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. 


Fun for the entire family can sometimes feel like a tall order. Kids with intellectual and developmental differences who are part of multi-child families may have needs and interests that are different from their siblings. 

If you’re hoping to make memories with the entire crew, your options are far from limited. Everyday activities can become opportunities for bonding. Here are some ways to get creative about how you accommodate the needs of each family member. 

sensory friendly play sandHonor all skill levels.

There is a job for everyone in your next family project. Whether you’re planting a garden, building a treehouse, or just making dinner, there are usually tasks within each activity that are suitable for kids of all ages and abilities.

While chopping vegetables may not be an ideal task for a child still mastering fine motor skills, mixing and measuring ingredients may be perfect. Giving each family member their own role in a collaborative project helps everyone come together and take pride in the end result. 

Include sensory-friendly modifications.

Kids with sensory sensitivities may find boisterous siblings overwhelming at times. Fortunately, small adjustments to your home can make family activities more enjoyable for everyone. 

Looking for fun outside of your home? 

Many attractions, including zoos, aquariums, amusement parks, and theaters, offer special sensory-friendly programming on select days. These events help the whole family enjoy outings with reduced sensory triggers. 

Choose no-rules activities.sensory friendly outdoors

Games that require that everyone understands and follows a set of rules can be frustrating for differently-abled siblings. This isn’t the case for playtime that is focused on self-expression.

Designated activities with no right or wrong approach can be relaxing and fun. Get everyone together for:

Share an adventure.

Regardless of our age or ability, we all have a unique perspective on the world around us. Shared experiences allow each family member to make their own memories while growing closer together. 

Plan a road trip.

Take a hike.

Visit a landmark. 

You’ll probably find that you don’t need to travel far to escape the ordinary. Encourage each child to discuss their perspective of your adventure: 

What stood out most?

What were they most excited about?

What was their favorite part of your outing?

Encouraging each family member to share their thoughts and impressions about an experience they have in common encourages empathy, perspective-taking, and closeness. Look for ways to use family activities to strengthen sibling bonds, and kids will view the differences in their abilities as part of what makes them unique. 


We know that each child is unique, therefore autism and autism spectrum disorder can manifest in many ways. One of the hallmarks that kids with autism typically share is a difference in the way that they process sensory information. 

For children with hypersensitivity, neurodivergence comes with a tendency to be easily overstimulated by the world around them. For others, hyposensitivity may drive them to seek stimulation from their environment by making loud noises or engaging in repetitive movements. Many children regularly experience both states. 

Navigating sensory differences is one of the biggest challenges for caregivers of children with autism, especially in families that have both neurotypical and neurodivergent children. If you want to make your home more sensory-friendly, it’s important to strike a balance that honors the needs of all household members.

Here are a few small changes that can make a big difference to a loved one with autism. 

Avoid overwhelming the senses.

For a person with neurodivergence, an ideal home environment allows them to safely explore their senses and retreat when they feel overwhelmed.

When you think about accommodating your loved one’s unique needs, consider all of the senses. 


Many people with sensory sensitivities find harsh fluorescent lights overwhelming. Natural light is often best, but when that isn’t possible, consider installing a dimmer switch to your interior lights. 

The ability to dial indoor lighting up and down slightly can make family time in common areas of the home more enjoyable for everyone. 


Children with sensory differences can experience textures with more intensity than neurotypical people. For this reason, they may strongly prefer their clothing, pillows, and blankets to be very soft. 

Caregivers who are completely unbothered by seams, tags, and zippers may have a hard time appreciating how distracting they are to children with hypersensitivity. Fortunately, there are now many options for adaptive clothing that can help kids foster more independence without sacrificing comfort.

For sensory-seeking kids, playtime can be a great opportunity to introduce new textures. Sensory play activities that incorporate paint, sand, and other craft materials can improve kids’ fine motor skills while gently stimulating their senses. 


Strong, unfamiliar flavors can be off-putting to kids with sensory sensitivities. In addition, aroma, color, and mouthfeel may play particularly important roles in these children’s enjoyment of food. 

If you’ve noticed that your child has gotten insistent on a few “safe” snacks, encourage variety by offering new foods alongside tried-and-true favorites.


Scented candles, air fresheners, and cleaning products are designed to smell nice, but to kids with sensory differences, they can be strong and unpleasant. 

If a member of your family experiences scents with a lot of intensity, consider choosing unscented versions of household products like laundry detergent, soap, and dish liquid. 

Improving the ventilation in your home and installing an air filtration system can also help dial back unavoidable aromas like the smell of food cooking.


Insulation is the best way to reduce startling, distracting noises inside your home. Even a few throw rugs can help dampen the sounds of other family members moving about. 

For common areas, agree to keep music and videos at a lower volume. Bluetooth-enabled noise-canceling headphones can allow families to watch or listen to media together while choosing a volume that is comfortable for each of them. 

Create a routine.

While it’s not always feasible, operating on a schedule is a great way to remove some of the unpredictability from your child’s daily life. 

Setting and managing expectations for the whole family can reduce the anxiety some children have around transitioning from one activity to the next. Knowing the sequence of recurring events (for example: dinner, bath time, then bed) creates an important sense of calm for sensitive kids. 

Embrace boundaries.

Regardless of our sensory processing abilities, we all need downtime. An important part of creating a sensory-friendly home is ensuring that all family members have space to retreat and be themselves.

Especially after a challenging or overstimulating event, designate a safe area of your home for decompression. Managing, rather than catastrophizing, stress is critical for healthy development as your child grows.

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. 

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. 

As the weather gets warmer and the days get longer, it’s time to plan some summer fun. 

Families with sensory-sensitive children may have specific criteria for safe, enjoyable activities, but their options are far from limited. Here are six of our favorite ways to laugh, learn, and explore together this summer. 

sensory friendly art1. Plan a sensory-friendly art project.

Unlike so many activities, there is no right or wrong way to approach arts and crafts. Whether your sensory-sensitive child is a creative soul or a reluctant artist, art is a fantastic way to encourage open self-expression. 

Consider laying down plastic table cloths to create an “art zone” where messes aren’t a concern. If textures are an issue, try to offer a variety of craft supplies that your child will find pleasant to the touch, like fabrics, construction paper, pom poms, and pipe cleaners. Let your child choose how to interact with the materials, and let the creativity flow. 

2. Take a yoga break.

Mindful movement is a great way to release pent-up energy without the sensory challenges of team sports. 

Yoga has been shown to have multiple benefits for children with autism and other sensory differences. With practice, yoga can relieve anxiety, improve emotional communication, and increase body awareness. 

Head online for free resources that can help you make sensory-friendly yoga part of your summer routine. 

3. Go for a nature walk.

Completing a hike comes with a wonderful sense of accomplishment. Whether your family loves long walks or shorter ones, spending time in nature is great for the body and mind. 

Make your nature walk sensory-friendly by choosing a quiet, familiar trail with lots of opportunities to stop and appreciate your surroundings. Consider visiting at off-peak hours, both to avoid crowds as well as harsh sunlight or high temperatures. 

Don’t worry about mileage — it’s about the memories you make, not the ground you cover. 

4. Try equine therapy.sensory friendly equine therapy

Some children who tend to find their peers overwhelming are quick to form powerful bonds with animals. 

Equine therapy for autism and sensory-processing disorders uses horseback riding to boost kids’ confidence, calm their anxieties, and improve communication skills. Research shows that the relationships children form with horses contribute to long-term improvements in emotional health.  Explore local equine therapy day camps to find programs tailored to your child’s individual needs. 

If your child is an animal enthusiast in general, reach out to your local animal rescue. Many shelters have kid-friendly opportunities to help animals in need while building self-esteem. 

5. Pack a picnic.

There’s a reason people say that food just tastes better outside. Add a new dimension to lunchtime this summer by taking your meal outdoors – even if it’s in your own back yard. 

Plan a sensory-friendly picnic by choosing a shady spot. Lay down a soft blanket to avoid any itchy sensations from the grass, and choose mild foods that you know your child will enjoy. 

6. Seek out local sensory-friendly events.

Tap into your local community to stay up-to-date on upcoming events geared towards families with sensory-sensitive children

Many local amusement parks, movie theaters, and attractions have designated sensory-friendly events that allow all children to join in on the fun by removing aspects of the experience that may be overwhelming. 

If you notice sensory-friendly options that are missing in your area, harness the power of your I/DD community and connect with other families who share your goals. 

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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