Brain injury is generally considered the leading cause of mortality and disability in children and youth (Savage & Wolcott, 1994). Each year one million children are taken to emergency rooms with traumatic brain injuries resulting from motor vehicle collisions, falls, sports, and abuse. Other nontraumatic brain injuries occur from anoxia (e.g., near drowning, strangulation, choking), infections (e.g., encephalitis, meningitis), tumors, strokes and other vascular accidents, neurotoxic poisoning, and metabolic disorders (Savage, 1997). Brain injuries to children between birth and 19 years of age annually result in 7,000 deaths and 150,000 hospitalizations. About 30,000 have a permanent disability after the injury each year (Savage, 1997).
Young males have the highest incidence rates of traumatic brain injury of any group. Some studies have shown that males under the age of 18 have a 1.6% chance of sustaining a brain injury each year (Forkosch, Kaye, & LaPlante, 1996), which is significantly higher than any other group. Recent data indicate that firearms are the most common cause of fatality due to brain injury in adolescents, surpassing the rate due to motor vehicle accidents associated with alcohol consumption (Sege, 1994; Forkosch et al., 1996).
Prior to the 1990 reauthorization of the Individuals with Disabilities Education Act (IDEA), students with brain injuries were often misclassified, inappropriately placed, and under served. Since the passage of IDEA, these students have been identified as falling under a separate category of disability. It is the purpose of this paper to address the unique sequelae these youth manifest and present a summary of cognitive, psychosocial, behavioral, and educational interventions that school counselors and educational personnel may employ to enhance their school adjustment. The roles that school counselors assume in this process is also discussed and analyzed. In a separate section, the authors present a summary of key multicultural considerations in the design and implementation of these interventions.
Types of Interventions
Different authors have summarized some of the cognitive deficits that affect educational performance in children with a brain injury (Lazar & Menaldino, 1995; Lord-Maez & Obrzut, 1996). These deficits include memory and learning impairments. A reduced capacity for new learning can severely impair the ability to perform in school, and this impairment may become more problematic over time. The speed of information processing is also slower, which compounds the problem and adds to the difficulties these children have in dealing with daily school demands. Lazar and Menaldino (1995) focused on the interaction of injury and developmental stage and concluded that cognitive deficits appear to become more evident with maturation, when the demands become more complex. As a result, ongoing intervention and support need to be provided to students throughout their school life.
Ylvisacker et al. (1995) suggest four levels of cognitive functioning in children after a brain injury, with corresponding cognitive tasks and interventions. Level one implies dependency on external support even for routine tasks. Level two requires the use of memory supports such as checklists, photos, log books, and graphic organizers. At level three, the student receives minor prompting to use organizing, planning, and memory aids and is expected to perform independently. Finally, level four indicates performance within normal limits, with no need for external support.
Many authors describe the use of microcomputers in cognitive remediation (Begali,1992; Gianutsos, 1992; Matthews, Preston, & Malec, 1991; Ylvisacker et al., 1995). Thomas-Stonell, Johnson, Schuller, Schuller, and Jutai (1994) evaluated a computer-based program (TEACHware) aimed at helping remediate cognitive/communication skills in children with brain injury. …