ABA Strategies for Students with Traumatic Brain Injury

Hundreds of studies have shown that applied behavior analysis (ABA) is the most effective method to teach children and adolescents with autism spectrum disorder (ASD) and other developmental disabilities. ABA is a methodology that uses applied scientific interventions to address behavioral needs.
 
Many people are not aware, however, that ABA techniques such as positive reinforcement, teaching in small steps, and repeated practice can also be very effective for students with traumatic brain injury (TBI).
 
The growing numbers of children with these conditions continue to be a major concern in our society. According to recent statistics, one in 59 children in the United States has an ASD, and approximately 62,000 children sustain brain injuries each year as a result of motor vehicle crashes, falls, sports injuries, physical abuse, and other causes [Brain Injury Association of America].
 
For both populations, treatments that incorporate ABA methodology can facilitate the development of language, social interactions, and independent living. They can also help reduce both everyday social problems and serious behavior disorders.
 
Young people who have sustained TBI, like those with ASD, may experience challenges in a number of areas including:

• using and understanding language

• social skills

• emotional control, flexibility, and coping

• academics and learning

• planning, organizing, and remembering

• personality changes

• paying attention

• gross and fine motor skills 

Treatment should include rehabilitation and special education services provided by a multidisciplinary team of professionals. The team can include licensed psychologists, physical and occupational therapists, speech and language pathologists, behavioral specialists, and teachers specifically trained in the treatment of brain injury. Residential services can also be useful for individuals who need extra care.
 
When teachers and therapists at the May Center School for Brain Injury and Neurobehavioral Disorders in Brockton, Mass., employ the principles of ABA in classrooms and therapy rooms, they find that many of the challenges experienced by students with TBI can be successfully addressed.
 
For example, if we try to replace a student’s inappropriate behavior with a more appropriate behavior, we would use reinforcement whenever he or she displays the desired behavior. This reinforcement could include offering verbal praise or a high five, giving the student a chance to play with a favorite toy, or allowing him or her to take a break from work. We would provide the reinforcement frequently and as quickly as possible after the desired behavior occurred. If we give the student a specific reward for the appropriate behavior, we would make sure it was age- and developmentally appropriate, and only provide it if he or she engaged in the specific behavior we were addressing.
 
Providing choices is another ABA strategy that works well to help students with TBI modify their behavior and increase their independence. For example, students can be allowed to choose the order of their work tasks or how much time (within reason) they want to play with a preferred toy. Students might also enjoy choosing the route they take while going for a walk or which staff member they want to work with during a given time. Building choices into a student’s day is a good way to increase independence as well as give him or her opportunities to problem-solve.
 
Other ABA techniques, such as individualizing each student’s rehabilitation and educational goals and breaking those goals down into small, achievable steps, are also often successful with this population. And, as is the case for students with ASD, students with TBI benefit from having repeated opportunities to practice new skills. They often respond well when they see teachers, therapists, and fellow students model appropriate behaviors. In addition, providing positive reinforcement when students with TBI are learning new skills will lead to the best and quickest improvements.
 
With effective treatment such as ABA, students with TBI can and do make significant progress in regaining skills and becoming more independent. ABA is also effective at reducing the challenging behaviors exhibited by students with brain injury so they can participate fully within their families and communities. By utilizing ABA within a multidisciplinary team of professionals, many of the students can make meaningful gains in academics, social skills, vocational skills, and using replacement skills for challenging behaviors. In spite of the significant challenges that accompany a diagnosis of TBI, there is much cause for hope.

 By Jennifer Silber-Carr, Ph.D., BCBA-D

May Institute is a nonprofit organization that is a national leader in the field of applied behavior analysis and evidence-based interventions, serving autistic individuals and those with other developmental disabilities, brain injury and neurobehavioral disorders, and other special needs. Founded nearly 70 years ago, we provide a wide range of exceptional educational and rehabilitative services across the lifespan. In addition to its school for children and adolescents with brain injury and neurobehavioral disorders, May Institute operates five schools for children and adolescents with ASD and other developmental disabilities. For more information, call 800.778.7601 or visit www.mayinstitute.org.