Research Reports - Adaptive Functioning Following pediatric traumatic brain injury: Relationship to executive function and processing speed

Neuropsychology. 2016 May 16. [Epub ahead of print]

Shultz EL, Hoskinson KR, Keim MC, Dennis M, Taylor HG, Bigler ED, Rubin KH,
Vannatta K, Gerhardt CA, Stancin T, Yeates KO.

OBJECTIVE: Pediatric traumatic brain injury (TBI) may affect children's ability
to perform everyday tasks (i.e., adaptive functioning). Guided by the American
Association for Intellectual and Developmental Disabilities (AAIDD) model, we
explored the association between TBI and adaptive functioning at increasing
levels of specificity (global, AAIDD domains, and subscales). We also examined
the contributions of executive function and processing speed as mediators of
TBI's effects on adaptive functioning.
METHOD: Children (ages 8-13) with severe TBI (STBI; n = 19), mild-moderate TBI
(MTBI; n = 50), or orthopedic injury (OI; n = 60) completed measures of executive
function (TEA-Ch) and processing speed (WISC-IV) an average of 2.7 years
postinjury (SD = 1.2; range: 1-5.3). Parents rated children's adaptive
functioning (ABAS-II, BASC-2, CASP).
RESULTS: STBI had lower global adaptive functioning (η2 = .04-.08) than the MTBI
and OI groups, which typically did not differ. Deficits in the STBI group were
particularly evident in the social domain, with specific deficits in social
participation, leisure, and social adjustment (η2 = .06-.09). Jointly, executive
function and processing speed were mediators of STBI's effects on global adaptive
functioning and in conceptual and social domains. In the STBI group, executive
function mediated social functioning, and processing speed mediated social
participation.
CONCLUSIONS: Children with STBI experience deficits in adaptive functioning,
particularly in social adjustment, with less pronounced deficits in conceptual
and practical skills. Executive function and processing speed may mediate the
effects of STBI on adaptive functioning. Targeting adaptive functioning and
associated cognitive deficits for intervention may enhance quality of life for
pediatric TBI survivors.  

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