Executive dysfunction in children and adolescents with behavior disorders and traumatic brain injury

Traumatic brain injury (TBI) is known to contribute to deficits in executive functioning (EF). Executive functioning abilities are disrupted in adolescents with either conduct disorder or oppositional defiant disorder, collectively known as disruptive behavior disorders (DBDs). There is little research on the relationship between executive dysfunction and DBDs in a group with a confirmed history of TBI. The current study endeavored to examine EF abilities, as measured by parent report on the Behavior Rating Inventory of Executive Function (BRIEF), in four groups: (1) adolescents with a TBI history and co-occurring DBDs history, (2) adolescents with a TBI history and no DBDs history, (3) adolescents with an orthopedic injury (OI) history and co-occurring DBDs history, and (4) adolescents with an OI history and no DBDs history. Groups were matched on the basis of age at injury and estimated socioeconomic status. Participants were evaluated at five time-points throughout the study, within 1 month of injury (initial assessment), 3, 12, 18, and 24 months post-injury. Results indicated the TBI and DBDs group was not significantly different from the OI and DBDs group, and both DBDs groups suffered higher levels of executive dysfunction than the TBI only and OI only groups, which were not significantly different from each other. Results also showed across the four groups, EF deficits were significantly lower at 1 month and 24 months post-injury, suggesting a positive trajectory in EF skill development. Results are discussed in terms of the prognostic importance of EF deficits in children with DBDs.