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Novel Oppositional Defiant Disorder 6 Months After Traumatic Brain Injury in Children and Adolescents
Daniel S Lowet1, Anish Kolan1, Florin Vaida1
1Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max).
Insights
Children with traumatic brain injury (TBI) are at risk for developing oppositional defiant disorder (ODD). Factors like socioeconomic status, family function, psychosocial adversity, and processing speed predict this outcome.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Neuropsychology
Background:
- Traumatic brain injury (TBI) can lead to significant neurobehavioral changes in children and adolescents.
- Oppositional defiant disorder (ODD) is a common behavioral outcome following pediatric TBI, impacting long-term adjustment.
- Understanding predictive factors is crucial for early intervention and support.
Purpose of the Study:
- To identify predictive factors for the development of new-onset oppositional defiant disorder (ODD) in children and adolescents within six months after a traumatic brain injury (TBI).
Main Methods:
- A cohort of 177 children and adolescents (ages 5-14) with TBI were assessed for pre-injury characteristics and followed up at six months.
- Biopsychosocial model variables included psychiatric history, adaptive/family function, psychosocial adversity, socioeconomic status, injury severity, and processing speed.
- MRI scans were used to assess brain lesions; psychiatric outcomes, including novel ODD, were evaluated at six months post-injury.
Main Results:
- Of 134 participants without pre-existing disruptive disorders, 11 (8.2%) developed new-onset ODD at six months post-TBI.
- Novel ODD was significantly associated with lower socioeconomic status, poorer pre-injury family functioning, and greater psychosocial adversity.
- Slower post-injury processing speed, a potential indicator of brain injury, was also a significant predictor of novel ODD.
Conclusions:
- A notable proportion of children and adolescents develop new-onset ODD after TBI.
- Predictive factors for ODD post-TBI encompass psychosocial elements (socioeconomic status, family function, adversity) and injury-related cognitive deficits (processing speed).
- These findings highlight the need for comprehensive psychosocial and neuropsychological assessments following pediatric TBI to identify at-risk individuals.
Objective:
The investigators aimed to assess predictive factors of novel oppositional defiant disorder (ODD) among children and adolescents in the first 6 months following traumatic brain injury (TBI).
Methods:
Children ages 5-14 years who experienced a TBI were recruited from consecutive admissions to five hospitals. Testing of a biopsychosocial model that may elucidate the development of novel ODD included assessment soon after injury (baseline) of preinjury characteristics, including psychiatric disorders, adaptive function, family function, psychosocial adversity, family psychiatric history, socioeconomic status, injury severity, and postinjury processing speed (which may be a proxy for brain injury). MRI analyses were also conducted to examine potential brain lesions. Psychiatric outcome, including that of novel ODD, was assessed 6 months after the injury.
Results:
A total of 177 children and adolescents were recruited for the study, and 134 who were without preinjury ODD, conduct disorder, or disruptive behavior disorder not otherwise specified (DBD NOS) returned for the 6-month assessment. Of those who returned 6 months postinjury, 11 (8.2%) developed novel ODD, and none developed novel conduct disorder or DBD NOS. Novel ODD was significantly associated with socioeconomic status, preinjury family functioning, psychosocial adversity, and processing speed.
Conclusions:
These findings show that an important minority of children with TBI developed ODD. Psychosocial and injury-related variables, including socioeconomic status, lower family function, psychosocial adversity, and processing speed, significantly increase risk for this outcome.
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