A Brief Overview
- A traumatic brain injury (TBI) is an injury that affects how the brain works.
- Approximately 1.7 million people receive traumatic brain injuries every year. Of children 0-19 years old, TBI results in 631,146 trips to the emergency room annually, 35,994 hospitalizations, and nearly 6,169 deaths.
- Children have the highest rate of emergency department visits for traumatic brain (TBI) injury of all age groups. TBI affects children differently than adults.
- Although TBI is quite common, many medical and education professionals may not realize that some difficulties can be caused by a childhood TBI. Often, students with TBI are thought to have a learning disability, emotional disturbance, or an intellectual disability. As a result, they may not receive the type of educational help and support really needed.
- Students with TBI who are not eligible for special education might be eligible for a Section 504 plan.
- TBI is a category of eligibility for special education under the Individuals with Disabilities Education Act (IDEA) and the Washington State Administrative Code (WAC)
- Washington law requires evaluation referrals in writing. The state provides a form for referrals, downloadable from a website page titled, Making a Referral for Special Education. The person making the referral can use the form or any other format for their written request.
- PAVE provides a Sample Letter to Request Evaluation.
A traumatic brain injury (TBI) is an injury that affects how the brain works. TBI can affect people of all ages and backgrounds. The exact definition of TBI, according to special education law, is referenced later. This injury can change how the person thinks, behaves, and moves. A traumatic brain injury can also change how a student learns and behaves in school. The term TBI is used for head injuries that can cause changes in one or more areas, such as:
- thinking and reasoning,
- understanding words,
- remembering things,
- paying attention,
- solving problems,
- thinking abstractly,
- walking and other physical activities,
- seeing and/or hearing, and
The term TBI is not used for a person who is born with a brain injury or for brain injuries that happen during birth.
How is TBI Defined?
The definition of TBI below comes from the Individuals with Disabilities Education Act (IDEA). The IDEA is the federal law that guides how schools provide special education and related services to children and youth with disabilities.
IDEA’s Definition of TBI
The Individuals with Disabilities Education Act (IDEA) defines traumatic brain injury as
“…an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a student’s educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psycho-social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.” [34 Code of Federal Regulations §300.8(c)(12)]
Washington State’s Definition of TBI
“Traumatic brain injury means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a student’s educational performance. Traumatic brain injury applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. Traumatic brain injury does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.” (WAC 392-172A-01035)
What Are the Signs of Traumatic Brain Injury?
The signs of brain injury can be quite different depending on where the brain is injured and how severely. Students with TBI may have one or more difficulties, including:
Physical disabilities: Individuals with TBI may have problems speaking, seeing, hearing, and using their other senses. They may have headaches and feel tired a lot. They may also have trouble with skills such as writing or drawing. Their muscles may suddenly contract or tighten (this is called spasticity). They may also have seizures. Their balance and walking may also be affected. They may be partly or completely paralyzed on one side of the body, or both sides.
Difficulties with thinking: Because the brain has been injured, it is common that the person’s ability to use the brain changes. For example, students with TBI may have trouble with short-term memory (being able to remember something from one minute to the next, like what the teacher just said). They may also have trouble with their long-term memory (being able to remember information from a while ago, like facts learned last month). People with TBI may have trouble concentrating and only be able to focus their attention for a brief time. They may think slowly. They may have trouble talking and listening to others. They may also have difficulty with reading and writing, planning, understanding the order in which events happen (called sequencing), and judgment.
Social, behavioral, or emotional problems: These difficulties may include sudden changes in mood, anxiety, and depression. Students with TBI may have trouble relating to others. They may be restless and may laugh or cry a lot. They may not have much motivation or much control over their emotions.
A student with TBI may not have all the above difficulties. Brain injuries can range from mild to severe, and so can the changes that result from the injury. This means that it is hard to predict how an individual will recover from the injury. Early and ongoing help can make an enormous difference in how the student recovers. This help can include physical or occupational therapy, counseling, and special education.
It is also important to know that, as children and youth grow and develop, parents and teachers may notice new problems. This is because, as young people grow, they are expected to use their brain in new and different ways. The damage to the brain from the earlier injury can make it hard for them to learn new skills that come with getting older. Sometimes families and teachers may not even realize that the student’s difficulty comes from the earlier injury.
How to Access Support
If a student is having a tough time at school and has a known or suspected disability, the school evaluates to see if the student qualifies for special education. A student is protected in their right to be evaluated by the Child Find Mandate, which is part of the federal Individuals with Disabilities Education Act (IDEA). if they do have a disability and, because of the disability, need special services under IDEA. These services can include:
Early Supports for Infants and Toddlers (ESIT): A system of family centered services to support infants and toddlers with disabilities (before their 3rd birthday).
Special education and related services: Services available through the public school system for school-aged children and youth, including preschoolers (ages 3-21). It is important to remember that the IEP is intended to be flexible. It can be changed as the family, school, and the student learns more about what support and services are needed at school.
If the student is not eligible for special education, a Section 504 Plan may help. Under Section 504, students with disabilities can access the accommodations, aids, and services they need to access and benefit from education. It also protects students from discrimination based on disability.
When students with TBI return to school, their educational and emotional needs are often quite different than before the injury. Their disability has happened suddenly and traumatically. They can often remember how they were before the brain injury. This can bring on many emotional and social changes which may result in mental and/or behavioral health needs. The student’s family, friends, and teachers also recall what the student was like before the injury. These and other people in the student’s life may have trouble changing or adjusting their expectations of the student. Therefore, it is important to plan carefully for the return to school.
Tips for Families and Caregivers
- Learn about TBI. The more you know, the more you can help yourself and your student.
- Work with the medical team to understand your loved one’s injury and treatment plan. Ask questions. Share what you know or think. Make suggestions.
- Keep track of your loved one’s treatment. A 3-ring binder or a box can help you store this history. As your youth recovers, you may meet with many doctors, nurses, and others. Write down what they say. Put any paperwork they give you in the notebook or place it in a box.
- Plan for your student’s return to school after the injury. Contact the school. Ask the principal about an evaluation for special education or a Section 504 plan. You may also consider asking the medical team to share information with the school.
- Talk to other families whose loved ones have TBI.
- Stay connected with your student’s teacher. Tell the teacher about how your student is doing at home. Ask how your student is doing in school.
- Sometimes students who do not qualify for the IEP will qualify for accommodations and other support through a Section 504 Plan. PAVE has an article about Section 504, which provides an individual with protections throughout the lifespan.
- Protections against bullying and discriminatory discipline are aspects of Section 504. Watch PAVE’s video, Behavioral Health and School: Key Information for Families.
Help from PAVE
PAVE’s Parent Training and Information (PTI) team provides 1:1 support and additional resources. Click Get Help or Call 1-800-5PARENT (572-7368) and select extension 115, English or Spanish available, to leave a dedicated message.
For information, help during a crisis, emotional support, and referrals:
- Suicide Prevention Lifeline (1-800-273-TALK): After July 16, 2022, call 988.
- Text “HEAL” to 741741 to reach a trained Crisis Text Line counselor.
- TeenLink (1-866-833-6546; 6pm-10pm PST)
- Seattle Children’s Hospital has a referral helpline. Families can call 833-303-5437, Monday-Friday, 8-5, to connect with a referral specialist. The service is free for families statewide.
Further information on TBI:
- The Center on Brain Injury Research and Training
- Department of Health and Human Services
- University of Washington TBI Model System
- Center for Disease Control and Prevention : Report to Congress on the Management of TBI in Children
- PAVE’s Family-to-Family Health Information Center provides technical assistance to families navigating health systems related to disability. Click Get Help at wapave.org or call 800-572-7368 for individualized assistance. Family Voices of Washington provides further information and resources.
- Department of Health and Human Services (DSHS) has a link to Washington TBI Support Groups.
- Brain Injury Association of America works to create a better future through brain injury prevention, research, education, and advocacy.
- Brain Injury Alliance of Washington is dedicated to improving the quality of life for people who have sustained a brain injury and their families by providing services such as information resources, legislative advocacy, public awareness campaigns, and support groups.