Brain Injury Matrix Guide

image006The graphic to the right represents the hierarchy of neurocognitive development and functioning. Our brains develop each and every process/domain in a progressive manner. The processes build upon each other to become more complex (i.e., higher order thinking). The processes included here represent typical areas of processing/learning and those that are commonly affected by brain injury.

  • There may be other areas affected by brain injury, as this is not an exhaustive list.
  • The graphic depicts the “building blocks” at the fundamental, intermediate, and higher order levels.
  • Each level is color coded – the fundamental or foundational processes are at the base (orange level). These fundamental processes are very sensitive to brain injury and are essential for all learning and behavior.
  • The intermediate level (green) denotes all learning and language processing.
  • The higher order thinking skills and social emotional competency is represented at the blue level.
  • Overall functioning and achievement (purple level) requires the fundamental, intermediate and higher order domains to be solidly in place and work in concert with one another. A brain injury may cause gaps in the functioning of these domain areas which can impact learning and/or behavior.

The brain injury matrix is provided as a general guideline for educators and professionals. It was developed as a beginning “reference point” for professionals working with students where a brain injury is suspected or known to be present. The matrix offers a wide range of suggested assessment tools and intervention strategies for students with brain injury. It includes the domain areas of processing/learning most commonly affected by a brain injury. It does not cover all areas affected by a brain injury, nor is an exhaustive list. For more resources, please refer to the additional resources at the end of this guide.

Brain Injury Matrix

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Neuro-Developmental Domain Behavioral Impacts Cognitive Academic Impacts Assessment Suggestions Environmental Supports and Accommodations Resources and Intervention
Neuro-Developmental Domain Behavioral Impacts Cognitive Academic Impacts Assessment Suggestions Environmental Supports Accommodations Resources and Intervention

Attention

  • Difficulty with turn taking
  • Doesn’t turn in assignments
  • Fidgets/squirms in seat or doesn’t stay in seat
  • Interrupts conversation
  • Is easily distracted
  • Loses things
  • Low frustration tolerance
  • Off topic
  • Spacey and forgetful
  • Talks excessively
  • Careless mistakes on school work
  • Difficulty following directions
  • Does not follow through with directions/tasks
  • Doesn’t complete assignments
  • Erratic memory
  • Fails to give close attention to school work
  • Has inconsistent performance in school
(These assessments are used to look at attention impacts secondary to TBI, not to diagnose ADHD/ADD.)

  • A Developmental Neuropsychological Assessment, 2nd Ed. (NEPSY-II), Attention and Executive Functioning Subtests
  • Behavior Assessment System for Children, 2nd Ed. (BASC-2)
  • Behavior Observations during testing
  • Behavior Rating Inventory of Executive Function (BRIEF)
  • Behavioral Observations of Students in Schools (B.O.S.S.)
  • Brain Injury Observation Form in Chapter 4
  • Classroom Observations On Task/Off Task Peer Analyses
  • Cognitive Assessment System, 2nd Ed. (CAS2), Attention Composite (Consider Planning Composite)
  • Comprehensive Executive Function Inventory (CEFI)
  • Conners, 3rd Ed. (Conners 3)
  • Conners Continuous Performance Test, 3rd Ed. (CPT3)
  • Delis Rating of Executive Function (D-REF)
  • Delis-Kaplan Executive Function System (D-KEFS)
  • Tasks of Executive Skills (TEC)
  • Vanderbilt Teacher Behavior Evaluation Scale (VTBES)
  • Woodcock Johnson, 4th Ed. (WJ-IV), Tests of Cognitive Abilities and Oral Language: COG 3 Verbal Attention, COG 10 Numbers Reversed, COG 18 Memory for Words, OL 5 Sentence Repetition
  • Brain Breaks
  • Ensure that you have the child’s focus prior to giving instructions
  • Minds in Motion FIT STICKS
  • Redirect
  • Reduce visual and auditory distractions
  • Seat child closest to point of instruction and away from distractions
  • Vigorous movement to stimulate the brain, which will enhance focus
  • Alert Program: How Does Your Engine Run
  • Behavior Intervention Plan
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed sections: #2 Attention
  • Executive Function in Children and Adolescents (Dawson/Guare)
  • Executive Function in Education (Meltzer)
  • Positive Behavior Support
  • Project LEARNet
  • Smart but Scattered (Dawson/Guare)
  • Tools for Teaching (Jones/Jones)

Inhibition

  • Blurts thoughts out and can talk excessively
  • Calling out rather than waiting with hand raised
  • Can be physically on the go or driven by a motor; adult concern for physical safety
  • Fidgety/squirmy
  • Hard time staying in line, seat, classroom, etc.
  • Impulsive; “jumps before she looks”
  • Interrupts; socially intrusive
  • Jumps into an activity rather than waits for/reads instructions
  • Physical touch with others may be too much; disregard for boundaries
  • See Initiation under Executive Functions
  • Can be disruptive in the classroom
  • Difficulty following directions, not slowing down to process directions
  • May complete assignments incorrectly
  • May require a lot of redirection from teacher
  • Social difficulty
  • A Developmental Neuropsychological Assessment, 2nd Ed. (NEPSY-II)
  • Behavior Assessment System for Children, 2nd Ed. (BASC-2)
  • Behavior Rating Inventory of Executive Function (BRIEF)
  • Brain Injury Observation Form in Chapter 4
  • Cognitive Assessment System, 2nd Ed. (CAS2)
  • Delis-Kaplan Executive Function System (D-KEFS)
  • Observation in environment/FBA
  • Observation in testing (jump right in or thoughtful about responses/approach)
  • Stroop Color-Word Interference
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • LifeSkills Training
  • Project Achieve – Stop & Think Program (Knoff)
  • Project Success (Kastner)

Processing Speed

  • Acts like he doesn’t understand
  • Appears inattentive
  • Delay in response
  • Fatigues easily
  • Frustration
  • Delay in response
  • Difficulty following lecture
  • Difficulty multi-tasking
  • Difficulty taking timed tests
  • Does not appear to remember information
  • Incomplete work
  • Poor grades in-spite good effort
  • Slow at doing work
  • Brain Injury Observation Form in Chapter 4
  • Differential Ability Scales, 2nd Ed. (DAS-II), Processing Speed
  • Task of Executive Control (TEC)
  • Wechsler Intelligence Scale for Children, 5th Ed. (WISC-V), Processing Speed
  • Woodcock Johnson, 4th Ed. (WJ-IV), Cognitive: COG 4 Letter-Pattern Matching, COG 11 Number-Pattern Matching, COG 17 Pair Matching
  • Allow for delay in response
  • Be brief and concise
  • Copies of notes and outlines
  • Extra time
  • Give instructions one at a time
  • Repeat instructions
  • Short directions
  • Tape record lectures
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed section: #11 Mental Processing Speed
  • CogMed
  • Project LEARNet

Memory

Make a differential distinction between memory problems and New Learning

  • Appears manipulative
  • Appears to have attitude issues
  • Can’t remember more than one thing at a time
  • Disorganized
  • Doesn’t remember recent events
  • Forgets to turn in assignments
  • Gets lost frequently and easily
  • Learned helplessness
  • Looks spacey
  • Can’t re-tell a story
  • Difficulty retaining new skills
  • Difficulty with multi-step directions/multi-step problem
  • Difficulty with spelling
  • Fails test in spite of studying
  • Forgets assignment
  • Forgets events
  • Forgets people and names
  • Inconsistent performance
  • Splintered learning
  • State dependent learning
  • A Developmental Neuropsychological Assessment, 2nd Ed. (NEPSY-II), Memory and Learning
  • Brain Injury Observation Form in Chapter 4
  • Child and Adolescent Memory Profile (ChAMP)
  • Children’s Memory Scale (CMS)
  • Differential Ability Scales, 2nd Ed. (DAS-II), Memory Working Memory Subtests
  • Differential Ability Scales, 2nd Ed. (DAS-II), Recall of Designs
  • Differential Ability Scales, 2nd Ed. (DAS-II), Recall of Objects Delayed
  • Test of Memory and Learning, 2nd Ed. (TOMAL-2)
  • Test of Visual Processing Skills, 3rd Ed. (TVPS3), subtests: Visual Memory & Visual Sequential Memory
  • Wide Range Assessment Memory and Learning, 2nd Ed. (WRAML2)
  • Woodcock Johnson, 4th Ed. (WJ-IV), Cognitive and Oral Language: COG3 Verbal Attention, COG 10 Numbers Reversed, COG 16 Object Number Sequencing, COG 18 Memory for Words, OL 5 Sentence Repetition
  • Woodcock Johnson, 5th Ed. (WISC-V), Working Memory
  • Experiential Learning
  • Have student paraphrase directions or steps
  • Mnemonic strategies
  • New concepts – engage background knowledge
  • Pictures or visual cues
  • Practice daily routine
  • “Priming the pump” – slightly elevate emotions when teaching new concepts
  • Repeat instructions out-loud
  • Use memory aids e.g. visual cues, planners, PDAs or other compensatory strategies
  • Use of competitive games
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed sections: #9 Memory
  • Project LEARNet

Sensory and Motor (over-stimulation)

  • Always touching people or things
  • Appears overwhelmed
  • Behavior may appear oppositional however, it may be adaptive; e.g. wearing hat to cover eyes, laying on the floor
  • Bumps into others when in line
  • Clothes are disheveled due to tugging and sucking on clothes
  • Emotionally melt down
  • Fidgety
  • Irritable, short fuse
  • Overly excited in stimulating environments such as the playground, PE, lunchroom, etc.
  • Seeks oral stimulation
  • Seeks physical feedback, e.g. leans on desk
  • Tunes out due to over stimulation
  • Difficulty completing worksheets with too many items on them
  • Difficulty shifting from workbook/text book to writing on answer sheet/paper
  • Difficulty transitioning
  • Difficulty with group work and group discussion
  • Difficulty with reading due to visual stimuli
  • Difficulty with seat work
  • Excessive erasing, crossing out of words
  • Gets overwhelmed in crowded environments
  • Incomplete work
  • Messy papers, school work is not well-organized
  • Poor handwriting
  • Behavioral Classroom Observations
  • Brain Injury Observation Form in Chapter 4
  • Effective informal vision – ocular motor control
  • Functional Behavioral Assessments
  • Functional vision
  • OT Consult
  • PT Consult
  • Sensory Processing Measure
  • Sensory Profile
  • Vision and hearing screening: conversion/tracking/depth perception
  • Allow student to dictate first draft of written assignment rather than write
  • Allow student to use a computer for written work
  • Ball cap or sunglasses for light sensitivity
  • Break down written work into chunks
  • Conduct assistive technology evaluation
  • Deep joint pressure
  • Preferential and thoughtful seating to reduce auditory and visual stimulation
  • Preferential seating to decrease sensory input
  • Reduce number of problems on a page
  • Reduce visual and auditory distractions
  • Situation intensity: turn stimulation down/off
  • Situation modification: earplugs, sunglasses, visors, moving to a new location
  • Situation selection: tune into preferential sound, mindfulness, goal orientation, diaphragmatic breathing
  • Use color overlays
  • Use line ruler to assist with visual tracking
  • Use study carrel
  • Weighted vests/items (blankets, animals)
  • Wiggle Seat/inflatable chair cushion/ dynamic seating systems
  • Alert Program: How Does Your Engine Run
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed section: #19 Sensory processing
  • Project LEARNet
  • Zones of Regulation

Sensory and Motor (under-stimulation)

  • Motor – can appear clumsy and run into objects/people
  • Motor – constantly on the move
  • Tactile – seeks out touch or being held
  • Takes a lot of sensation to stimulate the child – so they seek out more stimulation
  • Taste – picky eaters
  • Difficulty following verbal directions
  • Tactile – difficulty registering pain or pressure
  • Brain Injury Observation Form in Chapter 4
  • Allow them to chew gum, hard candy, or crunchy foods
  • Fidget items
  • Heavy work or deep pressure activities
  • Running or jumping
  • Stretch bands on chairs
  • Therapy seats/exercise balls for sitting
  • Therapy swings or swinging
  • Trampoline
  • Wall push-ups
  • Alert Program: How does Your Engine Run?
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)

Motor – Fine

Fine motor including sensorimotor

  • Difficulty with fasteners
  • Shaky hands/tremors
  • Avoids tasks involving writing
  • Difficulty with cutting
  • Difficulty with drawing
  • Poor handwriting
  • Takes long time to produce written work
  • A Developmental Neuropsychological Assessment, 2nd Ed. (NEPSY-II), Sensorimotor
  • Beery-Buktenica Developmental Test of Visual Motor Integration, Sixth Ed. (BEERY VMI)
  • Brain Injury Observation Form in Chapter 4
  • Bruininks-Oseretsky Test of Motor Proficiency, 2nd Ed. (BOT-2)
  • Differential Ability Scales, 2nd Ed. (DAS-II), Recall of Designs
  • Evaluation of Children’s Handwriting Skills – Grades 1-6 (ETCH)
  • OT Consult
  • Peabody Developmental Motor Skills, 2nd Ed. (PDMS-2)
  • PT Consult
  • Test of Visual Motor Skills (TVMS)
  • Adapted scissors
  • Allow student to use computer for written work
  • Develop pre-prepared materials so that they do not have to focus on cutting etc. but can focus on content
  • Guiding notes/outline
  • Pencil grips
  • Provide notes for student via another student or teacher
  • Slant boards
  • Speech to text technology
  • Typing/texting vs. writing
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed sections: #5 Fine motor control, #12 New Learning – Written Language, #16 Praxis
  • Project LEARNet
  • Assistive/Adaptive Technology

Motor – Gross

  • Avoids sports
  • Bumps into things
  • Can’t carry lunch tray
  • Clumsy
  • Falls
  • Stumbling
  • Unsteady on stairs, playground equipment or in crowds
  • Avoids recess
  • Difficulty with or avoidance of P.E.
  • Difficulty with slumping in seat
  • Brain Injury Observation Form in Chapter 4
  • Bruininks-Oseretsky test of Motor Proficiency, 2nd Ed. (BOT-2)
  • OT Consult
  • Peabody Developmental Motor Skills, 2nd Ed. (PDMS-2), for birth to 2 yr
  • PT Consult
  • Adapted PE
  • Adapted seating (chairs, desks)
  • Adaptive Sports and Physical Education
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed sections: #6 Gross motor Control, #16 Praxis

New Learning

Make a differential distinction between New Learning and Memory problem

  • Angry outburst or meltdowns
  • Can be misclassified as lazy
  • Can seem defiant
  • Copies others’ behavior or work
  • Follower
  • Forgetful
  • Frustration
  • Makes things up to save face
  • May not exert effort when new material is presented
  • Spacey
  • Cannot generalize or over generalizes information
  • Does not remember information they have been taught
  • Fails to see big picture; the gestalt
  • 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 learning
  • A Developmental Neuropsychological Assessment, 2nd Ed. (NEPSY-II), Memory and Learning- Immediate Trials
  • Brain Injury Observation Form in Chapter 4
  • Clinical Evaluation of Language Fundamentals, 4th Ed. (CELF-4), Paragraph Recall Subtest
  • Differential Ability Scales, 2nd Ed. (DAS-II), Recall of Objects-Immediate Trials
  • Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI) for Adolescents
  • Test of Memory and Learning, 2nd Ed., (TOMAL-2), New Learning Index
  • Wechsler Memory Scales, 3rd Ed. (WMS-III), and Children’s Memory Scales Immediate Trials
  • Wide Range Assessment Memory and Learning, 2nd Ed. (WRAML2)
  • Woodcock Johnson, 4th Ed. (WJ-IV), Cognitive: COG 6 Story Recall, COG 13 Visual Auditory Learning
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed sections: #12 New Learning
  • Project LEARNet
  • Teachers Encyclopedia of Behavior Management (100 Problems 500 Solutions) (Sprick/Howard)

Language – Receptive

  • Acts out
  • Confused
  • Difficulty understanding complex ideas or directions
  • 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
  • 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
  • Brain Injury Observation Form in Chapter 4
  • Clinical Evaluation of Language Fundamentals (CELF), Preschool
  • Clinical Evaluation of Language Fundamentals, 4th Ed. (CELF-4) and 5th Ed. (CELF-5), Receptive Language Index
  • Comprehensive Assessment of Spoken Language (CASL)
  • Listening Test
  • Metalinguistic Subtest
  • Oral and Written Language Scales, 2nd Ed. (OWLS-II)
  • Peabody Picture Vocabulary Test, 4th Ed. (PPVT-4)
  • Preschool Language Scales, 5th Ed. (PLS-5)
  • Test of Language Competence
  • Test of Problem Solving – 2 Adolescent (TOPS-2)
  • Test of Problem Solving – 3 Elementary (TOPS-3)
  • Wechsler Intelligence Scale for Children, 5th Ed. (WISC-V), Verbal Comprehension
  • Woodcock Johnson, 3rd Ed. (WJ-III), Auditory Processing
  • 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
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed sections: #4 Expressive Language, #17 Receptive Language, #12 New Learning – Reading, Written Language

Language – Expressive

  • Act out
  • Breakdown in logical sequencing of ideas
  • Circumlocution
  • Difficult to follow in conversations
  • Difficulty Interpreting sarcasm
  • Difficulty responding to facial expressions and body language
  • Dysarthric speech (slow, slurred speech, mumbling)
  • Follower
  • Frequently repeat the same question or make the same comment
  • Frustration
  • Ruminating on topics
  • Social withdrawal
  • Uses immature or inappropriate speech
  • Uses poor grammar or immature speech
  • Word retrieval difficulty using words and sentences to express ideas
  • 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
  • A Developmental Neuropsychological Assessment, 2nd Ed. (NEPSY-II), Language
  • Assessments in LANGUAGE-RECEPTIVE Section apply
  • Brain Injury Observation Form in Chapter 4
  • Clinical Evaluation of Language Fundamentals, 4th Ed. (CELF-4) and 5th Ed. (CELF-5), Expressive Language Index
  • Clinical Evaluation of Language Fundamentals, Preschool, 2nd Ed. (CELF: P-2)
  • Comprehensive Assessment of Spoken Language (CASL)
  • Differential Ability Scales, 2nd Ed. (DAS-II), Verbal
  • Expressive One-Word Picture Vocabulary Test
  • Functional Communication Measures (FCM)
  • Oral and Written Language Scales, 2nd Ed. (OWLS-II)
  • Preschool Language Scales, 5th Ed. (PLS-5)
  • Wechsler Individual Achievement Test, 3RD Ed. (WIAT-3), Oral Expression
  • Woodcock Johnson, 3rd Ed. (WJ-III), Verbal Comprehension
  • 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
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed sections: #4 Expressive Language, #12 New Learning – Reading, Written Language, #21 Word Retrieval

Language – Social Pragmatic

  • 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)
  • Frustration
  • Inappropriate use of jokes, sarcasm or humor
  • Understanding fast paced conversations
  • Use of appropriate tone of voice
  • 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.
  • A Developmental Neuropsychological Assessment, 2nd Ed. (NEPSY-II), Social Perception
  • Brain Injury Observation Form in Chapter 4
  • Clinical Evaluation of Language Fundamentals, 4th and 5th Ed., (CELF-4, CELF-5), Pragmatics Profile
  • Clinical Evaluation of Language Fundamentals, 5th Ed. (CELF-5), Metalinguistics
  • Clinical Evaluation of Language Fundamentals, 5th Ed. (CELF-5), Pragmatic Activities Checklist
  • Conversational Effectiveness Profile – Revised (CEP-R); http://www.socialpragmatics.com/cep-r.html
  • Social Language Development Test, Elementary or Adolescent
  • Test of Problem Solving-2 Adolescent (TOPS-2)
  • Test of Problem Solving–3 Elementary (TOPS-3)
  • Develop friendship groups
  • Get student involved with counselor
  • Work with classroom teacher to place student in work groups
  • 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)
  • (Also see Interventions in Social/Emotional Competency Section)

Visual-Spatial

  • Can experience behavior Difficulty due to frustration of not understanding visual materials and expectations
  • 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
  • Depth perception difficulty
  • Difficulty organizing written work
  • Difficulty using charts, maps and graphs
  • Difficulty with Mathematics/Geometry
  • Distance perception difficulty
  • Handwriting difficulty
  • Mental rotation
  • Object construction
  • Reading difficulty
  • Spatial perception and orientation difficulty
  • Visualizing mental maps
  • A Developmental Neuropsychological Assessment, 2nd Ed. (NEPSY-II), Visualspatial Processing
  • Beery-Buktenica Developmental Test of Visual Motor Integration, 6th Ed. (BEERY VMI)
  • Brain Injury Observation Form in Chapter 4
  • Differential Ability Scales, 2nd Ed. (DAS-II), Spatial Subtests
  • Kauffman Assessment Battery for Children (KABC-II), NonVerbal Scale
  • Leiter International Performance Scale, 3rd Ed. (Leiter-3)
  • Test of Visual Perceptual Skills, 3rd Ed. (TVPS-3)
  • Wechsler Intelligence Scale for Children, 5th Ed. (WISC-V), Perceptual Reasoning Subtests
  • Woodcock Johnson, 4th Ed. (WJ-IV), Cognitive: COG 7 Visualization, COG 14 Picture Recognition
  • Consider if visual presentation of worksheets needs to be modified
  • Enlarging written materials
  • Provide directions verbally-frequent check 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 to track reading
  • Verbal focus on learning
  • Visual planners (webs, diagrams) may be too confusing
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • See It, Say It, Do It (Hellerstein)
  • Visual Spatial Portals to Thinking, Feeling and Movement (Wieder/Wachs)

Executive Function: Initiation

  • Appears aloof or disinterested to peers
  • Can state what they are supposed to do but does not get started
  • Difficulty starting tasks
  • Does not independently start tasks
  • Does not make plans academically or socially
  • Follower
  • Lagging in independent living skills
  • May appear lazy or spacey
  • Often gets overlooked because they are not trouble in the classroom
  • Requires constant cueing
  • Seeks out adults for social interaction
  • Slow to shift at same time as peers
  • Unmotivated
  • Appears passive/resistant
  • Difficulty knowing how to get started
  • Difficulty managing long-range projects
  • Does not complete homework or seatwork
  • Turns in poor quality work
  • Woefully incomplete work
  • Assessment Observations
  • Behavior Rating Inventory of Executive Function (BRIEF)
  • Brain Injury Observation Form in Chapter 4
  • Classroom Observations
  • Comprehensive Executive Function Inventory (CEFI)
  • Delis Rating of Executive Function (D-REF)
  • Provide a written routine to assist/help student begin work
  • Provide assistance with getting started with school work
  • Provide more frequent check-ins to ensure student is completing work
  • Teach students how to observe others to identify what to do next
  • Use of contingency based interventions centering on video games
  • Use Visual imagery to practice the activity steps prior to initiation
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed section: #7 Initiation
  • Executive Skills in Children and Adolescents (Dawson/Guare)
  • Project LEARNet
  • Smart but Scattered (Dawson/Guare)
  • Tools for Teaching (Jones/Jones)

Executive Function: Planning

  • Difficulty with problem solving
  • Doesn’t make plans with friends
  • Rigidity of thinking
  • Difficulty with long term assignments
  • Difficulty with sequential tasks
  • Difficulty with time management
  • Difficulty writing papers
  • Doesn’t brainstorm
  • Often late for class
  • Often unprepared for class
  • A Developmental Neuropsychological Assessment, 2nd Ed. (NEPSY-II), Attention and Executive Function
  • Assessment Observations
  • Behavior Rating Inventory of Executive Function (BRIEF)
  • Brain Injury Observation Form in Chapter 4
  • Cognitive Assessment System, 2nd Ed. (CAS2), Planning Composite
  • Comprehensive Executive Function Inventory (CEFI)
  • Delis Rating of Executive Function (D-REF)
  • Delis-Kaplan Executive Function System (D-KEFS)
  • Parent/teacher interviews
  • Trails Making (A&B)
  • Woodcock Johnson 4th Ed. (WJ-IV), Cog- Planning Subtest
  • Antecedent Management
  • Anticipate transitions
  • Block & Box (Sara Ward)
  • Future Thinking
  • Get Ready, Do, Done
  • Provide student with “Planning Sheet” (see Executive Skills in Children and Adolescent resource book)
  • Report and Talk Aloud
  • Software programs – e.g., “Kidspiration” and “Inspiration” have graphic organizers and can export to a word doc in outline format
  • The Working Clock – Time Management Strategy (Sarah Ward)
  • Use a smart phone and set reminders and alarms
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed section: #15 Planning
  • Check In/Check Out
  • Executive Function in Education (Meltzer)
  • Executive Skills in Children and Adolescents (Dawson/Guare)
  • Project LEARNet
  • Smart but Scattered (Dawson/Guare)

Executive Function: Mental Flexibility

  • Argumentative
  • Concrete
  • Difficulty making friends
  • Difficulty taking feedback
  • Difficulty with transitions
  • Doesn’t like to try new things
  • Lacks empathy
  • Perseveration
  • Rigid thinkers
  • Stubborn
  • Difficulty coming up with solutions
  • Difficulty deviating from schedule
  • Difficulty shifting between tasks or ideas
  • Difficulty with Abstract thinking
  • Doesn’t do what asked
  • Doesn’t learn from mistakes
  • Doesn’t think well on his/her feet
  • A Developmental Neuropsychological Assessment, 2nd Ed. (NEPSY-II), Attention and Executive Function
  • Assessment Observations
  • Behavior Rating Inventory of Executive Function (BRIEF)
  • Brain Injury Observation Form in Chapter 4
  • Delis-Kaplan Executive Function System (D-KEFS)
  • Parent/teacher interview
  • Woodcock Johnson, 4th Ed. (WJ-IV), Cognitive: COG 3 Verbal Attention, COG 4 Letter-Pattern Matching, COG 10, Numbers Reversed, COG 11 Number-Pattern Matching
  • Block & Box (Sarah Ward)
  • Develop routines
  • Explicitly teach flexible thinking skills (i.e., warnings, counting down time, timers, practice changing schedule)
  • Guided Self-Reflection
  • Plan for situations that require mental flexibility
  • Teach coping strategies
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed section: #10 Mental Flexibility
  • Collaborative Problem Solving (Greene)
  • Executive Function in Education (Meltzer)
  • Executive Skills in Children and Adolescents (Dawson/Guare)
  • Explosive Child (Greene)
  • Five is Against the Law (Buron)
  • Project LEARNet
  • Smart but Scattered (Dawson/Guare)
  • Superflex (Winner)
  • Zones of Regulation

Executive Function: Reasoning

  • Acts without thinking of the consequences
  • Does not follow through with request to complete tasks
  • Doesn’t think well on his/her feet
  • Followers
  • Lacks common sense
  • Makes poor behavioral and social choices
  • May appear depressed
  • Oppositional
  • Poor social judgment e.g. promiscuity, school suspension
  • Stubborn
  • Can do rote learning but does not get broader concepts
  • Concrete thinker
  • Difficulty responding to essay questions
  • Difficulty with comprehension, e.g. reading, math, written expression
  • Difficulty with math word problems
  • Does better on multiple choice tests
  • Does not generalize information appropriately (over or under generalizes)
  • Does not get big picture
  • Lacks insight
  • Brain Injury Observation Form in Chapter 4
  • Cognitive Assessment System, 2nd Ed. (CAS2), Simultaneous Processing Composite
  • Differential Ability Scales, 2nd Ed. (DAS-II), Non-Verbal
  • Kauffman Assessment Battery for Children (KABC-II), NonVerbal Scale
  • Reys-Osterrieth Complex Figure Test (RCFT)
  • Test of Adolescent Problem-Solving (TOPS)
  • Wechsler Intelligence Scale for Children, 5th Ed. (WISC-V), Perceptual Reasoning Subtests
  • Woodcock Johnson, 4th Ed. (WJ-IV), Cognitive: COG 2 Number Series, COG 9 Concept Formation, COG 15 Analysis-Synthesis
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainWise (Barry)
  • BrainSTARS Chapter 3 and Blue tabbed sections: #8 Judgment, #12 New Learning, #13 Non-Verbal Learning, #20 Social Skills
  • Bully Proofing (Garrity/Bonds/ Camilli)
  • Circle of Friends
  • Cognitive Behavioral Therapy/Intervention
  • Executive Function in Education (Meltzer)
  • Five is Against the Law
  • Helping the Child who Doesn’t Fit In (Nowicki/Duke)
  • Problem Solving Groups
  • Project LEARNet
  • Refusal Skills
  • Skill Streaming (McGinnis)
  • Social Skills Groups
  • Stranger Danger
  • Why Try
  • Zones of Regulation (lesson 12)

Executive Function: Organizational Skills

  • Copies behaviors of others
  • Difficulty with transitions
  • Easily frustrated
  • Follower
  • Is disorganized
  • Loses things easily
  • Spacey
  • Difficulty with long range projects
  • Doesn’t turn in homework
  • Homework is incomplete
  • Not independent learner
  • Often Forgetful
  • Work is messy
  • Behavior Rating Inventory of Executive Function (BRIEF)
  • Brain Injury Observation Form in Chapter 4
  • Observations
  • Parent/teacher interview
  • Color code subjects
  • Provide student with step-by-step instructions
  • Report and Talk Aloud strategy
  • Smartphone apps: clock/timer, calendar with reminders, Evernote recordings/pictures/detailed instruction
  • Multiple small storage bins; label storage area contents – create routines for use
  • Support between home and school to implement an organization system
  • Teach/support organization skills/systems (folders, planners, etc.)
  • Use a “zipper” folder containing sections for each subject and sections for work “to do”, “completed” etc.
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed section: # 14 Organization, #15 Planning
  • Executive Function in Education (Meltzer)
  • Executive Skills in Children and Adolescents (Dawson/Guare)
  • Project LEARNet
  • Smart but Scattered (Dawson/Guare)
  • Tools for Teaching (Jones/Jones)

Social/Emotional Competency

  • Difficulty keeping and making friends
  • Difficulty reading social cues
  • Difficulty with anger management
  • Emotionally labile
  • Melt down
  • Over/under reaction
  • Cognitive distortions
  • Difficulty with group learning
  • Emotional pre-occupation that interferes with academics
  • Trouble focusing
  • Calm down area
  • Counting backwards
  • Deep breathing
  • Relaxation techniques
  • Visualization
  • Aggression Replacement Training
  • Behavior Intervention Plans
  • Behavior Management
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 4) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed sections: #1 Adolescent Self-Regulation, #3 Emotion Regulation, #18 Self-Regulation, #20 Social Skills
  • BrainWise
  • Cognitive Behavioral Therapy (CBT)
  • Collaborative Problem Solving
  • Five is Against the Law
  • Functional Behavioral Assessments
  • Incredible Years (Webster-Stratton)
  • Journaling
  • The Incredible 5 Point Scale (Buron)
  • Mental Health, Social-Emotional, and Behavioral Screening and Evaluation Compendium
  • Positive Behavior Support
  • Second Step
  • Skills Streaming
  • Smart but Scattered (Dawson/Guare)
  • Social Narratives
  • Superflex
  • Tools for Teaching (Jones/Jones)
  • Why Try
  • www.intensiveintervention.org
  • Zones of Regulation

For More Information on Social Emotional Competency

Additional Resources

(*indicates free)

  • Aggression Replacement Training. Goldstein, A, Glick, B. & Gibbs, J. Research Press
  • Assessment and treatment of TBI with school age children & adults. 1992. Ylvisaker, M. Buffalo NY: Educom Associates
  • *Brain Injury in Children and Youth: A Manual for Educators. 2013. Colorado Department of Education. www.cde.state.co.us/cdesped/sd-tbi
  • Brain Injury Survival Kit, 365 Tips, Tools, & Tricks to Deal with Cognitive Function Loss. 2008. Sullivan, C.
  • *BrainLine Kids – a feature of BrainLine.org. www.Brainline.org
  • BrainSTARS: Brain Injury—Strategies for Teams and Re-education for Students. 2002. Dise-Lewis, J., Calvery, M. & Lewis, H.
  • Executive Function in Education: From Theory to Practice. 2007. Meltzer, L. NY: Guilford Press.
  • Executive Skills in Children and Adolescents. 2004. Dawson, P. & Guare, R. NY: Guilford Press.
  • 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.
  • *Interventioncentral.org – Interventions, suggestions, tools for social/emotional strategies. interventioncentral.org
  • *LEARNet, Ylvisaker, M, HibbardM & Feeney, T. www.projectlearnet.org
  • Providing Alternative Thinking Strategies (PATHS), Kusche, C. and Greenberg, M., Channing Bete Company
  • SkillStreaming (books for Pre-K to 1 grades, 2 to 5 grades and 6-12 grades). 1997. Goldstein, A & McGinnis, E. Research Press Publishers
  • Smart but Scattered. 2009. Dawson P & Guare R. NY: Guilford Press
  • Superflex – ASuperhero 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. www.thinkkids.org
  • *The Center on Brain Injury Research & Training. Evidence-based strategies for students with Brain Injury. www.CBIRT.org
  • The Incredible Years, Incredible Years Program, Seattle, Washington
  • Tools for Teaching. 2007. Jones F. CA: Frederic H Jones & Associates, Inc.
  • *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.

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.

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.

Revise only with permission. www.COKidswithbraininjury.com