Research Reports - Longitudinal outcome and recovery of social problems after pediatric traumatic brain injury (TBI): Contribution of brain insult and family environment.

Int J Dev Neurosci. 2016 Apr;49:23-30. doi: 10.1016/j.ijdevneu.2015.12.004. Epub
2015 Dec 29.

Ryan NP(1), van Bijnen L(2), Catroppa C(3), Beauchamp MH(4), Crossley L(2),
Hearps S(2), Anderson V(3).

Pediatric traumatic brain injury (TBI) can result in a range of social
impairments, however longitudinal recovery is not well characterized, and
clinicians are poorly equipped to identify children at risk for persisting
difficulties. Using a longitudinal prospective design, this study aimed to
evaluate the contribution of injury and non-injury related risk and resilience
factors to longitudinal outcome and recovery of social problems from 12- to
24-months post-TBI. 78 children with TBI (injury age: 5.0-15.0 years) and 40 age
and gender-matched typically developing (TD) children underwent magnetic
resonance imaging including a susceptibility-weighted imaging (SWI) sequence 2-8
weeks post-injury (M=39.25, SD=27.64 days). At 12 and 24-months post- injury,
parents completed questionnaires rating their child's social functioning, and
environmental factors including socioeconomic status, caregiver mental health and
family functioning. Results revealed that longitudinal recovery profiles differed
as a function of injury severity, such that among children with severe TBI,
social problems significantly increased from 12- to 24-months post-injury, and
were found to be significantly worse than TD controls and children with mild and
moderate TBI. In contrast, children with mild and moderate injuries showed few
problems at 12-months post-injury and little change over time. Pre-injury
environment and SWI did not significantly contribute to outcome at 24-months,
however concurrent caregiver mental health and family functioning explained a
large and significant proportion of variance in these outcomes. Overall, this
study shows that longitudinal recovery profiles differ as a function of injury
severity, with evidence for late-emerging social problems among children with
severe TBI. Poorer long-term social outcomes were associated with family
dysfunction and poorer caregiver mental health at 24-months post injury,
suggesting that efforts to optimize the child's environment and bolster family
coping resources may enhance recovery of social problems following pediatric TBI. 

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