked at the perceptions of educators regarding childhood TBI. Nineteen primary school teachers in the Waikato and Bay of Plenty regions engaged in semi-structured interviews that covered their understanding of TBI, its mechanisms and consequences. Participants also discussed the use of programme adaptations for children with persistent difficulties after mTBI and perceived barriers to uptake. The majority of participants had a limited understanding of mTBI and its implications in childhood. None of the participants had received prior education regarding paediatric TBI and identified this as an area of weakness that they perceived could be addressed by professional development. However, participants were not aware of any available professional development opportunities specifically relating to paediatric TBI. Participants perceived significant barriers to the delivery of appropriate educational approaches for children with developmental impairments, including limited resourcing and funding for special education and poor communication between the education and health sectors, resulting in a lack of information and support for educators. Study 3 involved the development, delivery and evaluation of a professional development workshop and written information resource for teachers. The workshop and written information resource were delivered in three local primary schools to 38 participants. A knowledge quiz regarding mTBI was administered pre- and post-workshop. Participants also completed an evaluation of the workshop and brochure rating the usefulness of and their satisfaction with the materials. A repeated-measures experiment showed that knowledge levels significantly increased following participation in the workshop. The majority of participants were satisfied with the content of the workshop and expected to make changes to their practice with children who had experienced mTBI and were evidencing emotional, behavioural and/or cognitive symptoms. The results of this research indicate that while the cause of post-concussive difficulties may be ambiguous, children who have experienced mTBI are at higher risk of demonstrating developmental problems across a wide range of domains. These problems have the potential to impact on school functioning; however, teachers may not be aware of these issues and thus may not be well-placed to support children who are experiencing difficulties through the post-concussive period and beyond. On the other hand, teachers demonstrate insight into their limitations in this regard and appear keen to address their professional development needs in this area. A brief professional development approach that focuses on the epidemiology and possible consequences of mTBI in childhood, along with a range of programme adaptation strategies that teachers can opt to employ as necessary, may be useful in improving teacher knowledge, educational practice and, ultimately, functional outcomes for children who have experienced mTBI. The need for screening and intervention services for children with mTBI is highlighted, along with a reconceptualisation of how special needs are addressed in school settings.
University of Waikato
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