School performance of students with acquired brain injury

151 Pages·2011·1.2 MB·English

Classroom Performance of Students with
an Acquired Brain Injury: The Impact of Aide Programs

Ruth Tesselaar
BAppSci(DisStuds), Grad.Dip.Psych

Submitted in partial fulfilment of the requirements of the degree of
Doctor of Psychology (Clinical Neuropsychology)

School of Social Sciences and Psychology
Victoria University, Melbourne, Australia
July 2010
ABSTRACT

A number of studies have examined the behavioural and academic difficulties that
follow paediatric Acquired Brain Injury (ABI) and made recommendations that
students with an ABI be provided with an aide program. However, there is a lack of
studies that have been carried out to examine the outcomes of the implementation of
aide programs in the paediatric ABI population. The current study investigated the
impact of aide programs on eight students (aged nine to fifteen years) with an ABI.
In addition, the current study also investigated factors that were found to promote
positive outcomes of aide programs. Measures used included: direct observation;
interviews with the students, parents, teachers and aides; and neuropsychological
tests including the BRIEF, CAFT, TEA-Ch, and WISC-IV Digit Span subtest. The
data were analysed descriptively using both qualitative and quantitative techniques.
Results demonstrated that the provision of an aide program resulted in a decrease in
negative behaviours in the classroom and an increase in students‟ access to the
curriculum. In addition to three frequently discussed factors (including individual
assessments of students‟ cognitive profile, the provision of education and support to
teaching staff on the impact of ABI), additional factors important to the outcome of
aide programs were raised. These factors included aides having an adequate
knowledge of the curriculum, aides being able to provide support through a positive
helping style, and awareness of the students‟ need to fit-in. A model to promote
positive outcomes of aide programs for students with an ABI was then proposed
based on these six factors. This model suggested that these six factors fall into one
of two stages required for the provision of aide programs with positive outcomes.
The factors in stage one are those that require consideration during preparation for
the implementation of an aide program. The factors in stage two require
consideration during service delivery of an aide program (i.e. in the classroom).
Consideration of both stages was found to lead to positive outcomes of aide
programs, with an absence of either stage found to lead to negative outcomes of aide
programs for students with an ABI.

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DECLARATION

I, Ruth Tesselaar, declare that the Doctor of Psychology (Clinical Neuropsychology)
thesis entitled “Classroom Performance of Students with an Acquired Brain Injury:
The Impact of Aide Programs” is no more than 40,000 words in length including
quotes and exclusive of tables, figures, appendices, bibliography, references and
footnotes. This thesis contains no material that has been submitted previously, in
whole or in part, for the award of any other academic degree or diploma. Except
where otherwise indicated, this thesis is my own work.

Signature: Date:

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ACKNOWLEDGEMENTS

I would like to acknowledge the contributions of the following people without whose
help and guidance this thesis may never have reached completion:

My participants: the students, parents, aides, and teachers. Thankyou for letting me
into your homes, schools, and workplaces. Without your willingness to contribute
none of this would have been possible.

My dear friend Cathy Bucolo for being the one to nurture and encourage my interest
in paediatric ABI in the early days of my career.

A fellow researcher, Margaret Mealings, for willingly sharing her time for a
brainstorming session back in 2006 that helped shape this thesis.

Genevieve McMahon for her patience and interest in reading every word of my
literature review numerous times over, and for her feedback and assistance with
redirecting me when I felt lost in the middle of thousands of words

My supervisor, Dr. Gerard Kennedy, for somehow always having faith that I would
complete my thesis. Especially when I had none.

My family and friends for supporting me in numerous ways, and for allowing me the
time to complete my thesis. I am now available to spend as much time with you all
as I want!

My (nearly) husband, Danny, for his never ending support, encouragement, and
editing. And also for being the only person to have never asked me “aren‟t you done
yet?”

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TABLE OF CONTENTS

LIST OF FIGURES .................................................................................................. viii
LIST OF TABLES ..................................................................................................... ix
LIST OF APPENDICES ............................................................................................. x
CHAPTER ONE: INTRODUCTION .......................................................................... 11
1.1. Paediatric Acquired Brain Injury ................................................................ 12
1.1.1. Incidence of paediatric ABI ................................................................ 12
1.1.2. Paediatric ABI in the education system ............................................. 13
1.2. Sequelae of Paediatric ABI ......................................................................... 15
1.2.1. Physical, sensory, and psychosocial sequelae .................................. 15
1.2.2. Cognitive sequelae ............................................................................ 16
1.2.2.1. Attention ............................................................................ 18
1.2.2.2. Memory ............................................................................. 20
1.2.2.3. Speed of information processing ....................................... 22
1.2.2.4. Executive Functions .......................................................... 24
1.3. Return to School Following Paediatric ABI ............................................... 26
1.3.1. Academic outcomes .......................................................................... 27
1.3.2. Classroom performance .................................................................... 30
1.4. Educational Interventions ........................................................................... 32
1.4.1. Assessment of need .......................................................................... 33
1.4.2. Communication and knowledge ........................................................ 35
1.4.3. Teaching strategies ........................................................................... 38
1.4.4. Implications for future research ......................................................... 41
1.5. Aides ............................................................................................................ 42
1.6. Summary and Rationale for Current Study ............................................... 46
1.6.1. Aims and hypotheses ........................................................................ 47
CHAPTER TWO: METHOD ..................................................................................... 48
2.1. Participants .................................................................................................. 48
2.2. Materials ...................................................................................................... 48
2.2.1. Cognitive test battery......................................................................... 48
2.2.2. Semi-structured interviews ................................................................ 53
2.2.3. Observational measures ................................................................... 54
2.3. Procedure .................................................................................................... 54
2.3.1. Initial and revised research designs .................................................. 54
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2.3.2. Procedure ......................................................................................... 55
2.4. Preparation of Data for Analysis ................................................................ 57
2.5. Data Analysis ............................................................................................... 58
2.5.1. Quantitative data ............................................................................... 58
2.5.2. Qualitative data ................................................................................. 59
CHAPTER THREE: RESULTS ................................................................................ 60
3.1. Demographic characteristics of the participants ...................................... 60
3.2. Correlation between neuropsychological measures and observed
negative behaviours .................................................................................... 61
3.2.1. Measures of attention ........................................................................ 61
3.2.2. Measures of memory......................................................................... 62
3.2.3. Measures of speed of information processing ................................... 63
3.2.4. Measures of executive functioning .................................................... 63
3.3. Behaviours and Interventions .................................................................... 65
3.3.1. Observed behaviours and associated interventions .......................... 65
3.3.2. Impact of aide presence on the continuation of observed behaviours 67
3.4. Knowledge and Support of Teaching Staff ................................................ 68
3.4.1. Knowledge of Teaching Staff............................................................. 68
3.4.2. Support for Teaching Staff ................................................................ 70
3.5. The Impact of Aide Programs ..................................................................... 72
3.5.1. Quantitative data on the impact of the aide program ......................... 72
3.5.2. Impact of knowledge and support on student outcomes .................... 72
3.5.3. Qualitative data from parents on the impact of the aide program ....... 73
3.5.4. Qualitative data from students on the impact of the aide program ..... 74
CHAPTER FOUR: DISCUSSION ............................................................................. 77
4.1. Cognitive Performance and Classroom Behaviours ................................ 77
4.1.1. Attention ............................................................................................ 78
4.1.2. Memory ............................................................................................. 79
4.1.3. Speed of Information Processing ...................................................... 81
4.1.4. Executive Functions .......................................................................... 82
4.1.5. Implications for future research ......................................................... 84
4.2. Impact of Aide Programs on Classroom Performance ............................. 85
4.2.1. Targeted interventions ....................................................................... 85
4.2.2. Decrease in negative behaviours ...................................................... 88
4.2.3. Teaching strategies used .................................................................. 89
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4.2.4. Perceptions of students and parents ................................................. 90
4.2.5. Implications for practice ..................................................................... 91
4.3. Factors Leading to Positive Outcomes ..................................................... 91
4.3.1. Knowledge ........................................................................................ 92
4.3.1.1. Knowledge of the curriculum.............................................. 95
4.3.2. Support ............................................................................................. 96
4.3.3. Helping style ..................................................................................... 98
4.3.4. Implications for practice ................................................................... 100
4.4. Conclusions and Future Directions ......................................................... 101
REFERENCES ....................................................................................................... 104
APPENDICES………………………………………………………………………......….118

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LIST OF FIGURES
Figure 3.1: Mean number of occurrences of observed behaviours and interventions
provided across all four cognitive domains (n=6). ........................................ 66
Figure 3.2: Mean numbers of teaching strategies provided by the teacher and aide
(n=8). ........................................................................................................... 67
Figure 3.3: Mean number of observed behaviours which initially occurred and mean
number of behaviours which continued for more than one five-minute
segment of the observation period when an aide was present and not (n=6).
.................................................................................................................... 67
Figure 3.4: Count of teacher and aide self ratings of level of knowledge around
students with an ABI. ................................................................................... 68
Figure 3.5: Count of teacher and aide self ratings of support received to work with the
student with an ABI. ..................................................................................... 70
Figure 3.6: Mean ratings of teachers and aide‟s in regards to the current level of
support provided to them, and if they require extra supports. ....................... 71
Figure 3.7: Parent, teacher, and aide ratings of how well they think the aide program
is meeting the needs of the student. ............................................................ 72
Figure 4.1: A proposed model to provide aide programs with positive outcomes for
students with an ABI. ..................................................................................102

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LIST OF TABLES
Table 1.1: Examples of how cognitive impairments commonly manifest as negative
behaviours in the classroom ........................................................................ 31
Table 1.2: Examples of freely available resources on supporting students with an
ABI............................................................................................................... 36
Table 1.3: Commonly presented teaching strategies for students with an ABI. ........ 39
Table 2.1: Score conversion table .......................................................................... 57
Table 2.2: Pre-determined categories for data analysis ........................................... 59
Table 3.1: Demographic and educational characteristics of participants. ................. 60
Table 3.2: Number of data sets collected for each procedure. ................................. 61
Table 3.3: Correlations between formal measures of attention performance and
number of observed behaviours (one-tailed). ............................................... 62
Table 3.4: Correlations between formal measures of memory performance and
number of observed behaviours (one-tailed). ............................................... 62
Table 3.5: Correlations between formal measures of SOP performance and number
of observed behaviours (one-tailed). ............................................................ 63
Table 3.6: Correlations between formal measures of EF performance and number of
observed behaviours (one-tailed). ................................................................ 64
Table 3.7: Correlations between the BRIEF Teacher and Parents forms and number
of observed behaviours (one-tailed). ............................................................ 64
Table 3.8: Paired samples t-test and Wilcoxon signed ranks test results for difference
between the number of targeted interventions provided (one-tailed) (n=6). . 66
Table 3.9: Correlation matrix between ratings of how well the aide program meets
students‟ needs and ratings of teacher and aide levels of knowledge and
support (two-tailed) (n=6, unless otherwise indicated). ................................ 73
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LIST OF APPENDICES
Appendix 1: Recruitment advertisement .................................................................118
Appendix 2: CAFT administration instructions ........................................................121
Appendix 3: Semi-structured interviews ..................................................................123
Appendix 4: Observational reference table .............................................................133
Appendix 5: Observational chart.............................................................................135
Appendix 6: Ethics approval ...................................................................................137
Appendix 7: Participant information sheets and informed consent ..........................139
Appendix 8: The ideal aide as described by secondary school students with an ABI
...................................................................................................................150

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