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Published on: January 30, 2018
Trajectories of Executive Functions After Early Childhood Traumatic Brain Injury: Teacher Ratings in the Initial 81
Gary Rempe1, Christine Petranovich, Megan E Narad
1Neuropsychological Services of New Mexico, Albuquerque, New Mexico (Dr Rempe); Children's Hospital Colorado and the University of Colorado School of Medicine, Department of Rehabilitation Medicine, Aurora, Colorado (Dr Petranovich); Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Narad); Department of Psychology, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Alberta, Calgary (Dr Yeates); Abigail Wexner Research Institute, Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio (Dr Taylor); MetroHealth Medical Center, Cleveland, Ohio (Dr Stancin); Department of Rehabilitation, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Wade).
Objective:
To explore teacher-rated trajectories of executive functioning (EF) after early childhood traumatic brain injury (TBI) and to identify injury-related, academic, and family factors associated with growth trajectories using latent class growth analysis.
Participants:
A total of 121 children who sustained a TBI or orthopedic injury (OI) between the ages of 3 and 7 years were recruited from 3 tertiary care children's hospitals and a general hospital in Ohio, including 57 with moderate or severe TBI and 64 with OI.
Design:
Assessments were completed at baseline (0-3 months postinjury) and an average of 6, 12, 18, and 81 months postinjury. Changes in teacher-rated EF were modeled across time and heterogeneity in recovery and moderating factors was examined.
Measures:
Study variables included participant demographics, teacher-rated EF (Behavior Rating Inventory of Executive Function), family functioning (McMaster Family Assessment Device), and parenting style (Parenting Practices Questionnaire).
Results:
Analysis of teacher-rated EF yielded 2 trajectories: Normative (64.71%) and At-Risk (35.29%). Traumatic brain injury was a weak predictor of membership in the At-Risk trajectory ( P = .05). Membership in the At-Risk trajectory (compared with Normative category) was associated with a higher incidence of Individualized Education Programs, higher baseline EF concerns, increased endorsement of authoritarian parenting, lower socioeconomic status, and non-White race.
Conclusion:
Teacher-rated EF after pediatric TBI differs from OI. Increased EF concerns over time were associated with increased baseline EF and characteristics of the home and school environment. These findings extend previous research on recovery of EF to educational settings and outline potentially modifiable risk factors that can maximize success in the school settings for children who experience early-childhood traumatic injury.
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