Presentation on theme: "Instructional Strategies for Elementary Students with TBI"— Presentation transcript:
1 Instructional Strategies for Elementary Students with TBI Susan J. Roland
2 Areas for Interventions Everyday Instruction/Best PracticesExecutive FunctionsOrganizationCognitive FlexibilityOrientation IssuesProblem SolvingMemory and New LearningAttentionSome Specifics for Behavior
3 Interventions for Students with TBI Follow principles of good instructionAre often beneficial to entire groupAre 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, NY4
5 Best Practice for Instructions Demonstrate what you want the student to do (pair visuals with verbal)Use many positive and negative examplesShow an example of what you want AND don’t wantPoint 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 errorUse Rubrics for grading - this is the easiest way to modify grades for the teacher and the best way to lay out expectationsMonitor student performance to prevent errors in practice and responsesProvide 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 TeachingStarting level correct?Did youmonitor the student’s performance?record the student’s progressReview student progressChange the instruction as needed until the student is making progress in the designated curriculumMadigan, 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 assessmentList problem areasLink problem areas to the executive function that best describe the problemMatch information across and between settings and domainsChoose an executive function to work on, that will be meaningful to the student
10 PaulPaul 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 choiceThe areas are linked to help create Paul’s intervention
11 What might be an intervention to try with Paul?
12 PaulPaul 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/individualHe role plays/practices speaking to the target person with the guidance of the speech pathologist or other mentorPaul 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?DurationFrequencyHow 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, songsUtilize school organizational materials (planner, etc)
16 Moving to the Large Group Explicitly teach the EF skill needed in an applied settingFade supports as soon as the student is able to accomplish the skillsUse external reinforcements only as necessaryExplicitly teach the skill needed in other settings to assist in generalization of skillsGuide practice of skill through group coaching or mentoringFade guidance as skill becomes internalizedand guidance is no longer needed
17 Classroom Interventions for Executive Function Changes in the EnvironmentChange the physical or social environment byChanging the level of background noiseChanging the level of visual stimulationChanging the physical restrictions (walls, room size etc.)Use of lists or visual remindersChanging the amount of organizational structures
18 Can they answer the BIG 5? Know when to start How much to do How to do itWhat finished looks likeWhat to do next
20 OrganizationUse a planner or “back and forth” notebook with check-in and check-out systemHelp students develop methods to organizeMaterialsAccording file foldersBox on the floor rather than in the deskEasier to access and less of an opportunity for the “black hole”Ideas and informationProvide choices rather than open ended suggestions
21 Organizational strategies for note taking from lectures Cornell notes or two column notesGraphic organizers (i.e. Thinking Maps)Teacher provided note-taking templatesTeacher provided guided notesFocused 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 doneShow/display positive examples of completed assignments and productsStrategies for writingStructured and organizedShow/display examples and non-examples
24 Strategies to Help with Cognitive Flexibility: Develop a daily routine that is maximally functional.homework in plannerwhere and when to turn in homework each dayscheduleWhat 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 disputesAnticipate and plan for situations that require mental flexibility and thinking on one’s feet (practice)
26 Shifting from one topic to another Encourage students to compare current problems to previous problems and look for similarities and differences (facilitate making those connections!)Shifting from one topic to anotherPicture or written schedulesVerbally assist students with metaphorsEXPLAIN commonly used slang assume they do NOT understand it
27 Self Monitoring and Checking Helps students learn self regulationStudents need to knowtypes of errors to look forhow to check for these errorsexactly how to correct the errorsGive 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 learnTeach turn takingTeach asking for helpUse social stories (autism.org)SHOW what it looks like
29 Educational Accommodations for Orientation Issues Have student use assignment book or planner.Use peer buddiesMaintain 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.
36 Practice, Practice, Practice repeated practicespaced and varied intervalsspiraled practice (come back to it in 1-3 months)Include pictures or visual cues with verbal informationProvide 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 bankopen-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 knowledgeReduce the amount of information that you student is studying or working with to 5 or 6 main point rather than 9 or 10.
39 Reading Pair visual with audio Label everyday objects Write pg. # next to Q’s to find answersDecrease independent silent readingStart-to-Finish Books39
40 Reading (Continued)Injury prior to learning to read = early intervention to develop:To develop sound-symbol correspondencePre-reading competenciesTeach pattern word lists and sight wordsPre-teach vocabularyColor code highlight (i.e. yellow for Main Idea or Topic Sentence, green for details, orange for explanations or definitions, etc.)
41 Math Practice in natural settings Do not require copying from board Figure out when lunch or recess will beginFigure out how many bills and coins lunch will cost with 2 snacksDo not require copying from boardProvide space for ALL computations - have student circle final answer at the end - no separate answer sheets
42 Math (Continued) Provide fact tables and number lines Provide lists of rules, formulas, steps to follow and examples - examples - examplesUse MANIPULATIVES and visualsUse graph paper to enhance organization and spacing
43 Written Language Use a clipboard to stabilize paper Dictate “notes” for the student to “bring” to your teammate down the hallUse of a scribe, fill-in-the blanks, true- false, and matching formats for testAssistive TechnologyCo-WriterWrite Out-Loud43
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 draftAllow alternatives for written assignments:dioramatheatrical presentationa modelillustration
45 Educational Accommodations for Memory and New Learning Develop active learning situationsHave child utilize visual imagery.Visualizing and Verbalizing (SRA)Have child use verbal rehearsal or self-talk.Use a sufficient range of examples:visualnon-examplesUse all resources of the curriculum ex. CD’sStart-To-Finish Books
46 Have child role-play stories Provide sufficient practice.Provide cumulative review of previously taught material.Picture ScheduleClock face scheduleMaterials checklistsSchedules and lists on a key ring or clipboard
48 Educational Accommodations for Attentional Issues Limit NoiseRemove distractionsProvide concrete visual cuesLimit 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
51 Reminders from previous presentations: For Younger Students Give clear and simple directionsAvoid time outs (the student is NOT likely to independently regroup or calm down)Label the emotion and direct the student to show the acceptable behavior
52 For Older Students:Teach strategies and how to use them rather that offering assistanceDiscuss and practice age-appropriate behaviors in real life situationsAssume limited ability to generalize from one setting to another
53 Proactive Communication Always give information. Tell the person:Where you are going.How much you want the person to do.How long you want the person to do somethingWhat does finished look like?What is next….Write things down.Don’t say “no”, say “try again”.
54 Even More Proactive Communication Ask Questions & Give Choices“What did I say?”“Do you remember?”“What can you do now?”“What should you do now?”“Is this going to help you?”“How do you want me to help you?”“What do you want?”