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Symptoms of Persistent Behavior Problems in Children With Mild Traumatic Brain Injury
H Gerry Taylor1, Leah J Orchinik, Nori Minich
1Departments of Pediatrics (Drs Taylor and Wright and Ms Minich) and Psychological Sciences (Ms Orchinik), Case Western Reserve University, Cleveland, Ohio; Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio (Drs Taylor and Wright); Departments of Radiology and Neurosurgery, University Hospitals Health System, Cleveland, Ohio (Dr Bangert); Departments of Emergency Medicine (Drs Dietrich and Nuss) and Radiology (Dr Rusin) and Center for Biobehavioral Health, The Research Institute (Dr Yeates), Nationwide Children's Hospital, Columbus, Ohio; and Department of Pediatrics, The Ohio State University College of Medicine, Columbus (Dr Yeates). Dr Yeates is now with the Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
Insights
Children with mild traumatic brain injury (mTBI) show increased behavior problems, particularly younger children. This highlights the need for ongoing monitoring and research into risk factors for persistent symptoms after pediatric mTBI.
Area of Science:
- Pediatric neurology
- Child psychology
- Neuroscience
Background:
- Mild traumatic brain injury (mTBI) is common in children.
- Behavioral problems can persist after pediatric mTBI.
- Understanding long-term effects is crucial for intervention.
Purpose of the Study:
- To examine the impact of mTBI on behavior problems in children.
- To compare behavior ratings in the first year post-injury.
- To identify factors associated with increased behavioral symptoms.
Main Methods:
- Study conducted in emergency departments of two children's hospitals.
- 176 children with mTBI and 90 with orthopedic injuries (ages 8-15) participated.
- Parent and teacher ratings of behavior problems were compared, controlling for background factors.
Main Results:
- Younger children with mTBI showed significantly higher behavior problem ratings than orthopedic injury controls.
- Hospitalization, motor vehicle accidents, loss of consciousness, and MRI abnormalities correlated with higher ratings.
- mTBI was associated with increased odds of elevated T-scores on the Child Behavior Checklist.
Conclusions:
- School-aged children with mTBI are at risk for persistent behavioral symptoms.
- Younger age and more severe mTBI increase this risk.
- Long-term behavioral monitoring and further research are warranted.
Objective:
To investigate the effects of mild traumatic brain injury (mTBI) in children on symptom ratings of behavior problems across the first-year postinjury.
Setting:
Emergency departments of 2 regional children's hospitals.
Participants:
Parents of 176 children with mTBI and 90 children with orthopedic injury aged 8 to 15 years.
Design:
Group comparisons of postinjury parent and teacher ratings of child behavior problems controlling for background factors.
Main Measures:
Child Behavior Checklist and Teacher's Report Form.
Results:
For younger but not older children in the sample, children with mTBI compared with children with orthopedic injury had higher postinjury ratings on the Child Behavior Checklist Total Behavior Problem scale (t264 = 3.34, P < .001) and higher rates of T-scores of 60 or more on this scale (odds ratio = 3.00; 95% confidence interval, 1.33-6.77; P = .008). For children with mTBI, hospitalization, motor vehicle accidents, loss of consciousness, and magnetic resonance imaging abnormality were associated with higher parent or teacher ratings.
Conclusions:
School-aged children with mTBI are at risk for persistent symptoms of behavior problems, especially if mTBI is more severe or occurs at a younger age. The findings justify monitoring of behavior long after injury and further research to identify risk factors for these symptoms and their association with clinical disorders.
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