Citation

Keenan HT, Clark AE, Holubkov R, Cox CS, Ewing-Cobbs L. J. Neurotrauma 2018; 35(2): 286-296.

Affiliation

Texas, United States ; Linda.ewing-cobbs@uth.tmc.edu.

Copyright

(Copyright © 2018, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2017.5265

PMID

28854841

Abstract

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.

Language: en

Keywords

BEHAVIORAL ASSESSMENTS; NEUROPSYCHOLOGY; PEDIATRIC BRAIN INJURY