Traumatic Brain Injury in Children and Adolescents. M. Semrud-Clikeman. New York: Guilford Press, 2001. Hardcover, 211 pages, $32.00.
Children and adolescents with traumatic brain injury (TBI) face numerous challenges when they are reintegrated to home, school, and community. A primary focus for these children is reintegration and maintenance within the educational system and this focus continues for a number of years after the injury. Proactive assessment, planning, placement, and instructional support are critical to success in the educational program for these students. Semrud-Clikeman has written a book that helps professionals facilitate a reentry to regular or special education services that addresses those critical elements. The text establishes the neurological basis for the underlying challenges to learning that children and adolescents with TBI exhibit, outlines methods for psychological assessment that may reveal problems related to learning difficulty, and suggests teaching strategies that may help. Although the primary appeal of this text is to psychologists who may find themselves working with this population, much of the information is pertinent to related services personnel and teachers who may want additional background and suggestions for intervention with this population.
The text has 10 chapters that emphasize three main themes-characteristics that can challenge learning in the classroom; ideas for formal and informal neuropsychological assessment pertinent to planning reentry to the classroom; and suggestions and techniques for managing school reintegration and classroom teaching. The importance of the family and their participation in all aspects of assessment and planning is emphasized as well throughout the text.
The text begins with a description of the population and the behavioral characteristics that contribute to learning difficulties after TBI. A basic overview of the anatomical and neuropsychological changes that can occur after TBI is outlined. This overview is well-connected to the characteristic behaviors that contribute to learning problems that can develop as the student moves through different developmental stages. Practical examples of challenging behaviors such as inattention, poor problem solving, inadequate planning and organization, and sensory or motor inaccuracy help the reader to practically understand how a student may present or perform in the classroom. I found these examples to be a particular strength of the text. However, I was disappointed that the connection among language, learning, and unwanted behaviors was not developed because these aspects are often reported by school personnel as major concerns for students after TBI.
I appreciated the book's emphasis on the family system and the recognition of the impact of the student's injury on the entire family unit. However, the author adopts the perspective of a medical model that regards the family as people who need to be helped. This approach is distinct from a family systems approach that regards the family as equal partners in the assessment and school reintegration process. As a result, little time is spent in helping the reader to understand the expertness of families where their child is concerned and suggesting how to help them become proactive advocates with and for their child or adolescent. Although there is a suggestion that home and school personnel partner for the benefit of the child, I found it interesting that there was not a similar recommendation for medical personnel and families. Also, although there is a commendable attempt to provide resources for family assistance, many of these resources are outdated or provide incorrect organization names or contact information.
Despite these inconsistencies, other recommendations reveal true compassion for the dilemma of the family. Thus suggestions that the family be given a break from many service providers giving multiple recommendations are quite valid. The recognition that a family may be unable, rather than unwilling, to follow through reflects the author's obvious interaction with many families.
The segments of the text that discuss neuropsychological assessment parameters and how this assessment relates to school enrollment are very well-organized, practical, and useful for psychologists, related services school personnel, and teachers. Information about both formal and informal tests is provided. Supporting tables list tests by domain of function as well as any special considerations for use of each test. I found this approach to be extremely useful as an aid to understanding the necessity of selecting tests carefully. Two case studies that reflect different brain injury severity levels and academic challenges are very instructional. The case studies present a thorough case history, describe test selection and results, and outline impressions and recommendations. This segment is valuable as an example of effective report writing as well as the type of information that may be useful to school personnel for planning school reintegration. I found this section of the text to be very clearly written and well referenced within research literature. I also appreciated the author's obvious clinical experience that guides many practical suggestions and observations.
The last segment of the text emphasizes school reintegration policies, teaching techniques, and applications. Information presented in this segment is practical and reflects promising best practices of the last ten years. I found the information about promoting school reentry and classroom techniques to be very well-organized with excellent ideas. The case examples are well thought out and provide a basis for creative, proactive, individualized planning for students with TBI. Although the ideas presented are excellent and the practical information will aid in developing Individualized Educational Programs (IEPs) for students with TBI, I was surprised that many of the references were not updated to more current resources. For example, the texts by Ylvisaker (1985) and Rosenthal et al (1990) have newer editions that contain rewritten information that reflects newer thinking and research. The use of references from the late 1980s and early 1990s seems to be a problem throughout this section of the text; the segments on family issues has a similar need for updated references.
The author's final comments suggest several other areas where information is lacking. She recommends the following:
* Conduct research on the efficacy of teaching interventions commonly recommended and in use today.
* Although teaching strategies are routinely recommended, many have not been empirically tested with this population.
* Establish better means to identify, understand, and assist children and adolescents with mild TBI.
* Provide training about pediatric TBI at both at preservice and inservice levels so that professionals can work moreeffectively with the students, their families, and other service providers.
Despite the rather dated nature of the references provided, the author's approach reflects current thinking on her subject matter. I enjoyed reading this text and believe it to be a useful text for school psychologists and related personnel. It also could be used as a primary text for training neuropsychologists to work with a pediatric population. I especially liked the reader-friendly writing style. The book is easy to follow and contains technical and practical information that forms a basis for the ideas presented. I also appreciated the fact that this author has "walked the walk." Her personal comments and anecdotes made the text come alive and led me to believe she is sharing from her clinical life as well as her heart. I believe she has made a significant contribution to this field and readers will be able to use this text as a resource for many years to come.