Assessment Strategies/Ongoing Monitoring
Students who have sustained TBIs can demonstrate uneven patterns of strengths and weaknesses. Their skills can change rapidly during recovery. Thus, it’s important for educators to understand various tools that can help evaluate present levels of performance. A few useful assessment strategies students who have sustained TBIs include: observations, interviews, checklists and rating scales, standardized norm-referenced tests, curriculum-based measures, functional behavior assessments, and computer-based neurocognitive tests. This module contains information about what these assessment strategies can measure, the names of commonly used tests in schools, and the importance of implementing ongoing progress monitoring.
Students who have sustained TBIs often present with inconsistent profiles and behavioral difficulties in the classroom. When working with students who have sustained a TBI, it is crucial that educators implement appropriate assessment strategies and ongoing progress monitoring. Members of the school’s multidisciplinary team, such as the school psychologist, speech-language therapist, and occupational therapist, can assist teachers with conducting assessments and devising strategies for ongoing progress monitoring to help meet the student’s specific needs.
Types of School-Based Assessments
- Checklists and Rating Scales
- Standardized Norm-Referenced Tests
- Curriculum-Based Measures
- Functional Behavior Assessment
- Computer-Based Neurocognitive Tests
Teachers are observing their students all the time. However, they do not always have a systematic way of recording what they see. Teachers can collect observational data themselves through strategies such as narrative recording, A-B-C (antecedent-behavior-consequence) charts, scatter plots, event recording, and duration and latency recording. These strategies can help chart a child’s progress or response to intervention across time.
Sometimes it is helpful to have an outside observer, such as a school psychologist, come into the teacher’s classroom to conduct an observation during regular instructional time. This person can observe the individual student, as well as how the student interacts with the classroom environment (the teacher, the other students, the classroom, the materials, the physical space, the classroom management system, and so forth). The goal is to gather information about the child while in their natural setting. The independent observer will record where the observation takes places, what the child is doing compared to classmates, and the overall length of the observation. One example of this is a structured observation system called the Behavioral Observation of Student in School (BOSS), in which the observer records the student’s time on-task at regular intervals.
Interviews with parents, teachers, other school-based professionals, and medical providers can be a rich source of data. Talking with each of these individuals will help educators gain a better understanding of the student’s strengths and difficulties.
Often a comprehensive interview with parents will help shed light on issues at school, as they can provide information about sleep patterns, eating habits, relationships with siblings, medical history, and more. Parent interviews should involve questions related to a history of head injuries and well as background information on what the child was like (cognitively, emotionally, and socially) before the injury.
Interviews can be unstructured, semi-structured, or structured. Some interviews are norm-referenced and provide a score that compares a student to typical same-age peers, such as the Survey Interview and Expanded Interview form of the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II).
Checklists and Rating Scales
Checklists and rating scales can be used to monitor changes as a result of intervention, refine observations, and guide intervention formulation. Checklists typically involve simply endorsing (checking off) whether or not a child exhibiting a particular skill or behavior. Rating scales help to quantify how often or to what degree the skill or behavior is exhibited.
Checklists and rating scales are typically quick and easy to administer and score. Some might be informal and designed by educators for a specific purpose. For example, if Johnny is receiving a behavioral intervention that focuses on following classroom rules, his teachers might complete a twice-daily rating on a 1-5 scale (“unacceptable” to “excellent”) of how well he behaved in the classroom. They can also be completed by parents, related service personnel, and even by the students themselves to evaluate their self-perceptions and self-awareness.
Standardized checklists and rating scales can be used to inform us how far the child’s behaviors deviate from those of typical same-age peers. Some examples of such measures that might be useful for the student with TBI include:
Behavior and Social Skills
- Child Behavior Checklist (CBCL)
- Behavior Assessment System for Children—Third Edition (BASC-III)
- School Social Behavior Scale Rating Form—Second Edition (SSBS)
- The Social Skills Rating System (SSRS)
- Adaptive Behavior Assessment System—Second Edition (ABAS-II)
- Scales of Independent Behavior-Revised (SIB-R)
- Vineland Adaptive Behavior Scales—Second Edition (VABS-II)
- Behavior Rating Inventory of Executive Functioning (BRIEF)Behavior Rating Inventory of Executive Functioning (BRIEF)
Standardized Norm-Referenced Tests
Formal assessment measures are systematic preplanned methods of testing. Each formal assessment has the same set of instructions for all students, as well as the same criteria for scoring and interpretation. Standardized tests are used to compare a student’s knowledge and skills in a particular area to those of other students in the nation. These can be administered to groups of students or to individuals. They can measure a variety of domains, including cognitive ability (IQ) and academic skills.
While all students in the school may take a group-administered test of cognitive ability, a student with TBI who is being evaluated for special education eligibility would likely be administered a norm-referenced test of cognitive ability by the school psychologist. This gives the test administrator the opportunity to observe the student perform an array of tasks in an allotted amount of time. A few examples of such tests include:
- Weschler Intelligence Scale for Children—Fifth Edition (WISC-V)
- Woodcock-Johnson-IV Tests of Cognitive Abilities—Fourth Edition (WJ-IV)
- Stanford-Binet Intelligence Scales—Fifth Edition (SB-V)
- Differential Ability Scales—Second Edition (DAS-II)
- Cognitive Assessment System—Second Edition (CAS2)
- Comprehensive Test of Nonverbal Intelligence—Second Edition (CTONI -2)
- Differential Abilities Scale—Second Edition (DAS-II)
- Kaufman Assessment Battery for Children—Second Edition (KABC-II)
- Wechsler Preschool and Primary Scale of Intelligence—Third Edition (WPPSI-III)
- Wechsler Abbreviated Scale of Intelligence—Second Edition (WAIS-II)
It is important to know that a global or standard score on a test may not be fully representative of the student’s ability. There are often uneven patterns of performance or “spotty profile traits” for students who have sustained a TBI. Thus, it is important to look at each area of the assessment individually for TBI students to determine their skill levels. In addition to the overall IQ scores, cognitive assessments will measure processing areas, such as verbal ability, nonverbal ability, processing speed, and working memory.
Whereas typical classroom assessments measure a specific skill that was just taught, academic achievement tests measure specific academic areas compared to typical same-age peers. Skill areas might include reading, writing, math, and oral language skills. Each of these skill areas are generally broken down into subdomains, such as reading fluency, word recognition, decoding, and reading comprehension. A few commonly-used individual assessments of academic skills include:
- Wechsler Individual Achievement Test—Third Edition (WIAT-III)
- Woodcock Johnson Test of Achievement—Third Edition (WJ-III)
- Kaufman Tests of Educational Achievement—Second Edition (KTEA-II)
- Peabody Individual Achievement Test—Third Edition (PIAT-III)
- Key Math Diagnostic Test
- Woodcock Reading Mastery Tests—Third Edition (WRMT-III)
Following are additional standardized tests to evaluate functioning in various domains that might be affected by a TBI:
- Children’s Category Test
- NEPSY-II—Second Edition
- Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
- Children’s Memory Scale
- Continuous Performance Test-II
- Logical Memory I and II
- Wechsler Memory Scale—Fourth Edition (WMS–IV)
- Wide Range Assessment of Memory and Learning—Second Edition (WRAML-2)
- Behavior Rating Inventory of Executive Function (BRIEF)
- Delis-Kaplan Executive Function System
- Executive Control Battery
- Stroop Color and Word Test
- Trail Making Test—Part B
- Wisconsin Card Sorting Test
- Delayed Gratification Task
- Digit Span (Forward and Reversed) (Wechsler scales)
- Boston Naming Test
- Children’s Auditory Verbal Learning Test
- Multilingual Aphasia Examination
- Token Test—Short Form
- Clinical Evaluation of Language Functioning—Fifth Edition
- Arizona Articulation Proficiency Scale—Third Edition
- Goldman-Fristoe Test of Articulation—Third Edition
- Stuttering Severity Instrument—Fourth Edition
- Test of Childhood Stuttering
- Developmental Test of Visual Perception—Second Edition
- Test of Visual Perceptual Skills
- Grooved Pegboard
Some important things to note:
- Students with TBI often have test scores that are inconsistent with their daily functioning
- IQ tests can demonstrate the student’s knowledge of previously learned information. However, they do not address the ability to learn new information, which is often an area of impairment for students with TBI.
- Students who have sustained TBIs often focus better in a one-on-one interaction, but have trouble with focusing in a distracting classroom. Thus, their test scores may show their potential, but not areas of difficulty in the classroom.
Curriculum-Based Measures (CBM)
CBM is a method for sampling student skills in key curricular areas through the use of short-duration measures that assess accuracy and fluency. CBM content and procedures can sample the curriculum widely or specifically. CBM can be used for: screening, monitoring progress, diagnosis and instructional planning, and prognosis. CBM allows teachers to work efficiently, produce accurate meaningful information to index standing and growth, and provide information to plan better instructional programs.
For example, a student might complete a reading probe in which she reads aloud from a grade-level passage for one minute. The evaluator will tally how many words the student read correctly in one minute. This process can:
- help to identify areas of academic struggle
- allow progress monitoring in specific subjects
- allow for pre-injury and post-injury comparison
- provide a low-stress assessment that is easily administered in the classroom setting (Such tests that are less demanding can prevent exacerbation of symptoms such as headache and fatigue in a student with TBI.)
Functional Behavior Assessment (FBAs)
FBA is the foundation of a proactive and preventative approach to behavior problems. FBA identifies the environmental conditions that predict and maintain problem behavior and use it as a basis for the development of a behavior intervention plan. The FBA results in the development of a hypothesis which summarizes the event, antecedent, and consequences that predict and maintain the problem behavior. The purpose of FBA is to develop effective and efficient behavior interventions.
The previously discussed strategies of observations and interviews are key components of an FBA. The FBA can also include manipulation of variables to help evaluators recognize gradual and immediate triggers, as well as consequences of behavior. Data are then used to develop an effective intervention plan.
Computer-Based Neurocognitive Tests
Computer-based neurocognitive tests, such as the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) are typically used for student athletes. These assessments are administered pre-season to obtain a baseline of a student’s level of functioning. If a student athlete sustains a concussion, s/he re-takes the test and the scores are compared to baseline. The goal is to bring the student’s score back to baseline before allowing a return to active play. Computer-based neurocognitive tests should only be used along with other assessment strategies and a comprehensive evaluation from a health-care provider.