QUANTITATIVE ARTICLE REVIEW
Context-Sensitive Positive Behavior Supports for Young Children with Traumatic Brain Injury:
A Second Replication Study
EDUC 518
February 7, 2014

SUMMARY Traumatic brain injury or TBI as it is sometimes called is the injury of the brain that is caused by a powerful force outside of the body. Traumatic brain injury is a leading cause of death and disability in childhood (Kraus, 1995). As a result of TBI, many young children/students display negative behaviors ranging from aggression and rage to depression and withdrawal from peers and other adults. Aggression has been found to be the most prevalent problem behavior of children who receive a TBI during early childhood. Research shows that children who obtain traumatic brain injuries at an early age are more likely to development more challenging behaviors compared to children who might be injured at a later age of development. The purpose of this study was to replicate a previous study that was used to investigate the effects of multicomponent cognitive-behavioral intervention on students with behavioral problems due to traumatic brain injury. The study combined cognitive, behavioral and executive functions along with communication intervention. The hypothesis of the research was that a multicomponent (CBEF) or cognitive behavioral executive function intervention would aid in lowering the amount and frequency of problem behaviors while increasing the academic achievement of the two participants. An additional component of the hypothesis was that the teachers involved would find the interventions both easy to implement as well as useful in improving student interactions. The two participants of the study were both male and 6 year old first grade students. Participants Ben and Joe were both under 5 years of age when they were involved in separate automobile accidents that left them with bilateral frontal brain injuries. Ben had lived with both parents and siblings prior to his accident and had been a typical first grade student as identified by his teacher. After his injury, Ben’s parents divorced and he lived with his mother and siblings. Ben’s father slowly faded out of the picture. His teacher identified that he was a good student after injury but needed a little more assistance in grasping new material. Joe’s experience post injury was somewhat different. Joe’s parents were both killed in the accident that caused his injury and so he was put into foster care. His teacher claimed he was at the same academic level he had been prior to his injury. Both Ben and Joe were referred to school-based behavior intervention programs with their respective department of education. The referral became necessary when both boys began to display aggressive behavior post injury as well as becoming unable to meet academic demands of their grade level. Single subject reversal design was the research designed used in this study. This design was implemented to determine how effective the multicomponent intervention was on the subject’s challenging behavior and academic achievement. Before intervention began, a consultant was brought into both schools and met with the participating teachers. Each teacher was asked to complete a Functional Behavior Assessment on their student. This assessment determined the situations and consequences related to the problem behaviors. The teachers also completed the Motivational Assessment Scale and the results showed that the problem behavior most commonly exhibited was aggression. The baseline “A” condition included instructional and behavioral management procedures already being used in the classroom. The teacher for each test subject would remind each student of the required assignments and class schedule at the beginning of class and then again throughout the day. Condition “B” included the 7-component intervention and was used in the same classroom setting and by the same staff each time. Condition “B” remained in place until the subjects displayed the target behavior no more than 2 times a day for 5 straight days. The procedures in Condition “B” did not include ways to eliminate problem behaviors but instead implemented the Cognitive Behavioral Executive Function interventions in hopes of making the negative behavior unnecessary. There was a 3-day visit back to baseline “A” to determine if support was still needed. The researcher most likely chose the reversal design because he or she anticipated there would be both a cause and need for ongoing support. The dependent variables or quantitative data in this study were the amount and frequency of challenging behaviors as well as the amount of class work finished by the test subjects. The validity of the intervention used in the study was determined by qualitative measures. A consultant was brought in and met occasionally with the teachers and staff to evaluate the effectiveness of the intervention. Once the study was complete, the teachers and staff were asked to fill out a questionnaire and each individual sat through an interview regarding his or her perceived success of the intervention. The quantitative results of this study were that Ben’s behavior and completion of class work improved by 60% percent from the baseline phase to the intervention phase. Ben was able to consistently keep his behavior and work completion at the improved level even after the intervention ceased. Joe did not see as positive of a result. The quantitative results for Joe showed that he did have an improvement of over 70% from the baseline phase to the intervention phase. But unlike Ben, Joe was unable to consistently produce the same level of positive behavior and completed class work as he did during the intervention phase. But results did show that Joe saw success with the intervention. Follow-up with both subjects one year later showed that both Ben and Joe displayed few behavioral problems by the end of the school year. Both students moved on to the 2nd grade and were still using the supports they had received the previous year. Ben and Joe adjusted well to 2nd grade and had no significant problems reported by their teachers. ANALYSIS The results of this study did show that cognitive behavioral executive function intervention can be effective when working with young male children who have received a traumatic brain injury. But I do feel that this study did have some limitations in regards to gender and age. Will this same intervention work on female students with traumatic brain injuries or simply with female students who have behavioral problems? I also question whether this intervention would be as successful with older students in the middle school or even high school level. The study subjects had such a specific criteria and small sample that it would be impossible to rely on these results in regards to anyone but 6 year old males with problem behaviors in school. Another limitation with this study is that it used a combination of practices within the intervention. By doing so, it makes it difficult to impossible to determine which intervention or combination of interventions were successful or the cause of the positive results. Also, during interviews and questionnaires, the teachers concluded that the test subjects had improved in social interactions with their peers. But no collected data was documented as showing such a change so how can we feel confident in knowing this change actually happened. I believe there are opportunities for further research on this topic. There are so many age groups, gender groups and ethnic groups that could be studied regarding both positive behavior supports and those with other special needs. One implication of this research is that even though problem behavior is a normal and usual result of traumatic brain injury in young children, children can still experience an enjoyable, positive school experience though classroom integration. This can be accomplished by understanding the student’s individual needs and setting up supports accordingly.

References

Feeney, T. J., Ylvisaker, M. (2008). Context-sensitive cognitive-behavioral supports for young children with TBI: A second replication study. Journal Of Positive Behavior Interventions, 10(2), 115-128. Retrieved from http://search.proquest.com.ezproxy.liberty.edu:2048/docview/218788731/abstract?accountid=12085

Kraus, J. F. (1995). Epidemiological features of brain injury in children: Occurrence, children at risk, causes and manner of injury, severity, and outcomes. In S. H. Broman & M. E. Michel (Eds.), Traumatic head injury in children (pp. 22-39). New York: Oxford University Press.