Influences on first-year recovery from traumatic brain injury in children.

This study examined recovery over the first year following traumatic brain injury (TBI) in children 6–12 years of age. Forty-two children with severe TBI and 52 with moderate TBI were compared to 58 children with orthopedic injuries. The children and their families were evaluated at a baseline assessment and at 6- and 12-month follow-ups. Findings documented cognitive, achievement, and behavioral sequelae of TBI, with only limited evidence for recovery over the first year postinjury. Outcomes were predicted by preinjury factors, TBI severity, and measures of the postinjury family environment. Some of the sequelae of severe TBI were more marked in the context of higher compared with lower levels of family burden or dysfunction. The findings confirm the need to consider environmental contributions to outcomes of TBI in children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of short- and long-term neuropsychological outcomes after traumatic brain injury in children.

Longitudinal neuropsychological outcomes of traumatic brain injury (TBI) were investigated in 53 children with severe TBI, 56 children with moderate TBI, and 80 children with orthopedic injuries only. Neuropsychological functioning was assessed at baseline, at 6- and 12-month follow-ups, and at an extended follow-up (a mean of 4 years postinjury). Mixed model analyses revealed persistent neuropsychological sequelae of TBI that generally did not vary as a function of time postinjury. Some recovery occurred during the first year postinjury, but recovery reached a plateau after that time, and deficits were still apparent at the extended follow-up. Further recovery was uncommon after the first year postinjury. Family factors did not moderate neuropsychological outcomes, despite their demonstrated influence on behavior and academic achievement after childhood TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinically significant behavior problems during the initial 18 months following early childhood traumatic brain injury.

Objective: This study looked at the emergence of clinically significant problems in behavior, executive function skills, and social competence during the initial 18 months following traumatic brain injury (TBI) in young children relative to a cohort of children with orthopedic injuries (OI) and the environmental factors that predict difficulties postinjury. Participants: Children, ages 3–7 years, hospitalized for severe TBI, moderate TBI, or OI were seen shortly after their injury (M = 40 days) and again 6 months, 12 months, and 18 months postinjury. Design: Behavioral parent self-reports, demographic data, family functioning reports, and home environment reports were collected at injury baseline and each time point postinjury. Results: Results suggest that, compared with the OI group, the severe TBI group developed significantly more externalizing behavior problems and executive function problems following injury that persisted through the 18-month follow-up. Minimal social competence difficulties appeared at the 18-month follow-up, suggesting a possible pattern of emerging deficits rather than a recovery over time. Conclusions: Predictors of the emergence of clinically significant problems included permissive parenting, family dysfunction, and low socioeconomic status. The findings are similar to those found in school-age children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding predictors of functional recovery and outcome 30 months following early childhood head injury.

Much is known about outcome following traumatic brain injury (TBI) in school-age children; however, recovery in early childhood is less well understood. Some argue that such injuries should lead to good outcome, because of the plasticity of the developing brain. Other purport that the young brain is vulnerable, with injury likely to result in a substantial impairment (H. G. Taylor & J. Alden, 1997). The aim of this study was to examine outcomes following TBI during early childhood, to plot recovery over the 30 months postinjury, and to identify predictors of outcome. The study compared 3 groups of children sustaining mild, moderate, and severe TBI, ages 2.0 to 6.11 years at injury, with healthy controls. Groups were comparable for preinjury adaptive and behavioral function, psychosocial characteristics, age, and gender. Results suggested a strong association between injury severity and outcomes across all domains. Further, 30-month outcome was predicted by injury severity, family factors, and preinjury levels of child function. In conclusion, children with more severe injuries and lower preinjury adaptive abilities, and whose families are coping poorly, are at greatest risk of long-term impairment in day-to-day skills, even several years postinjury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The family environment as a moderator of psychosocial outcomes following traumatic brain injury in young children.

Objective: This study sought to determine whether the family environment moderates psychosocial outcomes after traumatic brain injury (TBI) in young children. Method: Participants were recruited prospectively from consecutive hospital admissions of 3- to 6-year-old children, and included 19 with severe TBI, 56 with complicated mild/moderate TBI, and 99 with orthopedic injuries (OI). They completed 4 assessments across the first 18 months postinjury. The initial assessment included measures of parenting style, family functioning, and the quality of the home. Children's behavioral adjustment, adaptive functioning, and social competence were assessed at each occasion. Mixed model analyses examined the relationship of the family environment to psychosocial outcomes across time. Results: The OI and TBI groups differed significantly in social competence, but the family environment did not moderate the group difference, which was of medium magnitude. In contrast, group differences in behavioral adjustment became more pronounced across time at high levels of authoritarian and permissive parenting; among children with severe TBI, however, even those with low levels of permissive parenting showed increases in behavioral problems. For adaptive functioning, better home environments provided some protection following TBI, but not over time for the severe TBI group. These 3-way interactions of group, family environment, and time postinjury were all of medium magnitude. Conclusion: The findings indicate that the family environment moderates the psychosocial outcomes of TBI in young children, but the moderating influence may wane with time among children with severe TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal Stressors and Resources as Predictors of Parental Adaptation Following Pediatric Traumatic Injury.

The authors examined the relationship of preinjury interpersonal resources and stressors to parental adaptation following pediatric traumatic brain injury (TBI) and orthopedic injury. Parents of children with severe TBI (n = 53), moderate TBI (n = 56), and orthopedic injuries (n = 80) were assessed soon after injury, 6 and 12 months after the initial evaluation, and at an extended follow-up with a mean of 4 years postinjury. General linear model analyses provide support for both main and moderating effects of stressors and resources on parental adjustment. Support from friends and spouse was associated with less psychological distress, whereas family and spouse stressors were associated with greater distress. The results also reveal a marked decline in injury-related stress over follow-up for families in the severe TBI group who reported a combination of high stressors and high resources. The decline suggests that interpersonal resources attenuated long-term family burden because of severe TBI. The findings are discussed in terms of their implications for intervention following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of the family for behavioral outcome in children and adolescents following traumatic brain injury.

This study assessed the behavioral outcome of 51 children with traumatic brain injury (TBI) up to 2 years following injury. Children with severe injuries, but not those with mild or moderate injuries, were reported by parents to have a greater incidence of behavior problems following TBI. Regression analyses indicated that the presence of a partner for the primary caregiver of the child and the acute emotional reaction of the parent to the injury were both predictive of child behavioral outcome, although not by 2-year follow-up. These findings suggest that parental coping resources may impact on the development of child behavioral sequelae following TBI, emphasizing the role of the family in the child's response and the importance of supportive intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-Term Educational Interventions After Traumatic Brain Injury in Children.

Objectives: To track educational interventions received by children with traumatic brain injury (TBI), examine factors associated with placement in special education, and explore the concordance of placement with children's needs. Methods: Interventions were monitored in 42 children with severe TBI, 42 with moderate TBI, and 50 with orthopedic injuries only (ORTHO group). A baseline assessment was completed soon after injury. Follow-up assessments were conducted 6 and 12 months after the baseline and at an extended follow-up about 4 years postinjury. Results: Rates of special education were higher in the severe TBI group than in the ORTHO. Predictors of special education included TBI severity, socioeconomic status, and measures of pre- and postinjury child status. Several children with TBI with residual deficits who were in regular education prior to injury did not receive special education at the extended follow-up. Conclusion: Although special education is frequently provided for several years after severe TBI, existing programs are of limited scope. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive outcome in children and adolescents following severe traumatic brain injury: influence of psychosocial, psychiatric, and injury-related variables

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than psychiatric or psychosocial factors as correlates of cognitive outcomes. We addressed this concern by recruiting a consecutive series (N = 24) of children age 5 through 14 years who suffered a severe TBI, a matched group who sustained a mild TBI, and a second matched group who sustained an orthopedic injury. Standardized intellectual, memory, psychiatric, family functioning, family psychiatric history, neurological, and neuroimaging assessments were conducted at an average of 2 years following injury. Severe TBI, when compared to mild TBI and orthopedic injury, was associated with significant decrements in intellectual and memory function. A principal components analysis of independent variables that showed significant (p < .05) bivariate correlations with the outcome measures yielded a neuropsychiatric factor encompassing severity of TBI indices and postinjury psychiatric disorders and a psychosocial disadvantage factor. Both factors were independently and significantly related to intellectual and memory function outcome. Postinjury psychiatric disorders added significantly to severity indices and family functioning and family psychiatric history added significantly to socioeconomic status in explaining several specific cognitive outcomes. These results may help to define subgroups of children who will require more intensive services following their injuries.     

Predicting longitudinal patterns of functional deficits in children with traumatic brain injury.

Longitudinal patterns of functional deficits were investigated in 37 children with severe traumatic brain injury (TBI), 40 children with moderate TBI, and 44 children with orthopedic injuries. They were from 6 to 12 years of age when injured. Their neuropsychological, behavioral, adaptive, and academic functioning were assessed at 6 months, 12 months, and 3–5 years postinjury. Functional deficits (     

Motor, visual-spatial, and somatosensory skills after closed head injury in children and adolescents: A study of change.

Correlational studies of recovery of function following traumatic brain injury have revealed weak, nonspecific relationships between outcome and injury variables. In order to better identify factors affecting recovery, 49 children (aged 6–15 yrs) were followed prospectively with repeated neuropsychological assessment of motor, visual–spatial, and somatosensory skills up to 5 yrs postinjury. Variability among growth patterns related robustly to injury variables. Younger children with severe injuries showed slower growth on visual–spatial and motor tasks than did older children of similar severity or similarly-aged children with less severe injuries. These findings support a hypothesis of increased vulnerability of rapidly emerging skills in young children and argue against an explanation of lowered recovery rates due to concomitant maturational influences on development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ultrasonographic signs of chromosome aberrations]

Factors predictive of psychiatric outcome in the second 6 months following traumatic brain injury (TBI) in 43 children and adolescents were assessed prospectively. The outcome measure was the presence of a psychiatric disorder not present before the injury ("novel"). Out of six models tested, four were predictive of novel psychiatric disorder: preinjury family function, family psychiatric history, socioeconomic class/intellectual function, and behavior/adaptive function. Post hoc analyses suggested that preinjury family functioning measured by a structured interview was a significant predictive variable. Severity of injury, when reclassified as severe versus mild/moderate TBI, significantly predicted novel psychiatric disorders. These data suggest that some children, identifiable through clinical assessment, are at increased risk for psychiatric disorders following TBI.     

Prediction of Educational Outcome After Pediatric Traumatic Brain Injury.

Objective: Evaluation of the predictive value of neuropsychological test scores with respect to special education placement following pediatric traumatic brain injury (TBI). Study Design: Longitudinal follow-up and hierarchical logistic regression analyses. Setting: Regional rehabilitation center. Participants: Consecutive series of referrals, including 58 children with TBI and no confounding premorbid histories or other complicating factors. Main Outcome Measures: Special education placement at, respectively, 12 and 24 months postinjury. Results: Children who obtained a composite T score of less than 45 on the California Verbal Learning Test--Children's Version during initial postinjury neuropsychological assessment were 8-13 times more likely to be placed in special education 12-24 months later compared with children who obtained higher scores. Conclusions: Neuropsychological test scores are not only sensitive to acute injury severity but also explain a substantial proportion of the variance in educational outcome after pediatric TBI, above and beyond that accounted for by demographic and medical variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Executive functions and social competence in young children 6 months following traumatic brain injury.

Objective: This study examined the impact of traumatic brain injury (TBI) in young children on executive functions and social competence, and particularly on the role of executive functions as a predictor of social competence. Method: Data were drawn from a prospective, longitudinal study. Participants were children between the ages of 3 years 0 months and 6 years 11 months at time of injury. The initial sample included 23 with severe TBI, 64 with moderate TBI, and 119 with orthopedic injuries (OI). All participants were assessed at 3 and 6 months postinjury. Executive functions were assessed using neuropsychological tests (Delayed Alternation task and Shape School) and parent ratings on the Behavior Rating Inventory of Executive Function and Child Behavior Questionnaire. Parents rated children's social competence on the Adaptive Behavior Assessment System, Preschool and Kindergarten Behavior Scales, and Home and Community Social Behavior Scales. Results: Children with severe TBI displayed more negative outcomes than children with OI on neuropsychological tests, ratings of executive functions, and ratings of social competence (η2 ranged from .03 to .11). Neuropsychological tests of executive functions had significant but weak relationships with behavioral ratings of executive functions (ΔR2 ranged from .06 to .08). Behavioral ratings of executive functions were strongly related to social competence (ΔR2 ranged from .32 to .42), although shared rater and method variance likely contributed to these associations. Conclusions: Severe TBI in young children negatively impacts executive functions and social competence. Executive functions may be an important determinant of social competence following TBI. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Childhood traumatic brain injury: initial impact on the family

Traumatic brain injury (TBI) is a significant source of morbidity and mortality in children, resulting in a wide range of cognitive and behavioral sequelae. However, little is known about the effects of pediatric TBI and its aftermath on families. The current investigation examined the impact of TBI on families during the first month following injury. Children with orthopedic injuries requiring hospitalization served as a control group. The sample consisted of 44 families of children of severe TBI, 52 families of children with moderate TBI, and 69 families of children with orthopedic injuries not involving the central nervous system (CNS). Families of children with severe TBI experienced significantly more injury-related stress than the other two groups of families. Parents of children with TBI also reported higher levels of psychological symptoms than parents of children with orthopedic injuries. Findings from regression analyses suggested that families facing multiple stressors in addition to the injury and those who cope poorly may be at greatest risk for adverse consequences. Future interventions could provide anticipatory guidance and support to at-risk families.     

The relationship of caregiver coping to family outcomes during the initial year following pediatric traumatic injury.

This study identified coping strategies associated with caregiver outcomes following pediatric injury and examined injury type as a moderator of coping efficacy. Families of 103 children with traumatic brain injury (TBI) and 71 children with orthopedic injuries were followed prospectively during the initial year postinjury. The groups had comparable preinjury characteristics and hospitalization experiences but differed on neurological insult. In hierarchical regression analyses, acceptance was associated with lower burden and denial was associated with greater distress in both groups. Active coping resulted in higher distress following TBI but not orthopedic injuries. Conversely, the use of humor was related to diminishing distress following TBI but unrelated to distress following orthopedic injuries. Results are discussed in terms of the implications for intervention following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors and indicators of academic outcome in children 2 years following traumatic brain injury

Within the context of a longitudinal study investigating outcome for children following traumatic brain injury, this paper reports on the utility of neuropsychological testing in predicting academic outcome in children 2 years following traumatic brain injury (TBI). Twenty-nine school-age children who were admitted to hospital after TBI were assessed with a battery of neuropsychological and academic measures at 3 and 24 months postinjury. The neuropsychological battery included measures of memory, learning, and speed of information processing. Academic outcome was assessed in terms of post-TBI change in school placement. According to logistic regression analysis, change in placement from regular to special education at 2 years post-TBI was predicted by injury severity and by neuropsychological performance at 3 months post-TBI. Findings suggest that neuropsychological testing is useful in identifying children with special educational needs subsequent to TBI.     

Can a Web-based family problem-solving intervention work for children with traumatic brain injury?

Objective: To examine the feasibility and efficacy of a Web-based intervention for children with traumatic brain injury (TBI). Participants: 6 families comprising 8 parents, 5 siblings, and 6 children with TBI (mean age=10.5 years). Intervention: Families received computers, Web cameras, and Internet access. Participants completed 7-11 online sessions and accompanying weekly videoconferences with the therapist. Main Outcome Measures: Outcomes included child behavior problems, social competence, executive function skills, and parent-child conflict. Results: Children with TBI rated Web site content as very to extremely helpful and reported high overall satisfaction. There was a trend for children with TBI to rate the videoconferences as less helpful than did other family members and relative to a face-to-face visit. Parents reported improvements in antisocial behaviors, and children with TBI reported reductions in conflict with parents regarding school. Conclusions: Web-based interventions hold promise for improving child outcomes following pediatric TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in Working Memory After Traumatic Brain Injury in Children.

The impact of traumatic brain injury (TBI) on working memory (WM) was studied in 144 children (79 with mild, 23 with moderate, and 42 with severe injuries) who underwent magnetic resonance imaging (MRI) at 3 months and were tested at baseline and at 3, 6, 12, and 24 months postinjury. An n-back WM task for letter identity was administered with memory load ranging from 1- to 3-back and a 0-back condition. A TBI Severity × Quadratic Tune interaction showed that net percentage correct (correct detections of targets minus false alarms) was significantly lower in severe than in mild TBI groups. The Left Frontal Lesions × Age interaction approached significance. Mechanisms mediating late decline in WM and the effects of left frontal lesions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of an online cognitive-behavioral family intervention in improving child behavior and social competence following pediatric brain injury.

Objective: To examine whether an online cognitive-behavioral intervention could improve child adjustment following traumatic brain injury (TBI). Participants: Thirty-nine families of children with moderate to severe TBI. Intervention: Families were randomly assigned to the online family problem-solving (FPS) group or to the Internet resources comparison (IRC) group. Main Outcome Measures: Outcomes included child behavior problems, social competence, and self-management/compliance. Results: The FPS group reported better child self-management/compliance at follow-up than did the IRC group. The child's age and socioeconomic status (SES) moderated treatment effects, with older children and those of lower SES who received FPS showing greater improvements in self-management and behavior problems, respectively. Conclusions: Findings suggest that an online cognitive- behavioral approach can improve child adjustment after TBI, particularly in older children and children of lower SES. (PsycINFO Database Record (c) 2010 APA, all rights reserved)