The PEDS Model of Child Neuropsychological Rehabilitation

The developmental and systems perspective is regarded as essential in producing change in childhood brain injury (Anderson & Catroppa 2006, Ylvisaker et al. 2005). Developmental perspective: there is an interaction between development and brain injury such that the timing and nature of the injury, the stage of skills development and the social context of the child interact to determine the outcome for the child (Eslinger et al. 1999, Ylvisaker et al 2005). The interaction between brain injury and development is exemplified by the finding that the profile of behavioural and psychiatric and emotional disturbance (a common and persistent sequelae of child brain injury) may worsen over time (Schwartz et al. 2003, Ylvisaker et al. 2005). These difficulties are usually associated with damage to the frontal lobes, an area of the brain typically affected in closed head injury. There is a growing emphasis on the interaction between childhood development and frontal lobe damage when designing and implementing behavioural intervention programmes for children with behavioural disturbance following a TBI. Traditional behavioural management methods require the capacity to learn efficiently from consequences. The ability to learn in this way is reduced significantly by frontal lobe injury (Rolls 2000, Schlund 2002). In recent years positive behaviour supports have been highlighted as more appropriate strategies for managing the behaviour of children with brain injury. They focus more on managing the environment (to prevent triggers to behaviour), rather than trying to shape and change behaviour.There is mounting evidence of the efficacy of this type of behaviour management (Feeney & Ylvisaker 1995, Ylvisaker 2003) including in the school environment (Pressley, 1995, Sweet & Snow, 2002, Ylvisaker et al. 2001). In addition, it is recognised that children with damage to the frontal lobes as a result of a brain injury have particular difficulty in planning and organising. Positive behaviour supports can also be used by the young person to compensate for these difficulties, for example by encouraging the young person to use graphic organisers and telephones and other specific organisational strategies, and through the provision and implementation of predictable and paced daily routines.