Students with TBI who may be depressed
Students with TBI may experience depression due to emotional, social, and physical changes after the trauma. The symptoms of depression tend to be most pronounced during the first 12 to 14 months and gradually decrease by the third or fourth year. Often, the symptoms of depression may go unnoticed because they are masked by the physiology of the trauma (Wright-Strawderman, Lindsey, Navarette, & Flippo, 1996). Clinical interventions may be necessary; however, there are steps that teachers may take to support students with depression, whether or not they are receiving additional professional counseling. A first step is knowing and understanding how depression may be expressed in student behavior. A second step is to work with the student on strategies to change unhealthy behaviors that support the depressing thoughts. At the same time, teachers should build collaborative relationships with the family, school counselor, school social worker, and any non-school personnel who work with the child, such as psychotherapists or physicians.
Whether or not they become depressed, adolescents who have a traumatic brain injury may be more aware of the capacities for thinking and doing that they have lost. These students will need help and caring support to rebuild feelings of self-worth and respect. Furthermore, some may require social skill retraining in addition to academic skill-building.
Common signs of depression:
- Loss of motivation and/or interest
- Being sluggish or inactive
- Difficulty concentrating while doing schoolwork or engaging in other activities, such as watching TV or playing games
- Persistent sadness
- Expressing or demonstrating low self-esteem
- Difficulties with personal relationships
- Feeling that they are not liked by others
- Feelings of hopelessness and helplessness
- Younger children may have physical symptoms, such as stomachaches and headaches
Strategies and techniques:
- Review and select strategies or activities from the previous chapters on this website and in your text. Many of those are appropriate for students with TBI who have low self-esteem, difficulty with personal relationships, and feeling that they are not liked.
- In particular, teachers might consider social autopsies, social stories and cartooning, mentoring younger children, and techniques for teaching the hidden curriculum.
- Scheduling pleasant events may be used to help a student through a difficult period. First, the teacher and student meet to plan a day or week's events, such as attend an after-school game or club meeting, go to a movie with a peer, or play a computer game. These are entered into a schedule so that the student can self-monitor attendance and response to the event. On a daily basis the student notes if they have experienced happiness, fun, or enjoyable feelings during any of these events. The journal allows them to see that life can still be pleasant.
- Some students are unable to think realistically about their abilities and set unrealistically high standards for themselves. When they do not meet those standards, they become depressed. Self-evaluation training is useful for these students. The teacher and student meet to discuss the student's perceived and actual present levels of performance. The differences are analyzed so that more realistic goals can be set.
- Once realistic goals are set, the student is prompted to self-reinforce achievement of goals with positive self-statements, pleasant images, and tangible rewards. This will help break the cycle of setting unrealistic goals that are not achieved, leading to self-punishment and self-hate.
Source:
Wright-Strawderman, C., Lindsey, P., Navarette, L., & Flippo, J. (1996). Depression in students with disabilities: Recognition and intervention strategies. Intervention in School and Clinic, 31(5), 261-275.
