Tuesday, May 1, 2012

The Implications of Concussions

Yesterday, we had a Committee on Special Education meeting on an interesting, and tough, case. Although, if I'm blogging about it, it'd have to be interesting, right? When do I ever blog about the cut-and-dry cases?

R was referred for the first time this year despite many years of below grade level performance. He's currently in one of our top Integrated Co-Teaching classrooms, so he's being watched and taken care of by two fantastic, intervention driven teachers. Ms. J came to me with concerns about him a few months ago and wanted to make a referral to help him have academic support services next year for seventh grade.

Some background on R... he looks like a 20 year old man, even though he's 13. He's the perfect sports specimen, built for football but with the height for basketball, and he excels at both (like, 10 trophies at home and the kid's in 6th grade). Just this weekend, he was in Florida for a basketball tournament. He could easily get scholarships to college with his skills. He's Rico Sauve, all the girls swoon over him and he loves the attention; but, he's got a sensitive side too as he's a fantastic artist and very protective over those he cares about. Great sense of humor, great story-teller, lots of "swag." I would want to be friends with this kid.

Last year, he had a very poor teacher and it was a wasted year for him, and as you may imagine, his behavior was a problem. He was often cutting up in class and butted heads with the teacher constantly. As an adult, you would guess he often instigated some of the issues, but if my teacher called me "big lipped," I would feel the need to defend myself, too. (Yes, she really called him that. I could barely be mad at him when I had to deal with the issue.) More typical behaviors are a lack of motivation, distractibility, taking a long time to complete assignments, and becoming easily frustrated over academic tasks and shutting down.

I happily took R for testing, but was blown away by the results. R had a Full Scale IQ standard score of 57 and academic achievement standard scores around 65-70, which place him in the Intellectually Disabled range. WHAT? I'll take "Results I Would Never Bet on in Vegas" for 1,000, Alex. How did this social, artistic, could-go-pro-football-some-day kiddo obtain a lower IQ score than the student we just placed in a life skills program? The scores didn't make sense--sure, R has a lot of difficulty academically, but an ID classification?

At the end of last week, our social worker went out to R's house to meet his mom for a social history, and things began to fall into place. R met all his developmental milestones on time or even early, and was sinking baskets at age 2. Then, at age 7, he was hit by a car riding his bike, lost consciousness, and was taken to the ER, where he was diagnosed with a concussion. He repeated second grade that year. By 9, he had at least three more concussions playing football. Around age 10, his mother started noticing changes in his behavior (problems concentrating, more listless, memory difficulties, impulsivity) and his academics dropped. Suddenly unexpected results make sense--R probably has a traumatic brain injury from multiple concussions over a two year span.

The worst parts about this whole scenario are two fold: 1) R has been struggling for years, and no one ever evaluated him before, and 2) R's future could be totally changed as a result of these concussions and special education classification. A child that could've gone to college on a sports scholarship may now require intensive supports to obtain higher education, if he makes it there at all.

Concussions are serious business, and a new "buzz" in the education world. What looks like a bump on the head when it happens can have serious, lasting, devastating impact on a child's future, especially if injuries are cumulative. Check out the CDC's "Head's Up" program, which has great information for parents, coaches, etc about concussions and traumatic brain injuries and their long-term impacts. Also, here are some resources from NASP's Communique:

Sports-Related Concussions, by Don Brady and Flo Brady
Getting School Psychologists Into the Game, by Susan C. Davies

One further exciting development in concussion research is a cool new app from PAR, Inc. called Concussion Recognition & Response: Coach and Parent Version. The app helps individuals screen the likelihood of a concussion at the moment an injury occurs. This app was recently featured in the Communique. At the October 2012 NY Association of School Psychologists Conference in Niagara Falls, NY, there will be a strain on concussions and head injuries, where PAR will come to present on the app and its use, as well as experts from University at Buffalo. I highly encourage all nearby to attend (and not just because I'm on the conference planning committee!).

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  1. This is incredibly sad, mind boggling yet exciting all at once. I am sad for this charismatic young man who lives appears to have been significantly impacted by trauma-induced brain injuries and it's mind boggling that no one saw the connection. However it's very exciting to hear and see all the research being conducted in this area of need.

    Love the post! as always..

  2. Am pleased to see you addressed the sport-related concussion topic in your blog.

    In my applied assessment work I have found students who were initially misdiagnosed with ADD when, in fact, later were found to be experiencing and displaying the adverse effects of subtle (and sometimes not so subtle) brain injury / concussion.

    Appreciate you mentioning the sport-related concussion (SRC) article published by NASP last June (2011) that my wife and I authored.

    May I suggest you include another NASP article that also appeared in last June's Communique entitled Sport-Related Concussions: Myths and Facts that my wife and I also wrote with the assistance of Communinqe's Editor.

    Below are some possible references that may be of interest to your readers. I included my PhD Dissertation research as many historical concussion-related references may be found in the document.

    Brady, D. (2004). A preliminary investigation of active and retired NFL players’ knowledge of concussions. Unpublished dissertation, The Union Institute and University.

    Cantu, R. C. (1998). Second-impact syndrome. Clinics In Sports Medicine, 17, 37–44.

    Evans, R. W. (1994). The postconcussive syndrome: 130 years of controversy. Seminars in Neurology, 14, 32–39.

    Goldstein, M. (1990). Traumatic brain injury: A silent epidemic. Annals of Neurology, 27, 327.

    Gronwall, D. (1989). Cumulative and persisting effects of concussion on attention and cognition. In H. S. Levin, H. M. Eisenberg, & A. L. Benton (Eds.), Mild head injury (pp. 153–162). New York, NY: Oxford University Press.

    Gronwall, D., (1991). Minor head injury. Neuropsychology, 5, 253–265.

    Gronwall, D., & Wrightson, P. (1975). Cumulative effect of concussion. The Lancet, 2, 995–997.

    Kelly, J., & O’Shanick, G. (2003, March). The diagnosis and management of concussion. Paper presented at the 54th annual meeting of the American Academy of Neurology, Denver, CO.

    Kieslich, M., Fiedler, A., Heller, C., Kreuz, W., & Jacobi, G. (2002). Minor head injury as cause and co-factor in the aetiology of stroke in childhood: A report of eight cases. Journal of Neurology and Neurosurgery Psychiatry, 73(1), 13–16.

    Langlois, J. A. Rutland-Brown, W., & Wald, M. M. (2006). The epidemiology and impact of traumatic brain injury: A brief overview. Journal of Head Trauma Rehabilitation 21, 375–378.

    Wrightson, P., & Gronwall, D. (1999). Mild head injury: A guide to management. New York: Oxford University Press.


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