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Recovery Trajectories of Executive Functioning After Pediatric TBI: A Latent Class Growth Modeling Analysis
Megan E Narad1, Amery Treble-Barna, James Peugh
1Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Drs Narad, Treble-Barna, Peugh, and Wade); Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (Dr Yeates); Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (Dr Taylor); MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio (Dr Stancin); and The University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Wade).
Objective:
To identify latent trajectories of executive functioning (EF) recovery overtime after childhood traumatic brain injury (TBI) and examine the predictive value of known risk factors within and across recovery trajectories using latent class growth modeling (LCGM).
Method:
A total of 206 children between the ages of 3 and 7 years with a moderate to severe TBI or orthopedic injury (OI) were included. LCGM was applied to identify longitudinal trajectories of postinjury EF as assessed by the Behavior Rating Inventory of Executive Functioning General Executive Composite (GEC). Separate models were estimated for the TBI and OI groups.
Results:
Two TBI trajectories-normal limits (70.8%) and clinically elevated (29.2%)-and 3 OI trajectories-normal limits (20.9%), subclinical (49.0%), and clinically elevated (30.17%)-were identified. Baseline GEC was the only predictor of class membership for all models. Both TBI trajectories demonstrated an increase in GEC over time, whereas only 1 of the 3 OI classes demonstrated this pattern. Family variables were associated with GEC across trajectories.
Conclusion:
The lack of association of injury characteristics with trajectory class membership highlights the heterogeneity in recovery after pediatric TBI. Associations of EF trajectories with family factors underscore the importance of involving the family in interventions for children with traumatic injuries.
