Sunday, May 6, 2012
Concussion Crisis: Special Education, Drug Abuse and Homelessness by Linda Carrol and David Rosner
Dr. Wayne Gordon specialized in the neuropsychology and rehabilitation of traumatic brain injuries at Mount Sinai School of Medicine in New York City. Most of the patients he saw were adults, but he began to wonder what might be happening to kids in similar situations. He and his colleagues developed a questionnaire designed to ferret out undiagnosed TBSs and cognitive difficulties in children and took it into New York City schools. The results gave Gordon pause. In one city school, 10 percent of the children said they had sustained a significant head injury. When tested later, these children turned out to have cognitive impairments. With a grant from the U.S. Department of Education, he was able to explore the issue further: surveying children who’d been enrolled in special education classes. He was startled by the result: more than 50% of the learning-disabled children had experienced a sharp jolt to the head.
The typical curriculum in special education classes didn’t help with the deficits associated with traumatic brain injuries. Gordon realized that the best way to help these children was to educated the educators. He gathered up a team of Mount Sinai psychologists and, with federal dollars that had been set aside to fund TBI education, set up a project in 1995 to send them into New York City schools.
They taught teachers to identify the specific signs of TBI and show them strategies to help brain-injured children cope better with the demands of school., helping them to focus their attention, avoid distractions, make lettering on handouts larger and to limit the amount of information presented on a single page so student’s wouldn’t be overwhelmed. Some students were provided with peer note-takers and tape-recorders to help then focus on understanding what was being said. Since brain-injured children tended to become exhausted easily, breaks between tough classes like math and science were scheduled. Students were encouraged to visit a special resource room before and after school so teachers could make sure to make sure they had the right assignments or to loan them materials they might have forgotten to bring to school. Since TBIs often lead to slow mental processing the kids were given more time for tests and reduced homework levels. Students were given more time to formulate questions in class. Students were encouraged to create day-planners and color-code their folders and notebooks. They were allowed to use calculators since it is so difficult for TBI kinds to memorized multiplication tables.
Over the five years that then program was in effect, the psychologists from Mount Sinai worked with more than four hundred children. Funding petered out in 2001 and no one else stepped up to keep the TBI program going.
The experience with “hidden” TBIs in the school system led Dr. Gordon to suspect that other people might be getting off track because of unrecognized brain damage. A 2000 study showed that people with a head injury were at higher risk for depression as well as alcohol and drug abuse, Gordon and his colleagues decided to look at the prevalence of TBI in New York State substance abuse programs. The researchers interviewed more than eight hundred patients and found that 54 percent had a history of head injuries. Forty percent of those with a history of head trauma had symptoms indicative of post-concussion syndrome. Further, those with head injuries turned out to have more mental illness and to be more prone to recidivism and treatment failure. “That suggests to me that these folks need a different treatment program,” says Gordon. “You can’t expect people with learning and memory problems to learn at the same pace as everyone else. If you see a thirty-day program doesn’t work, that may mean that these people need sixty or ninety. Maybe they need structured environments to live in, too.” Also, Gordon rightly concluded, early intervention could prevent damage down the line. “If (these kids) had been picked up and identified and treated as folks with TBI upon that first injury, they might have gotten the services they needed to prevent them from going down the path to substance abuse.”
Later, Gordon and his colleagues tested one hundred homeless persons for signs of brain injury. Nearly 70 percent had deficits in memory, language, or attention- all indicative of a possible brain injury. 2 percent reported a significant jolt to the head before they became homeless, often the result of abuse by a parent. Many of these people might be in a very different place in life had their brain injuries been been recognized as serious, had they received treatment. While the solution seems simple – get patients diagnosed quickly and then give them whatever rehab is necessary – it doesn’t translate into reality so easily.