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Traumatic Brain Injury (TBI) is an acquired brain injury after birth caused by external force.  For example, common causes of traumatic brain injuries include falls, car accidents and athletic injuries.  (“Brain Injury in Children and Youth: A Manual for Educators,” 2018)

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In Layman's terms, the word 'deaf' refers to a person who has no or very little hearing ability. 'Hard of hearing' refers to someone who has a hearing loss, but not to the extent of some who may be deaf. There are many who suffer with profound loss of hearing but do not consider themselves 'deaf' and prefer 'hard of hearing'. There is no singular definition between the two, so it is best to ask the individual which they prefer to be called to avoid offence.

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ADHD is a neurodevelopmental disorder that is commonly diagnosed in childhood. It causes children to have difficulty paying attention, lacking the ability to control impulsive behaviors, and being overly active (Center for Disease Control and Prevention, 2022). There are three categories of ADHD, predominantly inattentive presentation, predominantly hyperactive/impulsive presentation and combined presentation.

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The American Psychiatric Association (n.d.) outlines the symptoms of the 3 different types of ADHD.
Children with Predominantly Inattentive type generally have difficulty with organization of tasks and school work, they will miss details and are easily distracted. They also tend to daydream frequently, forget about daily tasks and struggle to follow through and finish a task or assignment.
Predominantly Hyperactive-Impulsive type tend to have excessive movement than can include high energy levels, struggling to sit still, and are talkative. Children can be impulsive and make decisions without thinking of the consequences of their actions. They may struggle to wait for their turn and interupt others during conversations.
Combined type is when symptoms from both types are present.

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Symptoms of hearing loss include:

Muffling of speech and other sounds

Difficulty understanding words, especially when  background noise is present

Shouting when speaking to another person

Frequently asking others to speak more slowly, clearly and loudly

Needing to turn up the volume of the television or radio

Withdrawal from conversations

Trouble hearing consonants

Avoidance of some social settings

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Symptoms of TBI can vary depending on the severity and the region of the brain affected.

The symptoms can be medical, cognitive, behavioral, and/or social.

Even Mild concussions can cause symptoms such as include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.

People with Moderate and Severe TBI may have the symptoms of mild TBI with the addition of headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.(“Traumatic Brain Injury | National Institute of Neurological Disorders and Stroke,” n.d.)

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CHADD (2019) describes different ways children can be impacted by ADHD. Many show delayes in independent functioning and may be less mature than their peers. They often have difficulty with executive functioning, which affects career amd academic sucess. Executive functioning is the brain's ability to manage and prioritize behavior and thoughts., which allows people to think of the long term consequences of their actions. This may cause inconsistent school performance because ADHD affects working memory which can cause children to forget about tasks and assignments. Children also report getting less sleep, having lower self-esteem and higher instances of bullying (Peasgood et. al., 2016).
Peasgood, et. al. (2016) explain how an ADHD diagnosis affects siblings and peers They found higher instances of bullying between siblings and siblings reported overall less happiness with quality of life.

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Possible Impacts on the Student in the classroom include:

A limited ability to sustain attention and/or poor memory skills, including but not limited to, difficulty retaining short term memory, long-term memory, working memory and incidental memory.

An inefficiency in processing, including but not limited to, a processing speed deficit and/or mental fatigue.

Deficits in sensory-motor skills that affect either one, or both, visual or auditory processing, and may include gross motor and/or fine motor deficits.

Delays in acquisition of information including new learning and visual-spatial processing.

Difficulty with language skills, including but not limited to, receptive language, expressive language, and social pragmatics.

Deficits in behavior regulation, including but not limited to, impulsivity, poor judgment, ineffective reasoning and mental inflexibility.

Problems in cognitive executive functioning, including but not limited to, difficulty with planning, organization and/or initiation of thinking and working skills.

Delays in adaptive living skills, including but not limited to, difficulty with activities of daily living (ADL).

Delays in academic skills, including but not limited to, reading, writing, and math delays that cannot be explained by any other disability. They may also demonstrate an extremely uneven pattern in cognitive and achievement testing, work production, and academic growth. (“Brain Injury in Children and Youth: A Manual for Educators,” 2018)

In addition to the specific effects of the brain injury, students may struggle with frustration, anxiety and depression with the loss of their skills.  Peers may also struggle with reconciling the changes in the student compared with the person before the TBI.  Peers may be affected by the students lack of personal boundaries and impulse control as behaviors may create safety concerns and/or disrupt learning in the classroom.

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Developmental Cognitive Disability (DCD) is defined as a condition that results in intellectual functioning significantly below average and is associated with concurrent deficits in adaptive behavior that require special education and related services. DCD does not include conditions primarily due to a sensory or physical impairment, traumatic brain injury, autism spectrum disorders, severe multiple impairments, cultural influences, or inconsistent educational programming (Developmental Cognitive Disabilities).

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Elements of Diagnosis:
- The student demonstrates below-average adaptive behavior in school and/or at home.

- The student academically performs significantly below average, in comparison to peers.

- Child needs higher-than-average levels of support in at least four of the seven adaptive behavior domains across multiple environments: (1) Daily living and independent living skills, (2) Social and interpersonal skills,  (3) Communication skills,  (4) Academic skills, (5) Recreation and leisure skills, (6) Community participation skills, (7) Work and work-related skills (MN Department of Education).

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Logan (2022) outlines some strategies to support children who are diagnosed with ADHD. She mentions the importance of developing routines for homework and task completion. The child should make a checklist of activities that need to be done at home. They can get a daily planner to write down all assignments, so they do not miss or forget any. There should be a designated time and location for homework completion. Include breaks and fidget supports when needed.
ADHD medication can reduce the s ymptoms. Logan (2019) emphasizes the importance of taking the medication correctly and at the same time everyday. She explains that healthy habits, such as a healthy diet combined with getting enougjh sleep and exercise may reduce the symptoms of ADHD.
Additionally, giving positive reinforcement and praise supports the child's emotional wellbeing. Short and clear directions with physical touch and eye contact are more effective for children with ADHD. (Logan, 2019)

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Deafness and Hearing loss can have a profound effect on a student's learning experience. Obviously, the student may not be able to hear simple instruction, so the teacher needs to take this into consideration when facilitating lessons. Students with hearing loss may possibly find the acoustics in a classroom challenging and may experience problems with literacy.

Being deaf or hard of hearing can also affect communication skills and therefore group work could become problematic. Students who have not worked with someone who is deaf or hard of hearing may become frustrated with the lack of understanding. People who are deaf or hard of hearing may struggle to groups because their lack of auditory processing and can therefore become disconnected and withdrawn. It is important that the teacher plans ahead with the below strategies and accommodations to ensure the student is given maximum support access the learning content.

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Students with DCD usually understand content at a slower pace than students without DCD. This might impact peers in the class because the teacher has to adjust the pace of the class to the level of understanding of the student with DCD. This could be frustrating, especially for the high achieving students in the class, because they could learn more or have more time to practice skills if the class moved at a faster pace. Furthermore, students without DCD might need to support the student with DCD to understand course material (for example, peers who sit next to the student might have to repeat or explain instructions, etc.). Finally, if the student with DCD has trouble with social interactions, it might be difficult for other students - especially when they're younger - to understand how to interact with them.

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Helping a student with a TBI be successful in school will likely involve a multi-disciplinary team of administrators, learning specialists, speech, physical and occupational therapists.  Specific accommodations and instructional strategies will vary with each student depending on the location and severity of the injury.  Each student may need a unique combination of the recommended accommodations below.  It is important to note that accommodations in one area, such as sensory/motor may also help with other areas like attention and visa versa.

Attention and Concentration:

Seating away from distractions and near positive peer role models, provide clear expectations for behavior in the classroom and learning objectives, break assignments into smaller chunks and frequently check for understanding, provide a variety of learning activities so that students have an opportunity for movement after sitting and for breaks after periods of concentration.  Tie new learning to previous learning and to areas of student interest. Provide alternative testing environments away from distractions and additional time as needed. Provide copies of class notes or outlines.  Have students “teach” concepts to a peer right after the teacher has given large group instruction.  Teach and encourage mindfulness and positive behavior self monitoring and refocusing strategies. Use written or picture organizers and check off completed steps.

Inhibition

In addition to the accommodations mentioned above, strategies that help a student who has difficulty with impulse control include having the student repeat the question before answering or waiting 10-15 seconds before answering.  Provide fidgets, wiggle seats and/or the opportunity to stand during lessons. Provide classroom jobs such as passing out papers that allow movement.   Provide verbal and/or non-verbal cues between teacher/student. Provide extra adult support to the student for transitions between activities and/or moving from classroom to other areas of the school.

Processing Speed

Have well established rules and routines, give instructions one at a time, focusing on the most important information and give students time to process between instructions.  Provide written directions that include visuals.  Reduce the number of questions/assignments required. Try not to pressure the student to hurry. Provide graphic organizers and teach them how to use them. Teach students how to highlight dense text and how to study from notes. Teach the student how to advocate for themselves in asking for people to slow down.

Memory

Pre-teach vocabulary and/or give notes to parent/student before class.  Allow students to use books/notes on assessments.  Use multiple choice questions instead of essay/short answers  Incorporate repetition/practice of new material and allow breaks between.Teach memory strategies: visual imagery, grouping information, mnemonics, connecting information to what the student already knows. Make emotional connections to  help trigger the limbic system.   Competition games are often effective.  Provide an extra set of books for home.  Provide a designated folder for homework.  Teach how to use technology like notes, calendar and alarms. During classroom instruction, if the student has their  hand up, call on them first so they don’t forget the question/response.  Teach memorization strategies like mnemonics.  Encourage/help students create a visual picture.  Ask the student the 5 Why questions to help with reading comprehension.  Use Errorless learning strategies to discourage guessing. Encourage students to self advocate to have information repeated or presented in another way.  Teach children in themes across content if possible.

Sensory/Motor

Students can be overwhelmed by visual/auditory stimuli or can need more sensory input.  Students should have access to earphones, sunglasses and quiet spaces to reset as well as rest breaks.  Recess and lunch are not rest for students with TBI. They may need an alternative location to eat with a small group of friends.  Students who need more stimuli should be allowed to chew gum or crunchy snacks, and be given weighted vests or blankets, stretch bands on chairs and other fidgets.  Students may need to transition before other students when the halls are quieter.  Students should be encouraged to participate in individual sports and activities that build strength and balance but don’t put the student at further risk of injury.  Allow the student to work in different positions including standing or laying on the floor.  Limit the amount of information on and/or use a ruler for visual tracking on a page.  Work with the physical and occupational therapists to determine needed adaptive equipment and technology such as special pencil grips or text to speech apps.  Give the student prepared materials rather than requiring them to cut or fold so they can focus on content.   (“Brain Injury in Children and Youth: A Manual for Educators,” 2018)

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1. Reduce reverberation in your classroom. This will help absorb unwanted sounds in the classroom and reduce the chance that instruction and communication get lost. Installing carpet and removing reflective surfaces will help significantly reduce reverberation. Soft displays and cork pin-boards can also have the desired effect.

2. Following instructions can be challenging for students with hearing loss, especially within noisy learning environments. Take appropriate steps to eliminate as much background noise as possible. Consider things like the air conditioner, foot-traffic, and proximity to major thoroughfares. By doing what you can to minimise the level of noise overall you will reduce the possibility of a student with hearing loss mishearing your instructions.

3. Students with hearing loss use a lot of concentration and effort to complete tasks, and are likely to tire. This may cause the students to become disengaged. Help students with their concentration by using assistive technologies, e.g an amplification system which may help amplify a single voice over classroom noise.

4. Introduce new concepts in small steps and deliver the lesson at a measured pace. It is also important to keep directions concise and simple and to support your verbal instructions with visuals. Present instructions up on a board, so there is always a point of reference for the student. Also provide them with printed notes or electronic visuals through their device.

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Video

https://braininjuryeducation.org/populations/children/13-traumatic-brain-injury-in-children.html

Resources specifically for Educators

Online Learning for Students with Brain Injury & FASD | CDE

Brain Injury in Children and Youth: A Manual for Educators

LEARNET: Living Education And Resources Network by the Brain Injury Association of New York State

Resources for Parents and Educators

Colorado Kids with Brain Injury

Self Advocacy Tools for Students returning to the classroom

http://www.cde.state.co.us/node/61401

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- Provide student with an outline of what will be taught in order to prepare them in advance for the lesson.
- Provide student with reading lists well before the start of a unit so that the student can begin reading with ample time.
- Tailor reading lists and provide guidance to key texts.
- Ensure that stages and sequences are made clear when introducing processes or procedures
- Make sure to give directions both verbally and in written form
- Investigate and provide assistive technology that might help student
- Use clear and simple language
- Reinforce concepts by connecting to real-life examples
- Present information in a variety of formats (images, videos, written form, etc.)
- Where possible, present material diagrammatically - in lists, flow charts, concept maps etc. Use color whenever possible to distinguish and highlight concepts.
- Recording lectures might help students go back and review parts they did not catch during live class.
- Seat students with DCD next to students who can help them, rather than marginalize them.
- Individually orient them around classroom equipment (library, lab, etc.), in order to minimize anxiety.

(Inclusive teaching: Intellectual disability).

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Students with ADHD are protected by the Individual with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973 (Center for Disease Control, 2022). Through IDEA, they may be eligible to receive and Independent Education Plan (IEP) which utilizes special education services to best support their individual needs. Section 504 provides servies and allows for the child's learning environment to be altered to meet their needs at the equivalent of their peers.
These accomations can include additional time on tests, altered assignments, differenciated instruction, time to move and take a break, positive reinforcement, environment change to avoid distraction, technology use to assist with tasks and extra help staying organized and on task Center for Disease Control, 2022).

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This is a program that works with children with DCD: https://www.arlingtonva.us/Government/Departments/DHS/Aging-Disability/Programs/Dev-Disability

Here is a great video that defines DCD: https://study.com/academy/lesson/developmental-cognitive-delay-in-children-definition-lesson-quiz.html

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Developmental Cognitive Disabilities. MN Department of Education. (n.d.). Retrieved September 14, 2022, from https://education.mn.gov/MDE/dse/sped/cat/dcd/#:~:text=Developmental%20Cognitive%20Disability%20(DCD)%20is,special%20education%20and%20related%20services.

Inclusive teaching: Intellectual disability. ADCET. (n.d.). Retrieved September 14, 2022, from https://www.adcet.edu.au/inclusive-teaching/specific-disabilities/intellectual-disability

MN Department of Education. (2019). (rep.). Manual on Developmental Cognitive Disability (DCD).

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This video uses interviews and actual classroom footage to explore successful practice when teaching deaf students in an inclusive setting.

The video includes information on the importance of teacher expectations, family background, myths about deafness and modifying classroom activities to accommodate deaf students.

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Teaching deaf students in the inclusive classroom- Part 1

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This video explains the major impact a mild hearing loss can have on a child in school, and what professionals can do to support a child with a mild hearing loss in their class.

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Tips for teaching deaf children with a mild hearing loss

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Classroom adjustments: Hearing loss - Nationally Consistent Collection of Data. Nccd.edu.au. (2022). Retrieved 18 September 2022, from https://www.nccd.edu.au/professional-learning/classroom-adjustments-hearing-loss#:~:text=The%20impact%20of%20hearing%20loss,technology%20to%20participate%20in%20class.

Hearing loss - Symptoms and causes. Mayo Clinic. (2022). Retrieved 18 September 2022, from https://www.mayoclinic.org/diseases-conditions/hearing-loss/symptoms-causes/syc-20373072.

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Brain Injury Guide and Resources. (2020). Retrieved September 17, 2022, from https://braininjuryeducation.org/populations/children/13-traumatic-brain-injury-in-children.html

Brain Injury in Children and Youth: A Manual for Educators. (2018). Retrieved September 17, 2022, from http://www.cde.state.co.us/cdesped/tbi_manual_braininjury

Colorado Kids with Brain Injury. (2022). Retrieved September 17, 2022, from https://cokidswithbraininjury.com/

LEARNET: Living Education And Resources Network by the Brain Injury Association of New York State. (n.d.). Retrieved September 17, 2022, from http://www.projectlearnet.org/for_teachers.html

Traumatic Brain Injury | National Institute of Neurological Disorders and Stroke. (n.d.). Retrieved September 17, 2022, from https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury

Traumatic Brain Injury (TBI): Pediatric Causes and Prevention Strategies. (2019). Retrieved from https://www.nichd.nih.gov/newsroom/digital-media/infographics/TBIinKids

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https://chadd.org/

This website is dedicated to educating and supporting people diagnosed with ADHD and others who know someone with it.

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ADHD 101 - Why Kids With ADHD Need Different Parenting Strategies

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Logan, Amanda. “5 Tips to Manage ADHD in Children.” Mayo Clinic Health System, Mayo Clinic Health System, 13 Sept. 2022, https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/5-tips-to-manage-adhd-in-children.

Peasgood, Tessa, et al. “The Impact of ADHD on the Health and Well-Being of ADHD Children and Their Siblings.” European Child &; Adolescent Psychiatry, vol. 25, no. 11, 1 Apr. 2016, pp. 1217–1231., https://doi.org/10.1007/s00787-016-0841-6.

“What Is ADHD?” American Psychiatric Association , n.d., https://www.psychiatry.org/patients-families/adhd/what-is-adhd.

“What Is ADHD?” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 9 Aug. 2022, https://www.cdc.gov/ncbddd/adhd/facts.html.

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Having this resource makes me feel more confident in my knowledge of ADHD and low incidence disabilities, and therefore how to best meet the needs of students who have them. This is the first year I have my own class, so the usefulness of this tool for my first year of teaching and for the future are basically the same.

I have a lot of students in my class this year who have ADHD, and knowing the different presentations of it is useful in helping them learn in the most effective way possible. I used to think of ADHD exclusively in its hyperactive presentation, and now I feel more understanding and empathetic towards students with inattentive presentation. I feel like I now know a range of interventions and strategies that can help students stay focused and learn at a similar pace as their peers.

I also have a student with DCD, who I feel more confident about being able to help after learning about this disability. Sometimes the pace of the schoolday is so quick that I forget to stop and think more profoundly about what happened and how I can do better, and this assignment gave me a chance to do that.

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This type of resource would have been very helpful to me as a first year teacher.  Looking back, I think it is likely that I had students in my class that had ADHD, but I only saw bad behavior and my responses were more punitive than instructional.  One of the strategies that likely would have been effective is to provide opportunities for movement.  Looking ahead, this resource will help me plan and prepare effective interventions for students in my classroom.  It is fairly common for me to experience students with ADHD in all levels of instruction and students with Developmental Cognitive Disabilities in my structured learning center self contained classrooms.  I have had students in the past with TBI and, unfortunately, a junior in our school is currently in the hospital and hopes to return soon. I currently have a student with profound hearing loss who has cochlear implants.  Knowing where to quickly find information and resources will help me serve these students with better results for them and their peers.

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This resource would have been very helpful for me as an early career teacher understanding the different disabilities presented. It provides clear definitions and strategies to support and find suitable accommodations for students. It would have also given me insight into ADHD and how to plan in advance to support students with ADHD, rather than just try to keep them concentrating on their work through extra instruction.

I've never had experience of teaching students who are deaf or hard of hearing, but I feel more equipped should I encounter this in the future. It would be great to have had a larger cohort and for more disabilities to be covered. I will recreate this Padlet with other disabilities added to support the staff at my current school create a more inclusive classroom.

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This resource will be very beneficial for my future in teaching. I’ll be able to use it as a reference point if I notice any signs of low incidence disabilities in my students. My cohort members clearly outlined strategies to support students with low incidence disabilities that I will be able to implement, and they provided additional resources I can utilize. I can also provide these sources to my colleagues and families who may need it.

In my year of teaching, this could have helped me navigate recognizing the signs of low incidence disabilities and given me tools to support the students who have them. I may have been able to be more proactive in implementing support systems and offering accommodations to these students.