Building Blocks - Fundamental Processes

Behavioral Impacts

• 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

Cognitive Academic Impacts

• 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

• 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 (PDF)
• Classroom Observations On Task/Off Task Peer Analyses
• Behavior observations during testing
• Parent, Teacher and Student Interviews

Environmental Supports and Accommodations

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

Resources and Intervention

• Brain Injury in Children and Youth: A Manual for Educators (PDF) (Chapter 3) 
• BrainSTARS Chapter 3 and Blue tabbed sections: #2 Attention
• Executive Function in Children and Adolescents, 2nd (Dawson/Guare)\
• Late, Lost and Unprepared (Cooper-Kahn/Dietzel)
• Promoting Executive Function in the Classroom (Meltzer)
• Smart but Scattered (Dawson/Guare)
• Smart but Scattered Teens (Guare/ Dawson/Guare)
• Tools for Teaching, 3rd (Jones)
• Alert Program: How Does Your Engine Run (Williams/Shellenberger)
• Positive Behavior Intervention Supports 
• Superflex: A Superhero Social Thinking Curriculum (Madrigal/Winner)
• Games that build attention skills: Center on the Developing Child 
• Center on Brain Injury Research & Training 
• Project LEARNet 

Behavioral Impacts

• 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

Cognitive Academic Impacts

• 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

Environmental Supports and Accommodations

• Brain Injury in Children and Youth: A Manual for Educators (PDF) (Chapter 3) 
• Provide structure
• Teach routines and expectations. Fade external support to internalization of routine and systems
• Intentional adult movement through room
• Brain Breaks and movement
• Fidgets, wiggle seats, exercise balls, etc.
• Allow standing while working
• Verbal and visual cues (cue word, nonverbal gesture, sticky note system, stop light system)
• Teach goal-directed problem solving process; Goal-Plan-Do-Review
• Teach stop, relax and think
• See Reasoning, Mental Flexibility and Social/ Emotional Competency Building Blocks

Resources and Intervention

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

Behavioral Impacts

• Acts like he doesn’t understand
• Appears inattentive
• Delay in response
• Fatigues easily
• Frustration

Cognitive Academic Impacts

• 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

Environmental Supports and Accommodations

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

Resources and Intervention

• Brain Injury in Children and Youth: A Manual for Educators (PDF) (Chapter 3) 
• BrainSTARS Chapter 3 and Blue tabbed section: #11 Mental Processing Speed
• CogMed cogmed.com
• Center on Brain Injury Research & Training https://cbirt.org/back-school
• Project LEARNet http://projectlearnet.org

Behavioral Impacts

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

Cognitive Academic Impacts

• 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 (PDF)
• 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

Environmental Supports and Accommodations

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

Behavioral Impacts

• 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

Cognitive Academic Impacts

• 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

Assessment Suggestions

• 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 (PDF)
• Vision and hearing screening: conversion/tracking/depth perception
• Observations in the environment
• Functional Behavioral Assessment Behavior observations during testing
• Parent, Teacher and Student Interviews

Environmental Supports and Accommodations

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

Behavioral Impacts

• 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

Cognitive Academic Impacts

• Difficulty following verbal directions
• Tactile – difficulty registering pain or pressure

Assessment Suggestions

• 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 (PDF)
• Vision and hearing screening: conversion/tracking/depth perception
• Observations in the environment
• Functional Behavioral Assessment Behavior observations during testing
• Parent, Teacher and Student Interviews

Environmental Supports and Accommodations

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

Behavioral Impacts

• Difficulty with fasteners
• Shaky hands/tremors
• Poor coordination

Cognitive Academic Impacts

• Avoids tasks involving writing
• Difficulty with cutting
• Difficulty with drawing
• Poor handwriting
• Takes long time to produce written work
• Messy work

Assessment Suggestions

• 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 (PDF)
• Observations in the environment
• Observations during testing
• Parent, Teacher and Student Interviews

Behavioral Impacts

• Avoids sports
• Bumps into things
• Difficulties carrying lunch tray
• Clumsy
• Falls/Stumbles
• Unsteady on stairs, playground equipment or in crowds

Cognitive Academic Impacts

• Avoids recess
• Difficulty with or avoidance of P.E.
• Slumps in seat

Environmental Supports and Accommodations

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

Resources and Intervention

• Brain Injury in Children and Youth: A Manual for Educators (PDF) (Chapter 3) 
• BrainSTARS Chapter 3 and Blue tabbed sections: #6 Gross motor Control, #16 Praxis
• Center on Brain Injury Research & Training 
• Project LEARNet 

• 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. 2018. 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 – Children with TBI  – 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.