Can TBI kids with frontal lobe damage learn to care about other people?

Question

I am working with a 5th grade TBI child. He is totally self-centered and does not have any social consciousness. He lies without remorse and does not have any interest in doing things because they are the right things to do. The only way we can keep hin in line at all is with a star chart that grants rewards he can earn throughout the day. His mother says that this is all because of the TBI and that he will never change. I have concerns that if we do not teach him social behaviors and do not try to do any values education, that he will have a very limited life. He is only my third TBI case and I need some help from people who have more expertise in this area. Do you have any suggestios for me?

Answer 1

As you will be aware, TBI patients exhibit a varied constellation of symptoms depending on the degree and site of the trauma. The very first thing you should do, if it has not been done already, is to have the child properly assessed by a neuropsychologist. It may well be that his condition precludes him from feeling empathy (in the manner of a narcissistic sociopath) so attempting to teach him values would be a supreme waste of time. Go back to his case notes, see what testing has been done so far and work from there.

Answer 2

The frontal lobes are responsable for cognitive and executive function. So NO you will not be able to "fix" him. My son is a stroke survivor. He has the same problems. If the star chart works, utilize it to the max possible. Make sure the next years teacher is made aware, so she can be ready when the child gets there.

Answer 3

Case notes will have already been done for the child and that's why he's placed where he's placed. It really depends on when his TBI was. If it was within the past year or even two years, research shows that yes, children can learn and the brain can adapt but not to full recovery of 100%. I would like to think that every TBI is able to adapt to their environment using tricks and tips and gadgets to help them.

It also depends on the child's personality before the TBI. I find that TBI completely reverses the person. If the person was outgoing before they tend to be shy after, if they are shy before they tend to be outrageous (and not in a funny way). TBI as you know is refered to as a "Second Life" or "Another Life" because it is so different from the one they have known.

Social behaviours can be taught. I have taught them to children and adults with TBI for 20 years. You will need to use "cues" to let him know when he is being inappropriate. These cues can be as simple as a finger to the nose or something discreet so that it doesn't embarass him.

You can also tie this into his reward system of the stars. Get him to think about what he wants to do in his later years and use that as a goal for him to modify his behaviour to get there. It really is about behaviour modification.

There are support groups out there as well that he can engage other children and adults and learn from them by example. Check with your local TBI agency in your community when the support meetings are and they might be able to assist you further.

I hope this helps.