Variability Across Caregiver and Performance-Based Measures of Executive Functioning in an Acute Pediatric...

Area of Science:

• Neuroscience
• Pediatric Intensive Care
• Traumatic Brain Injury

Background:

• Youth with traumatic brain injury (TBI) admitted to the pediatric intensive care unit (PICU) often experience lasting cognitive deficits, specifically in executive functioning (EF).
• The Behavior Rating Inventory of Executive Functioning, Second Edition (BRIEF-2) is a common caregiver-reported tool for assessing daily EF, but its accuracy may be affected by external factors.
• Discrepancies between caregiver reports and objective measures highlight the need for comprehensive EF assessment in pediatric TBI recovery.

Purpose of the Study:

• To examine the relationship between the BRIEF-2 and performance-based EF measures in youth recovering from TBI post-PICU admission.
• To explore how family distress, injury severity, and pre-existing neurodevelopmental conditions influence EF outcomes.
• To understand the differences between subjective caregiver perceptions and objective performance measures of EF in pediatric TBI.

Main Methods:

• A cohort of 65 youths (8-19 years) admitted to the PICU for TBI and referred for follow-up care were assessed.
• The study compared scores from the BRIEF-2 with results from performance-based EF tests.
• Statistical analyses investigated correlations between EF measures, injury severity, family distress, and pre-existing conditions.

Main Results:

• No significant correlations were found between BRIEF-2 scores and performance-based EF measures.
• Injury severity strongly correlated with performance-based EF measures, but not with BRIEF-2 scores.
• Caregiver-reported quality of life was associated with their BRIEF-2 responses, indicating potential caregiver-related influences.

Conclusions:

• Performance-based and caregiver-report measures capture distinct aspects of executive functioning in youth recovering from TBI.
• Injury severity is a significant factor in objective EF performance, independent of caregiver perception.
• Comprehensive assessment considering both objective performance and caregiver reports, alongside other morbidities, is crucial for understanding EF deficits post-PICU TBI.