Building Blocks of Brain Development

image006The graphic to the right represents the Building Blocks of Brain Development. Our brains develop each and every “building block” or brain function in a progressive manner. They build upon each other to become more complex (i.e., higher order thinking). The building blocks 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 building blocks are at the base (orange level). These fundamental building blocks are very sensitive to brain injury and are essential for all learning and behavior.
  • The intermediate level (green) building blocks denotes all learning and language and visual-spatial processing.
  • The higher order thinking skills – executive function and social emotional competency are represented at the blue level.
  • Overall functioning and achievement (purple level) requires the fundamental, intermediate and higher order building blocks to be solidly in place and work in concert with one another. A brain injury may cause gaps in the functioning of these areas which can impact learning and/or behavior.

The Building Blocks of Brain Development framework 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 framework offers a wide range of suggested assessment tools and intervention strategies for students with brain injury (as well as other conditions impacting neurocognitive functioning).

While this online framework provides the neuroeducational evaluation tools. There is also a manual, available electronically, that defines and fully illustrates each building block, called the Brain Injury in Children and Youth: A Manual for Educators. It is available for free on the CDE website: http://www.cde.state.co.us/cdesped/sd-tbi and the homepage: http://cokidswithbraininjury.com/). The manual provides a detailed explanation of how each building block may be effected in the school setting if a brain injury occurs. In addition, an extensive list of accommodations, strategies, and interventions for each building block are provided in the manual.

A very helpful tool for data collection in each of the Building Block areas is the Neurocognitive Evaluation Form.  For more resources, please refer to the additional resources at the end of this guide.

Building Blocks

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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

  • Spacey and forgetful
  • Easily distracted
  • Difficulty with turn taking
  • Doesn’t turn in assignments
  • Fidgets/squirms in seat or doesn’t stay in seat
  • Interrupts conversations
  • Loses things
  • Low frustration tolerance
  • Off topic
  • 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
  • Can’t keep up with rest of the class
(These assessments are used to look at attention impacts secondary to brain injury, not to diagnose ADHD/ADD.)

  • A Developmental Neuropsychological Assessment, 2nd (NEPSY-II): Auditory Attention and Auditory Attention Response Set
  • Cognitive Assessment System, 2nd (CAS2): Attention Scale (Consider Planning Scale)
  • Wechsler Intelligence Scale for Children, 5th (WISC-V): Cancellation, Symbol Search, Coding, Working Memory Index and Auditory Working Memory Index
  • Differential Ability Scale, 2nd (DAS-II): Working Memory Composite
  • Woodcock Johnson, 4th (WJ-IV) Tests of Cognitive Abilities: Verbal Attention, Numbers Reversed, Object-Number Sequencing, Pair Cancellation, Letter-Pattern Matching
  • Conners Continuous Performance Test, 3rd (CPT3)
  • Auditory Continuous Performance Test
  • Tasks of Executive Control (TEC)
  • Test of Everyday Attention for Children (TEA-CH)
  • Behavior Assessment System for Children, 3rd (BASC-3)
  • Behavior Rating Inventory of Executive Function, 2nd (BRIEF-2): Working Memory (examine specific items)
  • Comprehensive Executive Function Inventory (CEFI)
  • Delis Rating of Executive Function (D-REF)
  • Conners, 3rd
  • Vanderbilt Teacher Behavior Evaluation Scale (VTBES)
  • Behavioral Observations of Students in Schools (BOSS)
  • Neurocognitive Evaluation Form in Appendix, Colorado Department of Education Brain Injury in Children and Youth: A Manual for Educators
  • Classroom Observations On Task/Off Task Peer Analyses
  • Behavior observations during testing
  • Parent, Teacher and Student Interviews
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • Directly teach and practice what paying attention looks like
  • Teach self-monitoring
  • Brain Breaks
  • Vigorous exercise
  • Mindfulness, meditation, relaxation techniques, yoga
  • Ensure that you have the child’s focus prior to giving instructions
  • Frequent check-ins and redirection
  • Reduce visual and auditory distractions
  • Clear desk of everything except what is needed for the lesson
  • Seat child closest to point of instruction and away from distractions
  • Verbal and visual cues (cue word, nonverbal gesture, sticky note system, stop light system)
  • Behavior Intervention Plan

Inhibition

  • Acts on first thing that pops into their mind
  • Blurts thoughts out and can talk excessively
  • Calling out rather than waiting with hand raised
  • Fidgety/squirmy
  • Difficulty staying in line, seat, classroom, etc.
  • Impulsive; “jumps before looks”
  • Interrupts; socially intrusive
  • Jumps into an activity rather than waiting for/reading instructions
  • Physical touch with others may be too much
  • Disregard for boundaries
  • Social Difficulties
  • Participating in unsafe behaviors or behaviors that get them into trouble
  • Can be disruptive in the classroom
  • Difficulty following multistep directions
  • Not slowing down to process directions
  • May complete assignments incorrectly
  • May require a lot of redirection from teacher
  • A Developmental Neuropsychological Assessment, 2nd (NEPSY-II): Inhibition, Statue, Auditory Attention and Response Set
  • Delis-Kaplan Executive Function System (D-KEFS): Trail Making, Color Word Interference, Design Fluency, Sorting, Tower, 20 Questions
  • Cognitive Assessment System, 2nd (CAS-2): Attention Scale
  • Woodcock Johnson, 4th (WJ-IV) Tests of Cognitive Abilities: Pair Cancellation
  • Wechsler Intelligence Scale for Children, 5th (WISC-V): Matrix Reasoning (quickly responds without considering options or quickly responds and then immediately changes answer)
  • Differential Ability Scales, 2nd (DAS-II): Matrices (quickly responds without considering options or quickly responds and then immediately changes answer)
  • Kaufman Assessment Battery for Children, 2nd, (KABC-II): Riddles
  • Conners Continuous Performance Test, 3rd (CPT3): Response Speed, Commission Errors, Perseverations
  • Test of Everyday Attention for Children (TEA-Ch)
  • Stroop Color-Word Interference
  • Behavior Assessment System for Children, 3rd (BASC-3): Hyperactivity Scale
  • Conners, 3rd: Hyperactivity/Impulsivity Scale
  • Behavior Rating Inventory of Executive Function, 2nd (BRIEF2)
  • Comprehensive Executive Function Inventory (CEFI)
  • Delis Rating of Executive Function (D-REF)
  • Observations in the environment
  • Functional Behavioral Assessment Behavior observations during testing (jump right in or thoughtful about responses/approach)
  • Parent, Teacher and Student Interviews
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • Executive Function in Children and Adolescents, 2nd (Dawson/Guare)
  • Lost at School (Greene)
  • Promoting Executive Function in the Classroom (Meltzer)
  • Smart but Scattered (Dawson/Guare)
  • Smart but Scattered Teens (Guare/ Dawson/Guare)
  • Alert Program: How Does Your Engine Run (Williams/Shellenberger)
  • The Incredible 5 Point Scale (Buron/Curtis)
  • Project Achieve – Stop & Think Program (Knoff)
  • Project Success (Kastner)
  • Superflex: A Superhero Social Thinking Curriculum (Madrigal/Winner)
  • Zones of Regulation (Kuper)

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
  • Spotty learning of new information
  • Difficulty taking timed tests
  • Does not appear to remember information
  • Incomplete work
  • Poor grades in-spite good effort
  • Slow at doing work
  • Wechsler Intelligence Scale for Children, 5th (WISC-V): Processing Speed Index, Cancellation
  • Differential Ability Scales, 2nd (DAS-II): Processing Speed Composite
  • Woodcock Johnson, 4th (WJ-IV) Tests of Cognitive Abilities: Letter-Pattern Matching, Pair Cancellation
  • Cognitive Assessment System, 2nd (CAS2): Planning Index
  • Task of Executive Control (TEC)
  • Neurocognitive Evaluation Form in Appendix, Colorado Department of Education Brain Injury in Children and Youth: A Manual for Educators 
  • Observations in the environment
  • Behavior observations during testing
  • Parent, Teacher and Student Interviews
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • Establish daily routines and classroom expectations
  • Allow for delay in response
  • Copies of notes and outlines
  • Extra time
  • Give clear and concise instructions one at a time
  • Repeat instructions
  • Provide written instructions
  • Combine visual and verbal information
  • Limit number of tasks required to complete at one time

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
  • Repeatedly asks the same question
  • 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 (NEPSY-II): Memory and Learning Subtests
  • Woodcock Johnson, 4th (WJ-IV), Test of Cognitive Abilities: Verbal Attention, Numbers Reversed, Object Number Sequencing, Nonword Repetition, Memory for Words, Story Recall, Picture Recognition, Visual-Auditory Learning, Sentence Repetition (Oral Language Battery)
  • Wechsler Intelligence Scale for Children, 5th (WISC-V): Working Memory and Auditory Working Memory Indexes, Arithmetic, Matrix Reasoning (later items)
  • Differential Ability Scales, 2nd (DAS-II): Working Memory Composite, Recall of Objects Immediate and Delayed, Recall of Digits Forward, Recognition of Pictures, Recall of Designs, Matrices (later items)
  • Kaufman Assessment Battery for Children, 2nd, (KABC-II): Sequential Processing Ability Scale
  • Delis-Kaplan Executive Function System (D-KEFS): Sorting
  • Child and Adolescent Memory Profile (ChAMP)
  • Children’s Memory Scale (CMS)
  • Test of Memory and Learning, 2nd (TOMAL-2)
  • Wide Range Assessment Memory and Learning, 2nd (WRAML2)
  • California Verbal Learning Test, 2nd (CVTL-II)
  • California Verbal Learning Test-Children’s Version (CTVL-C)
  • Test of Visual Processing Skills, 3rd (TVPS3): Visual Memory & Visual Sequential Memory
  • Behavior Rating Inventory of Executive Function, 2nd (BRIEF2)
  • Comprehensive Executive Function Inventory (CEFI)
  • Delis Rating of Executive Function (D-REF)
  • Neurocognitive Evaluation Form in Appendix, Colorado Department of Education Brain Injury in Children and Youth: A Manual for Educators 
  • Behavior observations during testing (can only remember first or last parts of directions or stimulus materials)
  • Observations in the environment
  • Parent, Teacher and Student Interviews
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • Encourage to develop visual picture of what have learned or read
  • Teach concept and have them teach others
  • Experiential Learning
  • Have student paraphrase directions or steps
  • Mnemonic strategies
  • New concepts – engage background knowledge
  • Errorless learning
  • Pictures or visual cues
  • Provide copies of notes
  • Practice daily routines
  • “Priming the pump” – slightly elevate emotions when teaching new concepts
  • Use memory aids e.g. visual cues, planners, PDAs or other compensatory strategies
  • Use of competitive games
  • See New Learning Building Block

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/textbook 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
  • Sensory Profile-2
  • Sensory Processing Measure (SPM)
  • Sensory Processing Measure Preschool (SPM-P)
  • Sensory Integration Inventory
  • Degangi-Berk Test of Sensory Integration (TSI)
  • Dean-Woodcock Sensory Motor Battery
  • A Developmental Neuropsychological Assessment, 2nd (NEPSY-II): Sensorimotor Subtests
  • Effective informal vision – ocular motor control
  • Functional Vision Assessment
  • Neurocognitive Evaluation Form in Appendix, Colorado Department of Education Brain Injury in Children and Youth: A Manual for Educators 
  • Vision and hearing screening: conversion/tracking/depth perception
  • Observations in the environment
  • Functional Behavioral Assessment Behavior observations during testing
  • Parent, Teacher and Student Interviews
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • Occupational Therapist and/or Physical Therapist Consult
  • Allow student to dictate first draft of written assignment rather than write
  • Allow student to use a computer for written work
  • Reduce number of problems on a page
  • Break down written work into chunks
  • Deep joint pressure
  • Preferential and thoughtful seating to reduce auditory and visual stimulation
  • Preferential seating to decrease sensory input
  • Reduce visual and auditory distractions
  • 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
  • Conduct assistive technology evaluation

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
  • Sensory Profile-2
  • Sensory Processing Measure (SPM)
  • Sensory Processing Measure Preschool (SPM-P)
  • Sensory Integration Inventory
  • Degangi-Berk Test of Sensory Integration (TSI)
  • Dean-Woodcock Sensory Motor Battery
  • A Developmental Neuropsychological Assessment, 2nd (NEPSY-II): Sensorimotor Subtests
  • Effective informal vision – ocular motor control
  • Functional Vision Assessment
  • Neurocognitive Evaluation Form in Appendix, Colorado Department of Education Brain Injury in Children and Youth: A Manual for Educators
  • Vision and hearing screening: conversion/tracking/depth perception
  • Observations in the environment
  • Functional Behavioral Assessment Behavior observations during testing
  • Parent, Teacher and Student Interviews
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • Occupational Therapist and/or Physical Therapist Consult
  • 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

Motor – Fine

 

  • Difficulty with fasteners
  • Shaky hands/tremors
  • Poor coordination
  • Avoids tasks involving writing
  • Difficulty with cutting
  • Difficulty with drawing
  • Poor handwriting
  • Takes long time to produce written work
  • Messy work
  • Beery-Buktenica Developmental Test of Visual Motor Integration, 6th (BEERY VMI)
  • Bruininks-Oseretsky Test of Motor Proficiency, 2nd (BOT-2)
  • Bender Visual-Motor Gestalt Test, 2nd
  • Evaluation of Children’s Handwriting Skills – Grades 1-6 (ETCH)
  • Test of Handwriting Skills-Revised (THS-R)
  • Schooldles School Fine Motor Assessment, 4th (SFMA-4)
  • Peabody Developmental Motor Skills, 2nd (PDMS-2)
  • Test of Visual Motor Skills, 3rd (TVMS-3)
  • Preschool Visual Motor Integration Assessment (PVMIA)
  • Developmental Test of Visual Perception, 3rd (DTVP-3)
  • Wide Range Assessment of Visual Motor Abilities (WRAVMA)
  • Slosson Visual-Motor Performance Test (S-VMPT)
  • A Developmental Neuropsychological Assessment, 2nd (NEPSY-II): Sensorimotor Subtests
  • Dean-Woodcock Sensory Motor Battery
  • Differential Ability Scales, 2nd (DAS-II), Recall of Designs
  • Neurocognitive Evaluation Form in Appendix, Colorado Department of Education Brain Injury in Children and Youth: A Manual for Educators
  • Observations in the environment
  • Observations during testing
  • Parent, Teacher and Student Interviews
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • Occupational Therapist and/or Physical Therapist Consult
  • Assistive/Adaptive Technology
  • 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
  • Guided notes/outline
  • Pencil grips
  • Slant boards
  • Speech to text technology
  • Typing/texting vs. writing

Motor – Gross

  • Avoids sports
  • Bumps into things
  • Difficulties carrying lunch tray
  • Clumsy
  • Falls/Stumbles
  • Unsteady on stairs, playground equipment or in crowds
  • Avoids recess
  • Difficulty with or avoidance of P.E.
  • Slumps in seat
  • School Functional Assessment (SFA)
  • Test of Gross Motor Development, 2nd (TGMD-2)
  • Peabody Developmental Motor Scales, 2nd (PDMS-2)
  • Bruininks-Oseretsky Test of Motor Proficiency, 2nd (BOT-2)
  • Peabody Developmental Motor Skills, 2nd (PDMS-2), for birth to 2 yr
  • Dean-Woodcock Sensory Motor Battery
  • Neurocognitive Evaluation Form in Appendix, Colorado Department of Education Brain Injury in Children and Youth: A Manual for Educators
  • Observations in the environment
  • Parent, Teacher and Student Interviews
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • Occupational Therapist and/or Physical Therapist Consult
  • Adapted sports and physical education class
  • Adapted seating (chairs, desks)
  • Heavy work activities-e.g. standing wall pushups, carrying books, stacking chairs, etc.

New Learning

 

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
  • 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
  • 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

Language – Receptive

  • 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
  • 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
  • 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
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • 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

Language – Expressive

  • 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
  • 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
  • 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
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • 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

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)
  • Difficulty responding to facial expressions and body language
  • Frustration
  • Inappropriate use of jokes, sarcasm or humor
  • Inappropriate 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.
  • Clinical Evaluation of Language Fundamentals, 5th (CELF-5)
  • Conversational Effectiveness Profile–Revised (CEP-R); http://www.socialpragmatics.com/publications.html
  • 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
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3 and 4) (CDE)
  • 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
  • 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

Visual-Spatial

  • 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
  • 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
  • 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)
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • 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

Executive Function: Initiation

  • Difficulty starting tasks independently
  • Can state what they are supposed to do but does not get started
  • Slow to shift at same time as peers
  • Requires constant cueing
  • Does not make plans academically or socially
  • Appears aloof or disinterested in peers
  • Follower
  • Lagging in independent living skills
  • May appear lazy, unmotivated or spacey
  • Often gets overlooked because they are not trouble in the classroom
  • Seeks out adults for social interaction
  • 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
  • Behavior Rating Inventory of Executive Function, 2nd (BRIEF2)
  • Comprehensive Executive Function Inventory (CEFI)
  • Delis Rating of Executive Function (D-REF)
  • Neurocognitive Evaluation Form in Appendix, Colorado Department of Education Brain Injury in Children and Youth: A Manual for Educators
  • Observations in the environment
  • Behavior observations during testing
  • Parent, Teacher and Student Interviews
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • 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 visual imagery to practice the activity steps prior to initiation
  • May need friendship groups or support initiating social interactions
  • See Planning and Organization Building Blocks

Executive Function: Planning

  • Difficulty with problem solving
  • Doesn’t make plans with friends
  • Rigidity of thinking
  • Often late for class
  • Often unprepared for class
  • Difficulty organizing thoughts
  • Difficulty with long term assignments
  • Difficulty with sequential tasks
  • Difficulty with time management
  • Difficulty writing papers
  • Doesn’t brainstorm
  • Cognitive Assessment System, 2nd (CAS2): Planning Scale
  • Kaufman Assessment Battery for Children, 2nd: Planning Ability Scale
  • A Developmental Neuropsychological Assessment, 2nd (NEPSY-II): Attention and Executive Function Subtests
  • Wechsler Intelligence Scale for Children, 5th (WISC-V): Block Design
  • Differential Ability Scale, 2nd (DAS-2): Recall of Designs and Block Design
  • Behavior Rating Inventory of Executive Function, 2nd (BRIEF2)
  • Comprehensive Executive Function Inventory (CEFI)
  • Delis Rating of Executive Function (D-REF)
  • Delis-Kaplan Executive Function System (D-KEFS): Tower Test
  • Trails Making (A&B)
  • Rey-Osterrieth Complex Figure
  • Neurocognitive Evaluation Form in Appendix, Colorado Department of Education Brain Injury in Children and Youth: A Manual for Educators
  • Observations in the environment
  • Behavior observations during testing
  • Parent, Teacher and Student Interviews

Executive Function: Organizational Skills

  • Seems confused
  • Copies behaviors of others
  • Difficulty with transitions
  • Easily frustrated
  • Resistant
  • Follower
  • Is disorganized
  • Loses things easily
  • Spacey
  • Conversations may be disjointed
  • Difficulty with long range projects
  • Unable to do more than one step on a task
  • Doesn’t turn in homework
  • Homework is incomplete
  • Not independent learner
  • Often forgetful
  • Work is messy
  • Difficulties answering open-ended questions
  • Behavior Rating Inventory of Executive Function, 2nd (BRIEF2): Organization of Materials and Planning/Organization Scale (look at specific items)
  • Comprehensive Executive Function Inventory (CEFI)
  • Neurocognitive Evaluation Form in Appendix, Colorado Department of Education Brain Injury in Children and Youth: A Manual for Educators
  • Observations in the environment
  • Behavior observations during testing
  • Parent, Teacher and Student Interviews
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • Establish daily routine
  • Check in/Check out system
  • 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
  • Use of classroom websites with posted notes and assignments
  • 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 of graphic organizers
  • Use a “zipper” folder containing sections for each subject and sections for work “to do”, “completed” etc.
  • Teach goal-directed problem solving process; Goal-Plan-Do-Review
  • See Initiation and Planning Building Blocks

Executive Function: Mental Flexibility

  • Argumentative
  • Concrete thinker
  • Rigid thinker
  • Perseveration
  • Difficulty making friends
  • Difficulty taking feedback
  • Difficulty with transitions
  • Doesn’t like to try new things
  • Lacks empathy
  • Stubborn
  • Issues with understanding the perspective of others
  • 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 (NEPSY-II): Attention and Executive Function Subtests
  • Wechsler Intelligence Scale for Children, 5th (WISC-V): Picture Concepts, Matrix Reasoning, Comprehension (questions requiring multiple responses)
  • Differential Ability Scale, 2nd (DAS-2): Matrices
  • Woodcock Johnson, 4th (WJ-IV) Test of Cognitive Abilities: Concept Formation
  • Delis-Kaplan Executive Function System (D-KEFS): Sorting, Trail Making, Verbal Fluency, Design Fluency, Color-Word Interference, Tower
  • Wisconsin Card Sort Test
  • Children’s Category Test
  • Behavior Rating Inventory of Executive Function, 2nd (BRIEF2): Shift Scale
  • Comprehensive Executive Function Inventory (CEFI): Flexibility Scale
  • Neurocognitive Evaluation Form in Appendix, Colorado Department of Education Brain Injury in Children and Youth: A Manual for Educators
  • Observations in the environment
  • Functional Behavioral Assessment
  • Behavior observations during testing
  • Parent, Teacher and Student Interviews
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) (CDE)
  • Develop, teach and reinforce routines
  • Block & Box (Sarah Ward)
  • 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 Stop, Relax and Think
  • Teach coping strategies, belly breathing, mindfulness, meditation, relaxation techniques
  • Social skills groups. Teach perspective taking
  • Use of social narratives
  • See Reasoning and Social/Emotional Competency Building Blocks

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 and risk taking behaviors e.g. promiscuity, school suspension
  • Argumentative
  • Stubborn
  • Does not learn from mistakes
  • Can do rote learning but does not get broader concepts
  • Concrete thinker
  • Difficulty responding to open-ended or 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 the big picture
  • Lacks insight
  • Wechsler Intelligence Scale for Children, 5th (WISC-V): Fluid Reasoning Index, Picture Concepts, Arithmetic
  • Cognitive Assessment System, 2nd (CAS2): Simultaneous Processing Scale
  • Differential Ability Scales, 2nd (DAS-II): Nonverbal Reasoning Composite
  • Kauffman Assessment Battery for Children (KABC-II): Simultaneous Processing Ability Scale
  • Woodcock Johnson, 4th (WJ-IV), Test of Cognitive Abilities: Number Series, Concept Formation, Visualization, Analysis-Synthesis
  • Test of Problem Solving, 2nd Ed Adolescent (TOPS-2)
  • Test of Problem Solving, 3rd Ed Elementary (TOPS-3)
  • Delis-Kaplan Executive Function System (D-KEFS): Sorting, 20 Questions, Word Context, Proverb
  • Behavior Rating Inventory of Executive Function, 2nd (BRIEF2): Monitor Scale
  • Comprehensive Executive Function Inventory (CEFI): Monitoring Scale
  • Neurocognitive Evaluation Form in Appendix, Colorado Department of Education Brain Injury in Children and Youth: A Manual for Educators
  • Observations in the environment
  • Functional Behavioral Assessment Behavior observations during testing
  • Parent, Teacher and Student Interviews

Social/Emotional Competency

  • Difficulty keeping and making friends
  • Difficulty reading social cues
  • Difficulty with anger management
  • Emotionally labile
  • Meltdowns
  • Over/under reaction
  • Cognitive distortions (exaggerated or irrational thought patterns)
  • Difficulty with group learning
  • Emotional pre-occupation that interferes with academics
  • Trouble focusing
  • A Developmental Neuropsychological Assessment (NEPSY-II): Social Perception Subtests
  • Behavior Assessment System for Children, 3rd (BASC-3)
  • Emotional Disturbance Decision Tree (EDDT)
  • Scales for Assessing Emotional Disturbance, 2nd (SAED-2)
  • Behavior Rating Inventory of Executive Function, 2nd Ed (BRIEF2): Emotional Control Scale
  • Comprehensive Executive Function Inventory (CEFI): Emotional Regulation Scale
  • Children’s Depression Inventory, 2nd (CDI2)
  • Reynold’s Adolescent Depression Scale, 2nd (RADS-2)
  • Revised Children Manifest Anxiety Scale, 2nd (RCMAS-2)
  • Multidimensional Anxiety Scale for Children, 2nd (MASC 2)
  • Conners, 3rd
  • Conversational Effectiveness Profile – Revised (CEP-R): An assessment tool measuring Social Interaction, Social Communication, and Social-Emotional Regulation; socialpragmatics.com
  • Social Skills Rating System (SSRS)
  • Test of Pragmatic Language, 2nd (TOPL-2)
  • School Functional Assessment (SFA)
  • Vineland Adaptive Behavior Scales, 2nd (Vineland-II)
  • Adaptive Behavior Assessment System, 2nd (ABAS-II)
  • Functional Behavioral Assessment (FBA) Behavior observations during testing
  • Neurocognitive Evaluation Form in Appendix, Colorado Department of Education Brain Injury in Children and Youth: A Manual for Educators
  • Observations in the environment
  • Parent, Teacher and Student Interviews
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3 and 4) (CDE)
  • Give clear and simple directions
  • Provide, teach and reinforce routines and clear expectations
  • Provide calm down area
  • Discuss and practice age-appropriate behaviors in real life situations
  • Social skills groups
  • Social narratives
  • Teach coping strategies, belly breathing, mindfulness, meditation, relaxation techniques
  • Behavior Intervention Plans
  • See Inhibition, Mental Flexibility and Reasoning Building Blocks
  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3 and 4) (CDE)
  • BrainSTARS Chapter 3 and Blue tabbed sections: #1 Adolescent Self-Regulation, #3 Emotion Regulation, #18 Self-Regulation, #20 Social Skills
  • Collaborative Problem Solving (Greene/Ablon)
  • Explosive Child (Greene)
  • Lost at School (Greene)
  • Tools for Teaching (Jones)
  • Alert Program: How Does Your Engine Run (Williams/Shellenberger)
  • Aggression Replacement Training (Goldstein/Guck/Gibbs)
  • BrainWise (Barry)
  • Bully Proofing (Garrity)
  • Circle of Friends http://www.circleofriends.org
  • In Focus (McSheehy)
  • Incredible 5 Point Scale (Buron/Curtis)
  • Incredible Years (Webster-Stratton)
  • Make Social Learning Stick! (Sautter)
  • MindUp Curriculum (Hawn Foundation)
  • Positive Behavior Intervention Supports https://www.pbis.org
  • Project Achieve – Stop & Think Program (Knoff)
  • Project Success (Kastner)
  • Second Step secondstep.org
  • Social Thinking Worksheets for Tweens and Teens (Winner)
  • Skill Streaming (McGinnis)
  • Superflex: A Superhero Social Thinking Curriculum (Winner)
  • You are a Social Detective (Winner)
  • Why Try (Moore)
  • Zones of Regulation (Kuper)

For More Information on Social Emotional Competency

Additional Resources

(*indicates free)

  • Aggression Replacement Training. Goldstein, A, Glick, B. & Gibbs, J. Research Press
  • American Speech Language Hearing Association http://www.asha.org
  • 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. 2017. 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.  
  • BrainWise: 10 wise ways to stop and Think 1996. Barry, P.G. Denver, CO: Innisfree Press.
  • Bully Proofing Your School. 2004. Garrity. C. Longmont, CO: Sopris West.
  • *The Center on Brain Injury Research & Training. Evidence-based strategies for students with Brain Injury. https://cbirt.org/back-school
  • *Center on the Developing Child: Harvard University. http://developingchild.harvard.edu/resources/activities-guide-enhancing-and-practicing-executive-function-skills-with-children-from-infancy-to-adolescence/
  • Circle of Friends.  https://www.circleofriends.org/
  • Essentials of School Neuropsychological Assessment, Second Edition. 2013. Miller, D.C. Hoboken, NJ: John Wiley and Sons, Inc.
  • Executive Function in Education: From Theory to Practice. 2007. Meltzer, L. NY: Guilford Press.
  • Executive Skills in Children and Adolescents, 2nd Edition. 2010.  Dawson, P. & Guare, R.  NY: Guilford Press.
  • Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children. 2014. Greene, R.W. Harper Paperbacks
  • 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 (2017): 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.