Instructional Strategies for Elementary Students with TBI

1. Instructional Strategies for Elementary Students with TBI Susan J. Roland

2. Areas for Interventions • Everyday Instruction/Best Practices • Executive Functions • Organization • Cognitive Flexibility • Orientation Issues • Problem Solving • Memory and New Learning • Attention • Some Specifics for Behavior

3. Interventions for Students with TBI • Follow principles of good instruction • Are often beneficial to entire group • Are highly specific to the individual needs of the student

4. 4 Facts on Long-Term changes: • No 2 students will be alike. • Changes are unlikely to disappear fully over time; the student’s recovery will most likely only be partial. • Negative consequences may not be seen immediately but only emerge when developmental demands reveal deficits and problems. • An injured brain is less likely to meet the increasingly complex tasks all children face as they get older. Hibbard, M., Gordan, W., Martin, T., Raskin, B., Brown, M. (2001) Students with Traumatic Brain Injury: Identification, Assessment and Classification, Assessment and Classroom Accommodations : NYC, NY 4

5. Best Practice for Instructions • Demonstrate what you want the student to do (pair visuals with verbal) • Use many positive and negative examples • Show an example of what you want AND don’t want • Point out how the positive examples are the same - Point out the obvious - it most likely is NOT obvious to some

6. Best Practice: Instruction • Use consistent language to reduce the chance for error • Use Rubrics for grading - this is the easiest way to modify grades for the teacher and the best way to lay out expectations • Monitor student performance to prevent errors in practice and responses • Provide positive corrective feedback (“The more we work on this, the easier this is going to get!”) • Include systematic reinforcement and correction in a positive way

7. Best Practice: Instruction • Evaluate Your Teaching • Starting level correct? • Did you • monitor the student’s performance? • record the student’s progress • Review student progress • Change the instruction as needed until the student is making progress in the designated curriculum • Madigan, K., Hall T.E.,& Glang, A., (1997). Effective Instructional Practices for students with ABI in Students with Acquired Brain Injury: The school’s response. Glang, A., Singer, George, Todis, B. Eds. Brookes: Baltimore

8. Executive Function Strategies • planning, organization, initiation, time management, working memory, flexibility cognition, memory, attention, reasoning, abstract thinking; judgment; and problem-solving

9. Key Components of an Intervention Plan for EF: • Get information from a variety of sources: • interviews, behavior checklists, observations, and work samples along with formalized assessment • List problem areas • Link problem areas to the executive function that best describe the problem • Match information across and between settings and domains • Choose an executive function to work on, that will be meaningful to the student

10. Paul • Paul has been having a difficult time at school socializing with his peers. He enjoys socializing and talking but classmates get frustrated with him because he only wants to talk about himself. When he tries to talk with his peers, they just ignore him. What has been observed is that he talks at length without allowing anyone else to speak. He only speaks about himself. • Using his goal of wanting to talk to others and addressing Paul’s needs to listen, and be more flexible in topic choice • The areas are linked to help create Paul’s intervention

11. What might be an intervention to try with Paul?

12. Paul • Paul might set a goal of talking to others about something of interest to them. • Paul works with the speech pathologist to generate a list, of topics of interest, specific to a targeted peer/individual • He role plays/practices speaking to the target person with the guidance of the speech pathologist or other mentor • Paul practices with other people using less and less adult coaching for increased flexibility in a variety of situations.

13. Evaluation of Paul’s Intervention • Examine the effectiveness of the intervention by documenting the following: • Were the intervention and supports put into place? • Duration • Frequency • How did it work? • How many teacher prompts were needed? • How natural was the conversation? • What’s the plan for reducing the number of supports?

14. Students may grasp the main concepts but may be unable to show their knowledge because of EF difficulties

15. Teach Routine • The day should be predictable but still fun! • Routines within your daily schedule (stimulation breaks, set restroom breaks) • Visual schedule (on the board for all, on desk for a few, or an individualized picture schedule - use clock faces if you need to) • Creeds, chants, songs • Utilize school organizational materials (planner, etc)

16. Moving to the Large Group • Explicitly teach the EF skill needed in an applied setting • Fade supports as soon as the student is able to accomplish the skills • Use external reinforcements only as necessary • Explicitly teach the skill needed in other settings to assist in generalization of skills • Guide practice of skill through group coaching or mentoring • Fade guidance as skill becomes internalized and guidance is no longer needed

17. Classroom Interventions for Executive Function • Changes in the Environment • Change the physical or social environment by • Changing the level of background noise • Changing the level of visual stimulation • Changing the physical restrictions (walls, room size etc.) • Use of lists or visual reminders • Changing the amount of organizational structures

18. Can they answer the BIG 5? • Know when to start • How much to do • How to do it • What finished looks like • What to do next

19. Specific strategies for ORGANIZATION

20. Organization • Use a planner or “back and forth” notebook with check-in and check-out system • Help students develop methods to organize • Materials • According file folders • Box on the floor rather than in the desk • Easier to access and less of an opportunity for the “black hole” • Ideas and information • Provide choices rather than open ended suggestions

21. Organizational strategies for note taking from lectures • Cornell notes or two column notes • Graphic organizers (i.e. Thinking Maps) • Teacher provided note-taking templates • Teacher provided guided notes • Focused notes (main points - not everything)

22. Use of rubrics or other systemic methods of informing a student exactly what is expected for a job well done • Show/display positive examples of completed assignments and products • Strategies for writing • Structured and organized • Show/display examples and non-examples

23. Specific strategies for COGNITIVE FLEXIBILITY

24. Strategies to Help with Cognitive Flexibility: • Develop a daily routine that is maximally functional. • homework in planner • where and when to turn in homework each day • schedule • What is most important to you as the teacher, parent or student?

25. Practice identifying multiple meanings in words, jokes, and riddles • Take advantage of on the spot teaching when ever the opportunity arises! • Encourage students to generate multiple ways to solve problems or settle disputes • Anticipate and plan for situations that require mental flexibility and thinking on one’s feet (practice)

26. Encourage students to compare current problems to previous problems and look for similarities and differences (facilitate making those connections!) • Shifting from one topic to another • Picture or written schedules • Verbally assist students with metaphors • EXPLAIN commonly used slang assume they do NOT understand it

27. Self Monitoring and Checking • Helps students learn self regulation • Students need to know • types of errors to look for • how to check for these errors • exactly how to correct the errors • Give EXPLICIT instructions show an example hand-over-hand or after showing the class the example, go over to Mary and ask her to show you an example of how to “correct” an error”

28. Cognitive Scripting Specifics • Help children understand what it looks like to learn • Teach turn taking • Teach asking for help • Use social stories (autism.org) • SHOW what it looks like

29. Educational Accommodations for Orientation Issues • Have student use assignment book or planner. • Use peer buddies • Maintain consistent room arrangement, materials. • Label significant objects and materials. • Teach child to look for permanent landmarks.

30. Educational Accommodations for Orientation Issues (Continued) • Provide charts, schedules, maps, that describe daily routines and routes. • Have child verbalize how to get a to place before going. • Allow extra time in moving from one location to another.

31. Educational Accommodations for Problem Solving • Role play cause and effect scenarios. • Teach the structure and format of an activity. • Raise questions about alternatives for behavior. • Demonstrate application or problem solving skills across daily routines. • Provide ongoing feedback.

32. Educational Accommodations for Problem Solving (Continued) • Provide a highly structured learning environment. • Provide assistance with alternate solutions and courses of actions. • Provide assistance with sequencing tasks and prioritizing objectives. • Provide clear expectations.

33. Commonsense Guidelines • Always make your expectations clear. • Keep focused on task on hand. • Praise effort, not outcome. • Pick your battles, do not force confrontations. • Don’t say “no”, say “try again”. • Ask questions and give choices.

34. Commonsense Guidelines cont. • Speak with respect: give choices not orders; speak calmly and firmly; and do things to help the child learn. • Make a plan prior to every activity. • Evaluate activities and outcomes frequently. • Create an organized, structured learning environment. • Describe and model behaviors that you want.

35. Specific Strategies for Memory & NEW LEARNING

36. Practice, Practice, Practice • repeated practice • spaced and varied intervals • spiraled practice (come back to it in 1-3 months) • Include pictures or visual cues with verbal information • Provide a schedule of tests, reports, and assignments to parents several week prior to due dates

37. Due to difficulties of free recall of information, allow use of aids such as: • a vocabulary list or a word bank • open-book and open-notes test formats (with highlighted information) • test questions in a multiple-choice or matching format

38. Focus the student’s attention on specific information: “ I’m going to read a story and ask WHO is in the story.” • Draw connections between new information and prior knowledge • Reduce the amount of information that you student is studying or working with to 5 or 6 main point rather than 9 or 10.

39. Pair visual with audio Label everyday objects Write pg. # next to Q’s to find answers Decrease independent silent reading Start-to-Finish Books Reading 39

40. Reading (Continued) • Injury prior to learning to read = early intervention to develop: • To develop sound-symbol correspondence • Pre-reading competencies • Teach pattern word lists and sight words • Pre-teach vocabulary • Color code highlight (i.e. yellow for Main Idea or Topic Sentence, green for details, orange for explanations or definitions, etc.)

41. Practice in natural settings Figure out when lunch or recess will begin Figure out how many bills and coins lunch will cost with 2 snacks Do not require copying from board Provide space for ALL computations - have student circle final answer at the end - no separate answer sheets Math

42. Math (Continued) • Provide fact tables and number lines • Provide lists of rules, formulas, steps to follow and examples - examples - examples • Use MANIPULATIVES and visuals • Use graph paper to enhance organization and spacing

43. Use a clipboard to stabilize paper Dictate “notes” for the student to “bring” to your teammate down the hall Use of a scribe, fill-in-the blanks, true-false, and matching formats for test Assistive Technology Co-Writer Write Out-Loud Written Language 43

44. Written Language (Continued) • Allow student to dictate the first draft of a writing assignment for a parent/teacher to type (word-for-word) student revises, makes additions and edits from this first draft • Allow alternatives for written assignments: • http://blabberize.com/ • diorama • theatrical presentation • a model • illustration

45. Educational Accommodations for Memory and New Learning • Develop active learning situations • Have child utilize visual imagery. • Visualizing and Verbalizing (SRA) • Have child use verbal rehearsal or self-talk. • Use a sufficient range of examples: • visual • non-examples • Use all resources of the curriculum ex. CD’s • www.BookShare.org • Start-To-Finish Books

46. Have child role-play stories • Provide sufficient practice. • Provide cumulative review of previously taught material. • Picture Schedule • Clock face schedule • Materials checklists • Schedules and lists on a key ring or clipboard

47. Specific strategies for Attention

48. Educational Accommodations for Attentional Issues • Limit Noise • Remove distractions • Provide concrete visual cues • Limit amount of info on a page. • Adjust assignments. • Focus on most salient aspect of lesson. • Maintain brisk pace. • Repeat instructions

49. Use short and concise instructions. • Reinforce on-task behavior. • Give frequent breaks. • Break assignments up. • Set up personalized cuing system based in classroom system(s)

50. Emotional, Social Skills and Behavior: Strategies for Intervention