Research Reports - Psychosocial and executive function recovery trajectories one year after pediatric traumatic brain injury

J Neurotrauma. 2017 Aug 30. doi: 10.1089/neu.2017.5265. [Epub ahead of print]

Keenan HT(1), Clark AE(2), Holubkov R(3), Cox CS(4), Ewing-Cobbs L(5)(6).

Time since traumatic brain injury (TBI) and developmental stage at injury may
affect the trajectory of outcomes associated with adjustment and school success.
We prospectively enrolled a cohort of 519 children with either TBI or orthopedic
injury (OI) aged 2.5 - 15 years to examine children's psychosocial and executive
function outcomes at 3 and 12-months post-injury. Outcome measures included the
Child Behavior Checklist (CBCL), Strengths and Difficulties Questionnaire (SDQ)
and Behavior Rating Inventory of Executive Function (BRIEF) ratings. Controlling
for preinjury ratings and using the OI group as the reference, children with TBI,
regardless of age or injury severity, had affective, anxiety and attention
deficit hyperactivity (ADHD) problems on the CBCL. Symptom trajectories differed
both by injury severity and age at injury. Children with mild and complicated
mild TBI had a decreasing anxiety trajectory while children with severe TBI had
increasing symptoms. Children 6 - 11 years of age had high ADHD and affective
scores; however, the youngest children had increasing symptoms over time. On the
SDQ, peer relationships and prosocial behaviors were not significantly affected
by TBI but were associated with family environment. Children with severe TBI had
the worst executive function scores; however, mild and complicated mild/moderate
TBI groups had clinically important working memory deficits. Hispanic ethnicity
and strong social capital were positively associated with multiple outcomes.
Children's recovery trajectories differed by injury severity, time since injury,
and developmental stage when injured. Schools need to reassess children's skills
over time as new problems in behavior and learning may emerge. 

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