Spina Bifida Family Support
"Families Helping Families"
Neuropsychological and School
Understanding how a brain injury affects a student's behavior
Written by Marilyn Lash, M.S.W. & Ron Savage, Ed.D.
Neuropsychologists have special training to evaluate how a brain injury affects learning, communication, planning, organization and relationships with others. Already trained in psychology, the neuropsychologist specializes in the relationships between brain and behavior.
Standard tests used by school psychologists to evaluate students with special needs may not be as useful when evaluating a student with a brain injury. Many intelligence and achievement tests primarily measure what the child has learned in the past.
Students with brain injuries often do not lose the knowledge they had prior to the injury. Tests on previously learned material such as vocabulary and general information may score average or above average. Measuring what the student learned in the past, or before the brain injury, is not the same as evaluating how the student with a brain injury is learning now and will learn in the future. The neurophysiologist can help parents and teachers:
identify how the child learns and uses new information
understand changes in behavior
figure out compensatory strategies
develop an educational plan for the student
provide training for parents and teachers
identify changes to watch for as the child gets older
There is no set timetable for a neuropsychological evaluation. The brain changes rapidly during the first year after the injury. Many students experience new challenges with each developmental milestone. Look for signs that the student is having difficulty with learning or behavior and that teachers need suggestions for effective teaching.
The severity of the injury is an indicator for a neuropsychological evaluation. Moderate to severe brain injuries are more likely to result in changes in the student's abilities. However, it may also be needed for the student who has had a mild traumatic brain injury and continues to have trouble with attention, learning, behavior or emotions.
Evaluations usually involve several tests, including games, puzzles and responses to words and images. These give the student's brain function when challenged to reason, analyze, store and recall information. The selection of test depends on the student's age, reported difficulties, and the information requested.
Choosing a neuropsychologist
Look for a neuropsychologist experienced with.....
students with brain injuries of similar age
stage of recovery or time since injury
schools and special education
developing an IEP or special education plan
compensatory strategies for learning and behavior
Tips on what to ask.....
Do you observe the student in the classroom?
How do you decide what tests to use?
How can you help classroom teachers?
What information will school staff receive?
What information will family members receive?
What follow up do you provide?
Sharing and getting information
This is a three way process between parents, educators and the neuropsychologist.
What information can parents provide?
date and cause of injury
history of medical and rehabilitation care
summary of child's strengths and interests prior to injury
changes in abilities, behaviors and learning after the injury
concerns about your child's education
questions about your child's future
What information can schools provide?
description of current school programs and activities
detailed educational history
current record of grades
individualized educational plan and quarterly reports for special education
written descriptions of strengths and difficulties
specific concerns or questions
What information can the neuropsychologist give?
How the brain injury affects the student's......
ability to concentrate and learn in groups
need for individualized instruction
ability to learn new materials
success in timed tests/quizzes
control over behavior
relationships with friends
ability to complete assignments on time
stamina during school day
emotional adjustment and sense of well being
reactions to medications
Ask if the report and recommendations will.....
describe the student's strengths and needs
explain most effective learning styles
give examples of what teachers can do in the classroom to help the student
suggest how peers and friends can help
describe compensatory strategies for learning and behavior
provide suggestions for the family
What to expect from an evaluation?
strategies to help complete assignments
methods to improve new learning
effective ways to cue or direct the student
management of difficult behavior
adaptive aids for memory, communication or organization
alternative methods of evaluation, such as...
open book tests
pictures vs. words
oral vs. written
multiple choice vs. essay
silent vs. spoken reading
Who pays for a neuropsychologist?
Evaluations can be expensive and depend on how much time, formal testing, observation and meetings are involved. Discuss and negotiate costs in advance. Conflicts can be avoided by agreeing on who is responsible for the costs, what is covered under special education, and if medical insurance provides any benefits.
What about follow up?
The best testing, evaluations and reports can be a waste of time and money if there is no follow up to insure that information and recommendations are used to help the student.
Choices for follow up include:
school visits with the student
appointments with family to discuss results
attendance at IEP or planning meetings
consultation with school staff
Tips for follow up by parents......
Get copies of test results, reports and recommendations
Ask the neuropsychologist to help develop the educational plan
Have the neuropsychologist to review the written educational plan before approving it
Arrange follow up meetings with school staff
Ask if follow up is included in the charge for an evaluation
Have a back up plan for what to do if recommendations are not followed or not work
Give positive feedback when recommendations are effective
Keep copies of all referrals and reports by date.
If you child has hydrocephalus, I would highly recommend contacting the Hydrocephalus Association. There is much information that can be obtained from this organization that can greatly benefit your child and yourself during IEP meetings and educating your child's teachers.
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