A TBI (traumatic brain injury) can temporarily or permanently impact many different areas of functioning. Depending on the severity of the injury and which regions of the brain are affected, survivors can have very different experiences as they recover.

Damage to the brain’s physical structure can impact an individual’s mobility, sensory perception, and even their ability to regulate their mood and emotions. Unlike degenerative illnesses, a TBI can leave survivors and their loved ones feeling like everything changed in an instant. By understanding the scope of the injury and making necessary accommodations, families can better navigate life after a TBI together.

1. Sensory Challenges

Different regions of the brain specialize in particular functions, from motor skills to taste, texture, sound, and smell. As we take in information from the world around us, we count on our brains to translate neural impulses into experiences.

When one or more of these regions is damaged, an individual can experience noticeable changes in the way they process sensory information. Common symptoms might include:

Living with Sensory Changes

A loved one’s new sensory sensitivities or aversions following a TBI can require families to make some changes for their comfort and safety.

Fortunately, many simple modifications can make your home more sensory-friendly. Whether or not the changes in a TBI survivor’s senses are permanent, removing some of these daily hurdles can make recovery a more positive experience.

2. Difficulties with Social Relationships

TBIs can cause deficits that impact survivors’ ability to connect socially. Coordination problems may make speech physically more difficult, or cognitive changes might make it harder to participate in conversations. Individuals recovering from a traumatic brain injury report difficulties staying engaged during social interactions and remembering what’s been said.

These new communication challenges can be frustrating and isolating for people living with a TBI. These individuals are at risk of withdrawing socially, which is particularly unfortunate because of the role that a strong support network plays in recovery.

Managing Relationships After a TBI

Patience and understanding are key. TBI survivors are typically well aware that their cognition has changed, so pointing out that they are repeating themselves will only cause embarrassment and frustration.

Speak clearly, talk about one topic at a time, and allow extra time to process information and respond. Otherwise, treating your loved one as you normally would can go a long way toward helping restore a sense of normalcy.

3. Emotional Changes

Our mood, emotions, and ability to self-regulate are all controlled by different areas of the brain. Damage to these regions can cause unusual, uncharacteristic, or situationally inappropriate behaviors.

People recovering from a TBI may be more prone to emotional outbursts, or they may become very emotionally “flat.” Other common behavioral changes can include:

In addition to emotional challenges that stem from physical changes to the brain, social difficulties and loss of mobility can contribute to depression and anxiety.

Emotional Support for TBI Survivors

It’s important to notice and get help for any alarming emotional or behavioral changes. Professional mental health support is often an important part of TBI recovery.

Because it’s often difficult to predict how long TBI symptoms will last or to what extent they will resolve, survivors shouldn’t wait to seek interventions and learn new coping skills. A patient, supportive network of loved ones and professionals can make all the difference throughout this journey.

The term “Intellectual and Developmental Disability” (I/DD) is designed to be as inclusive as possible. This diverse community is made up of individuals with their own unique strengths and challenges, and experiences vary tremendously from one person to the next. 

So what exactly does it mean to have an intellectual or developmental disability, and what is the distinction between them? It’s helpful to think of “developmental disability” as an umbrella term that encompasses both physical and cognitive differences. Intellectual disabilities, on the other hand, are a subcategory of developmental disabilities that doesn’t include differences that are strictly physical in nature. 

i/dd girl with paintsWhat is an intellectual disability?

An intellectual disability is a difference that appears during childhood (before the age of 18) that significantly impacts a person’s ability to learn, reason, communicate, socialize, or perform self-care tasks. While there is a lot of variation in how individuals are impacted by an intellectual disability, the effects are expected to be lifelong. 

Some intellectual disabilities are genetic, while some are acquired during childhood or fetal development. Injuries, exposure to toxins, environmental factors, and childhood health problems can contribute to these cognitive and neurological differences. 

Some of the most common syndromes associated with intellectual disabilities are: 

What is a developmental disability?

Developmental disabilities include intellectual disabilities as well as physical ones. Some conditions, like blindness or muscular dystrophy, may not impact cognitive functioning at all, while others tend to create both physical and intellectual differences. 

Because some diagnoses, like epilepsy and cerebral palsy, may or may not contribute to learning challenges, “developmental disability” is a helpful term that doesn’t assume anything about an individual’s unique situation. 

Developmental disabilities appear before the age of 22 and have an ongoing impact on the activities of daily living. Like intellectual disabilities, they may have genetic, physical, or environmental causes. 

How are intellectual and developmental disabilities classified? developmental disability wheelchair

One of the key differences between intellectual and developmental disabilities is the way they are classified. 

Intellectual disabilities are stratified according to severity:

By contrast, developmental disabilities are more often classified by their specific diagnosis. Because the specific impact of a developmental difference varies so much between people, it’s best to avoid making assumptions about any individual’s experience before getting to know them. 

Do intellectual or developmental disabilities affect intelligence?

While specific intellectual disabilities can be associated with a lower-than-average intelligence quotient (IQ), there are many ways to measure intelligence. Differences in the way that some I/DD individuals learn or express themselves often mean that traditional inventories don’t really reflect their true cognitive abilities. Furthermore, many people with developmental disabilities are intellectually and neurologically typical. 

The only way to know the scope of a person’s differences is to take the time to get to know them. Interact with members of the I/DD community the same way you would anyone else unless you’re told otherwise. You may be blown away by a new friend’s unique perspective. 


Interpersonal connections are important for everyone, but they may be especially critical to the healthy development of children with special needs. The ability to relate to others and make friends can help differently-abled kids enjoy improved academic outcomes and better mental health as they grow. 

  “15% of all public school students (7.2 million) receive special education services.”

In 2020-21, 15% (or 72 million) public school students aged 3-21 received special education services under the Disabilities Education Act (IDEA). Among these students, the most common need was assistance with a specific learning disability. 

Social skills don’t come as naturally to some kids, but they can develop with time, patience, and practice. Here are a few tips for prioritizing socialization and making it a positive experience for your child.

1. Choose a comfortable setting. 

Socialization is all about meeting new people and trying new things. For kids with special needs, branching out can be easier when at least some aspects of the situation feel familiar. 

This can apply to the venue you choose for a playdate, like a favorite park or your own backyard. It may also extend to details of the experience including snacks and activities. Everyone feels more confident when they know what to expect in a given situation, and confident kids will be more likely to have a positive social experience. 

If your child expresses anxiety over an upcoming playdate, discuss the steps you can take to help them feel more secure. This may include agreeing to either give space or stay close by, or agreeing on a codeword if they begin to feel overwhelmed. 

2. Practice social skills at home. 

Just like role-playing can help us prepare for an important meeting or job interview, rehearsing general social interactions can be helpful for kids with intellectual and developmental differences. 

Interpersonal interaction is more intuitive for some children than for others. Remind your child of the things they do well and the qualities they have to offer in a conversation. Then, make time to practice age-appropriate exchanges like:

Social skills are tough to master, but a little preparation can go a long way toward helping your child feel more at ease in conversations. 

3. Make time for decompression. 

Even if they’ve spent the day doing their favorite activities with people they enjoy, it’s normal for kids with I/DD to feel that their social batteries are drained. 

If you’ve noticed that play dates leave your child exhausted or overstimulated, build in time to help them rebalance. This could mean setting aside time to allow them to share details about their day, or just creating a space for quiet time before dinner or bed. Giving your child the outlet that they need can help make sure they view social time as a positive experience. 

4. Connect with your I/DD community. 

Get familiar with your I/DD resources, and use them to help build a social circle that includes a diverse group of differently-abled friends. 

Teachers and caregivers can be an important source of support as kids practice their social skills. You may also be surprised to discover how many programs specifically designed for special needs kids exist in your community. 

Explore I/DD and sensory-friendly events near you, and you may also discover a vital network of like-minded new friends. 

The differences in our abilities make us unique, but they don’t define our worth.

People with intellectual and developmental disabilities all have their own interests, preferences, and goals. They also have a valuable perspective to offer the world. 

Here are some tips for connecting with members of this community in a way that affirms their dignity, independence, and individuality. 

friends with wheelchair special needsSpeak to differently abled people like peers.

Talk to individuals with I/DD just like you would anyone else. If you’re meeting for the first time, introduce yourself as you normally would. Look for common ground and shared interests to build on in a conversation. 

If you’re having any difficulty communicating, ask clarifying questions and make it clear that you’re interested in understanding. Many people have a tendency to talk louder when confronted with a communication challenge, but that isn’t necessary or helpful unless the individual has a known hearing issue. 

Take your cues from your conversation partner – they will help set the tone and pace for your talk. 

Be age appropriate.

No one enjoys interacting with someone condescending. It’s important to remember that adults with disabilities are still adults. Avoid baby talk unless the person you’re speaking to is, in fact, a child.

Unless you’ve been told differently, assume that individuals with I/DD have the same interests and hobbies as their peer group. Statements like, Isn’t that movie too scary for you are infantilizing for mature individuals, regardless of their disability status.

Ask before assisting.happy cheerleader girl special needs

When offering help to an individual with I/DD, always ask their permission before jumping in.

Except in emergencies, it’s common courtesy to allow other people a say in whether or not they want our assistance. If they are receptive to your help, look for ways to work together to accomplish a goal rather than taking over. 

Respect differently abled people’s intelligence.

Even when communications challenges are present, it’s important to speak to people in the I/DD community directly rather than speaking to others on their behalf. 

Ease of speech isn’t an indicator of intelligence – many individuals with disabilities that make it difficult to process language and respond to questions are very bright. Be patient and courteous in conversation, and don’t change your normal way of speaking unless you’re asked to do so.

Give them space to be themselves.

We all feel more comfortable in conversations with warm, open people. We all have idiosyncrasies – they make us who we are.

At the end of the day, an interaction with a member of the I/DD community is just another opportunity to make a new friend. Be curious, genuine, respectful, and kind, and a great conversation will flow. 

It’s about so much more than the daily grind: the right job can be a source of tremendous satisfaction and personal fulfillment. 

Members of the I/DD community deserve the opportunity to pursue rewarding, enjoyable work. If you’re considering joining the workforce, you should know that holding a job offers many potential benefits like: 

Unsure of how to get started? Here are four tips for starting your search. 

idd job search with disability1. Know your strengths.

Planning your job search around your strengths will help ensure that you find work that is satisfying and rewarding. 

Think about your best qualities: are you hardworking and reliable? Friendly? Artistic? Organized? 

What challenges are you facing? What kind of work would you feel comfortable doing, and what makes you happy?

Whether you seek a job by asking friends and family or through your state’s I/DD Employment Services, it’s important to look for work that suits your skills and personality. 

Your resume is your chance to summarize your unique skills and work experience so that potential employers can get to know you better. Writing or updating your resume can be intimidating, so take advantage of resources to help you get started. Successful resumes are clear with good spelling and grammar, so it’s a good idea to have someone your trust read your resume and give you feedback. 

2. Sharpen your skillsidd job search office wheelchair

Because many jobs look for prior experience in a relevant field, it may be a good idea to build up your resume by volunteering. 

Volunteer work can allow members of the I/DD community opportunities to try out different varieties of work without the pressure of traditional employment. Giving back to your community feels great, and you may also discover brand-new talents and interests in the process.

Do you enjoy being a student? Organizations like the United Disabilities Services Foundation (UDSF) connect individuals with intellectual and developmental disabilities with the training they need to succeed in their field of choice. 

idd job search restaurant3. Practice makes perfect.

Individuals living with intellectual and developmental disabilities and neurodivergence often feel more comfortable in novel situations when they know what to expect. 

Research frequently asked interview questions and practice your answers. Think about what you want to tell your interviewer about your interest in the job and the skills that you can bring. Role-playing the interview with a trusted friend or family member can help you feel relaxed and prepared for the real thing.  

4. Explore your resources.

Look to your community for help with refining your skills and identifying employment opportunities. 

Local programs like Everybody Works NC exist to connect I/DD job seekers with potential employers. These services also help community members connect with each other to share their insights and experiences. 

Take advantage of resources tailor-made for I/DD job candidates, and explore how you can turn your unique skillset into a rewarding career. 

With the recent pandemic, many of us have experienced some impact on our mental health.   We have faced loss, uncertainty and disruption of our normal routine. To make matters worse, we have not had access to our usual support systems and loved ones.  This has been a challenge and although the vaccine and decrease in COVID cases is a welcome relief, the mental health effects are still lingering. 

People with intellectual and developmental disabilities are not immune to these same mental health impacts.  They experience the same range of mental health symptoms that the rest of the general population does. However, the resources for people with these dual needs are often scarce and difficult to access.

We recently came across a resource that we want to share with you.  The Mental Health and Developmental Disabilities National Training Center is an organization that works to improve mental health services and support for people with developmental disabilities by providing access to training and other resources. They have free easy-to-read online learning modules for people with IDD, their families and caregivers as well as evidence-based, trauma-informed, modules and resources for mental health clinicians. 

On their website, you can also access blogs, podcasts and storytelling videos of people with IDD sharing their experiences with mental health conditions. Check out their website here:  https://www.mhddcenter.org/learn-now/


Melinda Frederick, MS, LCMHC, NCC

Sr. Director of Quality Management

Community Based Care

For Immediate Release

CBC Expanding into Virginia as They Announce Merger with F.A.C.E.S. Community Services

F.A.C.E.S. Community Services, LLC. is pleased to announce that they have joined the CBC family of providers.  F.A.C.E.S. was founded by Albert and Adrianne Sears in Chesapeake, Virginia, in 2009, with the goal of providing services that are designed to help each individual develop independent skills in a variety of home and community based settings. Albert Sears stated, “We are pleased to announce that we are joining the CBC family.  CBC is exactly what F.A.C.E.S. has been seeking to further the development of the individuals we serve.  Our values and goals are aligned perfectly.  We are not only pleased and excited to be joining CBC, we are extremely proud to be a part of their family!”


Mike Kotzen, CBC President/CEO, said, “We are thrilled to welcome F.A.C.E.S. to the CBC family of providers.  Albert and Adrianne have built an incredible legacy of service in the Chesapeake area and we look forward to building upon that foundation for the benefit of the individuals we serve, their families and our employees.”


Gene Rodgers, CBC Executive Vice President, added, “As we have gotten to know the Sears family, we have been impressed by who they are as people and as the leaders of F.A.C.E.S. They were the perfect partners for the work we do serving individuals and their families, while also working to match them with the most talented, well-trained, compassionate caregivers anywhere. The Sears are and always will be a part of the CBC family.”

To learn more about F.A.C.E.S., please visit http://www.facescommunityservices.com/.


About Community Based Care


The CBC family of providers supports people with Intellectual and/or Developmental Disabilities and Home Care/Companion Care needs, and their families, in order to achieve their fullest potential, by matching them with the most talented, well-trained, compassionate caregivers anywhere.  CBC serves over 2,500 clients in Florida, North Carolina and Virginia and employs over 3,500 talented and committed caregivers. CBC providers offer state of the art training, benefits, 401k and electronic health records to best serve our employees and clients.


For more information on CBC and its family of providers, please visit www.cbcare.com.  For more information on mergers & acquisitions please contact Gene Rodgers, CBC Executive Vice President, at grodgers@cbcare.com.

About the N.C. Innovations Waiver and What’s New

The Home and Community Based Services Waiver for North Carolina is called “NC Innovations”.  The waiver is, essentially, an agreement between the state of North Carolina and the federal government — Medicaid or “CMS”, specifically — about the service offerings available to persons with disabilities on the waiver. Currently, there are about 13,000 people in NC on the waiver, and approximately the same number on the Registry of Unmet Needs — the waiting list. 

If you or your family member is currently on the waiver, you should know that the waiver is updated periodically, and when it is, it is posted for public comment. It so happens, that we are in a public comment period right now.  You can read the proposed changes to the NC Innovations waiver by visiting this website and the actual proposed policies can be found here (warning — large file). 

Our provider leadership has reviewed the proposed waiver changes, and, in case you’re interested, is providing the following feedback to the state. 

First, a few positives…

Throughout the new waiver, there is a heightened emphasis on competitive employment for people with disabilities.  This is great!  NC is a “work first” state, meaning that people who want to work should be supported to seek jobs that pay at least minimum wage.  Work and meaningful daily activities are key quality of life outcomes for everyone — you, me, our staff, and the people we serve.  Having more opportunities to support people towards competitive employment in Day Supports, Supported Employment, Community Networking, and other services, is good for people with disabilities. 

Another positive is enhanced support for individuals with disabilities to live more independently.  Community Navigation could include tenancy supports, which would provide assistance in seeking affordable housing — a major barrier to Supported Living services.  The Supported Living definition itself does not change much, but, there is a lot of support required before Supported Living can even begin, and these additions could help meet that need. 

On the downside…

Family members (non-parents) would not be allowed to support persons on the waiver under 18 living in the same home.  Outside of the current COVID-19 easing of restrictions, this has been the case for parents.  We do, however, have some siblings who are serving in this role, and there is no grandfathering provision in the waiver to allow this to continue. 

Also, while the Individual Budgets section (Appendix F) has been amended to clarify that a person’s individual budget should not be tied to his/her Supports Intensity Scale score, we think the language could be stronger.  The budget is not a cap on annual spending; it is only a guideline. 



There is a lot to like about the direction the state is going with the NC Innovations Waiver.  There is an increasing emphasis on meaningful daily activity, employment, independent living — and broadening the availability and flexibility of supports to achieve these outcomes, including through expanded telehealth options. 

NC has been sincere in its outreach for individual and family member input, so I would encourage you to review the proposed changes and share your perspectives. 

Together, we make the difference — 

Richard Edwards

CBC Regional Vice President, North Carolina



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