Academic journal article Exceptional Children

Academic and Language Outcomes in Children after Traumatic Brain Injury: A Meta-Analysis

Academic journal article Exceptional Children

Academic and Language Outcomes in Children after Traumatic Brain Injury: A Meta-Analysis

Article excerpt

Traumatic brain injury (TBI) is among the most frequent injuries and causes of functional morbidity in children and adolescents in the United States (Langlois, 2000). On average, 20 out of every 10,000 students in a school district in the United States sustain a TBI that requires specialized educational services (Arroyos-Jurado, Paulsen, Merrell, Lindgren, & Max, 2000). Among the most frequent types of functional morbidity caused by TBI are academic and language difficulties. However, relatively few children who incur a TBI receive the special education services they are entitled to under the Individuals With Disabilities Education Act (IDEA): Fewer than 2% of students with a TBI are identified in American schools as eligible to receive services via IDEA (Glang, Tyler, Pearson, Todis, & Morvant, 2004). This discrepancy between the number of children identified as having TBI and the number receiving services suggests that many children with TBI may be misidentified or unidentified at school (Carney et al., 1999). More careful attention, therefore, needs to be paid to the academic and language outcomes of children with a history of TBI in order to identify students most likely to require special services, including remediation and accommodation.

It is generally recognized that many children experience some degree of academic and language difficulties following a TBI. Less well understood is the extent of difficulties at different times post-injury as a function of acute injury severity, the residual deficits requiring remediation, and the course and degree of recovery. A better delineation of the effects of TBI on academic and language skills would provide critical data for developing special education guidelines targeted to the academic and language needs of children who have experienced a TBI.

In addition to examining general academic outcomes, we examined receptive and expressive language functioning and discourse-related skills post-TBI; speech and language services are among the most widely provided special education services for children with TBI. Impairments in functional language ability likely have negative real-world consequences, not just in academic settings but also in vocational and social settings (Biddle, McCabe, & Bliss, 1996; Ylvisaker & Feeney, 2007). Although children who have incurred a TBI have speech and language problems, those problems are not necessarily the same as language-related specific learning disabilities more commonly seen in children receiving special education services.

Academic outcomes and receptive and expressive language skills typically are assessed by highly structured tests. In contrast, discourse-related communication skills (using language to communicate to others) are measured from speech samples, providing insights into real-world communication skills. Using language to communicate not only requires the coordinated functioning of lexical, syntactic, semantic, and pragmatic language functions, but also cognitive functions associated with planning, sequencing, and goal regulation (Ewing-Cobbs, Brookshire, Scott, & Fletcher, 1998), including the formulation of grammatical structures and word selection (Frederickson, Bracewell, Breuleux, & Ranaud, 1990). Because discourse requires the coordination of higher order cognitive and language processes, examining these skills may identify deficits not apparent on more structured and artificial tasks (Ewing-Cobbs, Brookshire et al., 1998).

Summarizing the extant literature on the effects of TBI on academic and language functioning is difficult because of variation across studies on a number of important methodological factors. These include differences in the characterization and range of injury severity, age ranges of study participants, measures employed to assess academic outcomes, and injury-test intervals. Study design--cross-sectional versus longitudinal--is another important factor, the latter providing more rigorous information about recovery patterns. …

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