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Building Blocks - Intermediate Processes

Colorado Kids with Brain Injury - A banner with young kids in primary colors and a colorful brain.

Building Blocks of Brain Development

The intermediate level (green) building blocks denotes all learning and language and visual-spatial processing.


New Learning

 

Behavioral Impacts

Make a differential distinction between New Learning and Memory problem

  • Easily frustrated or overwhelmed
  • Angry outbursts or meltdowns
  • Can be misclassified as lazy
  • Can seem defiant
  • Copies others’ behavior or work
  • Follower
  • Forgetful
  • Makes things up to save face
  • May not exert effort when new material is presented
  • Spacey

Cognitive Academic Impacts

  • Cannot generalize or over generalizes information
  • Does not remember information they have been taught
  • Fails to see big picture
  • Forgets people and names
  • Inconsistent performance day to day
  • May be able to memorize but cannot apply information
  • Poor result in spite of extensive effort
  • Splintered or Uneven learning

Assessment Suggestions

  • A Developmental Neuropsychological Assessment, 2nd (NEPSY-II): Memory and Learning- Immediate Trials
  • Differential Ability Scales, 2nd (DAS-II): Recall of Objects-Immediate Trials
  • Kaufman Assessment Battery for Children, 2nd, (KABC-II): Learning Ability Scale
  • Woodcock Johnson, 4th (WJ-IV): Test of Cognitive Abilities: Story Recall, Visual Auditory Learning
  • Test of Memory and Learning, 2nd, (TOMAL-2): New Learning Index
  • Wide Range Assessment Memory and Learning, 2nd (WRAML2)
  • Wechsler Memory Scales, 3rd (WMS-III)

  • Children’s Memory Scales (CMS)
  • California Verbal Learning Test, 2nd (CVTL-II)
  • California Verbal Learning Test-Children’s Version (CTVL-C)
  • Clinical Evaluation of Language Fundamentals, 4th (CELF-4): Paragraph Recall Subtest
  • Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI) for Adolescents
  • Observations in the environment
  • Behavior observations during testing
  • Parent, Teacher and Student Interviews

Environmental Supports and Accommodations

  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • Teach new material in context and draw on background knowledge
  • Teach to learning style strength and reinforce with different types of learning methods
  • Use real world examples in teaching to make new learning meaningful
  • Multimodal learning
  • Preview new material
  • Repeat instructions
  • Review daily learning
  • Have child repeat back instruction to demonstrate understanding
  • Visualization

Resources and Intervention

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Language - Receptive

 

Behavioral Impacts

  • Acts out
  • Confused
  • Difficulty with auditory information
  • Does not understand multiple meaning words, inferential, figurative and more complicated abstract language
  • Echolalia
  • Follower
  • Inability to follow multi-step directions
  • Inattentive, distractible
  • Says “huh” frequently
  • Slow or does not respond to directions
  • Social withdrawal

Cognitive Academic Impacts

  • Difficulty understanding complex ideas or direction
  • Answers wrong question
  • Circumlocution
  • Delayed reading
  • Difficulty following instructions
  • Difficulty problem solving
  • Difficulty understanding homework assignments
  • Difficulty with math word problems
  • Poor reading comprehension
  • Reading or writing weakness
  • Slow to understand
  • Writing output is weak

Assessment Suggestions

  • Clinical Evaluation of Language Fundamentals-Preschool, 2nd (CELF-Preschool-2)
  • Clinical Evaluation of Language Fundamentals, 5th (CELF-5): Receptive Language Index
  • Comprehensive Assessment of Spoken Language, 2nd (CASL-2)
  • Listening Test
  • Oral and Written Language Scales, 2nd (OWLS-II)
  • Peabody Picture Vocabulary Test, 4th (PPVT-4)
  • Preschool Language Scales, 5th (PLS-5)
  • Test of Language Competence, Expanded Edition (TLC-E)
  • Test of Problem Solving, 2nd Adolescent (TOPS-2)
  • Test of Problem Solving, 3rd Elementary (TOPS-3)
  • Observations in the environment
  • Observations during testing
  • Parent, Teacher and Student Interviews

Environmental Supports and Accommodations

  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) 
  • Speech Language Pathologist Consult
  • Allow extra “think” time
  • Break complex directions into concrete examples
  • Give directions slowly and one at a time
  • Have child repeat back instructions
  • Provide directions, assignments, lectures in writing
  • Reduce semantic load to minimize frustration and confusion
  • Reinforce with visual cues
  • Teach the use of graphic organizers to visually represent concepts
  • Identify target vocabulary and integrate throughout lessons

Resources and Intervention

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Language - Expressive

 

Behavioral Impacts

  • Word retrieval difficulty using words and sentences to express ideas
  • Uses poor grammar or immature speech
  • Breakdown in logical sequencing of ideas
  • Circumlocution
  • Difficult to follow in conversations
  • Difficulty interpreting sarcasm
  • Dysarthric speech (slow, slurred speech, mumbling)
  • Frequently repeat the same question or make the same comment
  • Act out
  • Follower
  • Frustration
  • Ruminating on topics
  • Social withdrawal

Cognitive Academic Impacts

  • Difficulty identifying or providing salient details
  • Difficulty summarizing
  • Difficulty with problem-solving
  • Lack of specific language in academic work
  • Often repeats the same idea rather than providing more or different information about a topic
  • Responses may be short without much elaboration on topic
  • Trouble participating in class discussions
  • Trouble writing essay questions or re-telling stories

Assessment Suggestions

  • Clinical Evaluation of Language Fundamentals, 5th (CELF-5): Expressive Language Index
  • Clinical Evaluation of Language Fundamentals-Preschool, 2nd (CELF-Preschool-2)
  • Comprehensive Assessment of Spoken Language, 2nd (CASL-2)
  • Expressive One-Word Picture Vocabulary Test, 4th (EOWPVT-4)
  • Functional Communication Measures (FCM)
  • Oral and Written Language Scales, 2nd (OWLS-II)
  • Preschool Language Scales, 5th (PLS-5)
  • Wechsler Intelligence Scale for Children, 5th (WISC-V): Verbal Comprehension Index
  • Differential Ability Scales, 2nd (DAS-II): Verbal Composite
  • Kaufman Assessment Battery for Children, 2nd (KABC-II): Knowledge Ability Scales
  • Woodcock Johnson, 4TH (WJ-IV): Oral Vocabulary
  • A Developmental Neuropsychological Assessment, 2nd (NEPSY-II): Language Subtests
  • Wechsler Individual Achievement Test, 3RD Ed. (WIAT-3): Oral Expression

Environmental Supports and Accommodations

  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) 
  • Speech Language Pathologist Consult
  • Allow child to dictate thoughts prior to writing
  • Ask open-ended questions
  • Provide choices
  • Teach attributes of concepts
  • Teach summarization skills
  • Teach the child appropriate expressions, role play
  • Allow plenty of time for responses and do not pressure the child

Resources and Intervention

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Language - Social Pragmatic

 

Behavioral Impacts

  • Difficulty building or maintaining friendships
  • Difficulty negotiating social rules
  • Difficulty staying on topic
  • Difficulty taking turns
  • Difficulty understanding humor, jokes or sarcasm
  • Difficulty with proprioception (knowing body in space)
  • Difficulty responding to facial expressions and body language
  • Frustration
  • Inappropriate use of jokes, sarcasm or humor
  • Inappropriate tone of voice

Cognitive Academic Impacts

  • Difficulty making and maintaining friendships
  • Difficulty working in groups in the classroom
  • Doesn’t seem to fit into social groups in less structured settings such as recess, lunch, etc.

Assessment Suggestions

  • Clinical Evaluation of Language Fundamentals, 5th (CELF-5)
  • Conversational Effectiveness Profile–Revised (CEP-R)
  • Social Language Development Test, Elementary or Adolescent
  • Test of Problem Solving, 2nd Ed Adolescent (TOPS-2)
  • Test of Problem Solving, 3rd Ed Elementary (TOPS-3)
  • Test of Pragmatic Language, 2nd (TOPL-2)
  • Children’s Communication Checklist, 2nd (CCC-2)
  • Social Emotional Evaluation (SEE)
  • Social Language Development Test-Elementary or Adolescents
  • A Developmental Neuropsychological Assessment, 2nd (NEPSY-II): Social Perception Subtests
  • Observations in the environment
  • Parent, Teacher and Student Interviews

Environmental Supports and Accommodations

  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3 and 4) 
  • Develop friendship groups
  • Consider students place with for partner/group work
  • Model and role play social interactions
  • Social narratives
  • Teach social problem solving skills
  • See Social/Emotional Competency Building Block

Resources and Intervention

  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • Social Language Development Scenes (Elementary/ Adolescent) (Linguisystems)
  • Social Thinking Worksheets for Tweens and Teens (Winner)
  • Superflex: A Superhero Social Thinking Curriculum (Winner)
  • You are a Social Detective (Winner)
  • American Speech Language Hearing Association http://www.asha.org
  • See Interventions in Social/Emotional Competency Section

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Visual-Spatial

 

Behavioral Impacts

  • Can experience behavior issues due to frustration of not understanding visual materials and expectations
  • Appears overwhelmed
  • Struggles reading social cues or facial expressions
  • Complains that “it all blends together”
  • Difficulty organizing materials
  • Difficulty with proprioception (knowing body in space)
  • Gets lost
  • Increased headaches during visual tasks
  • Sensitivity to light

Cognitive Academic Impacts

  • Depth perception issues
  • Difficulty organizing written work
  • Difficulty using charts, maps, and graphs
  • Difficulty with Mathematics/Geometry
  • Distance perception difficulty
  • Handwriting issues
  • Struggles with mental rotation and object construction
  • Reading difficulty
  • Spatial perception and orientation difficulty
  • Issues visualizing mental maps

Assessment Suggestions

  • A Developmental Neuropsychological Assessment, 2nd (NEPSY-II): Visualspatial Processing Subtests
  • Wechsler Intelligence Scale for Children, 5th (WISC-V): Visual Spatial Index, Fluid Reasoning Index, Picture Concepts
  • Woodcock Johnson, 4th (WJ-IV), Cognitive: Visualization, Picture Recognition
  • Differential Ability Scales, 2nd (DAS-II): Spatial Composite
  • Kauffman Assessment Battery for Children (KABC-II): Simultaneous Processing Ability Scale
  • Beery-Buktenica Developmental Test of Visual Motor Integration, 6th (BEERY VMI)
  • Leiter International Performance Scale, 3rd (Leiter-3)
  • Test of Visual Perceptual Skills, 3rd Ed. (TVPS-3)

Environmental Supports and Accommodations

  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) 
  • Consider if visual presentation of worksheets needs to be modified
  • Enlarge written materials
  • Provide directions verbally
  • Frequent checks for understanding
  • Provide support in aligning math problems (graph paper)
  • Provide support in organizing writing from left to right and organizing/expressing thoughts
  • Reduce visual “clutter” at student’s desk
  • Use a ruler/straight edge to track reading
  • Verbal focus on learning
  • Visual planners (webs, diagrams) may be too confusing

Resources and Intervention

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Additional Resources

 

(*indicates free)

  • Helping the Child who Doesn’t Fit In. 1992. Nowicki, S. and Duke, MP. Peachtree Publishers
  • How does your engine run? Alert Program for Self-Regulation. 1996. Williams, MS. & Shellenberger, S. TherapyWorks, Inc.
  • In Focus: Improving Social and Emotional Intelligence One Day at a Time. 2013. McSheehy, T. Burlington, WI: Thoughtful Learning.
  • Incredible 5 Point Scale. 2012  Burone, K. D. & Curis, M. Lenexa, KS: AAPC
  • Incredible Years, Incredible Years Program, Seattle, Washington http://www.incredibleyears.com/
  • *Interventioncentral.org – Interventions, suggestions, tools for social/emotional strategies. www.interventioncentral.org
  • Kidspiration (Grades K-5) & Inspiration (Grades 6-Adult) Software programs – http://www.inspiration.com/
  • Late, Lost, and Unprepared: A Parent’s Guide to Helping Children with Executive Funtioning. 2008. Cooper-Kahn, J. & Dietzel, L. Bethesda, MD: Woodbine House, Inc.
  • *LEARNet, Ylvisaker, M, HibbardM & Feeney, T. www.projectlearnet.org
  • Lifeskills Training http://www.lifeskillstraining.com
  • Lost at School: Why Our Kids with Behavioral Challenges are Falling Through the Cracks and How We Can Help Them. 2014. Greene, R.W. New York, NY: Scribner.
  • Make social learning stick!: How to guide and nurture social competence through everyday routines and activities. 2012. Sautter, E. Shawnee Mission, KS: AAPC Publishing.
  • The MindUp Curriculum: Brain Focused Strategies for Learning and Living. 2010. Hawn Foundation. New York, NY: Scholastic Teaching Resources.
  • *Positive Behavior Intervention Support. https://www.pbis.org
  • Project Achieve: Stop & think social skills program. 2001.  Knoff, H. Longmont, CO: Sopris West.
  • Promoting Executive Function in the Classroom. 2010. Meltzer. L. New York, NY: Guilford Press.

  • Providing Alternative Thinking Strategies (PATHS), Kusche, C. and Greenberg, M., Channing Bete Company.
  • Sarah Ward: Cognitive Connections: 360 Thinking.  http://efpractice.com/
  • SecondStep: Skills for Social and Academic Success. 2011. Goldstein, A & McGinnis, E. Research Press Publishers http://www.cfchildren.org/second-step SkillStreaming.
  • Smart but Scattered. 2009.  Dawson P & Guare R. NY: Guilford Press.
  • Smart but Scattered Teens. 2013. Guare, R., Dawson, P. & Guare. New York, NY: Guilford Press.
  • Social Thinking Worksheets for Tweens and Teens. 2014. Garcia Winner, M. San Jose, CA: Think Social Publishing, Inc.
  • Superflex: A Superhero Social Thinking Curriculum. 2008. Madrigal, S. & Garcia Winner, M.  Think Social Publishing.
  • Teachers Encyclopedia of Behavior Management 100 Problems/500 Plans. 2012. Sprick, R and Howard, L. Pacific Northwest Publishing
  • *Think:Kids – Rethinking Challenging Kids. Massachusetts General Hospital.  http://www.thinkkids.org/
  • Tools for Teaching, 3rd Edition. 2013. Jones F. CA: Frederic H Jones & Associates, Inc.
  • Treating Explosive Kids: The Collaborative Problem Solving Approach. 2005. Greene, R.W. & Ablon, J.S. New York, NY: Guilford Press.
  • Visual Spatial Portals to Thinking, Feeling and Movement 2012. Wieder, S., & Wachs, H. Mendham, New Jersey: Profectum Foundation
  • *What Works Clearinghouse. 2002. U.S. Department of Education, Institute for Education Sciences.   www.whatworks.ed.gov
  • Why Try – Building Resilience in the Workplace, at School and at Home.  Moore, C. https://www.whytry.org/
  • You are a Social Detective. 2008.  Garcia Winner, M. & Crooke, P. San Jose, CA: Think Social Publishing, Inc.
  • The Zones of Regulation: A Framework to Foster Self-Regulation & Emotional Control. 2011. Kuypers, L. San Jose, CA: Think Social Publishing.

Building Blocks of Brain Development & Glossary Developers/Authors (2018): Nicole Crawford, Patricia Colella, Judy Dettmer, Heather Hotchkiss, Karen McAvoy, Peter Thompson, Janet Tyler. Special Thanks to Tami Cassel, Donna Detmar-Hannah, Laura Dosch, Jayne Dougherty, Mary Linz, and Jennifer Mathis.

Revise only with permission.

Revised Brain Injury Matrix & Glossary Developers/Authors (2015): Nicole Crawford, Patricia Colella, Donna Detmar-Hannah, Judy Dettmer, Heather Hotchkiss, Corey Klein, Karen McAvoy, Peter Thompson, Kristy Werther.

Traumatic Brain Injury Networking Team Steering Committee (TNT)-Original Developers/Authors of the Brain Injury Matrix (2012): Nicole Crawford, Judy Dettmer, Jeanne Dise-Lewis, Priscilla Hurley, Megan Koepsell, Karen McAvoy, Kathy Patrick, Peter Thompson, Liz Wilburn.