Related Experiment Video
Updated: May 5, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Social Environment and Neurobehavioral Outcomes 1 Year After Severe Pediatric TBI in the Intensive Care Unit
Aimee E Miley1, Jamie Patronick1, Nanhua Zhang2,1,3
1Aimee E. Miley and Jamie Patronick are co-first authors.
Insights
Home and neighborhood environments impact neurobehavioral outcomes in children after severe traumatic brain injury (TBI). Vulnerable environments are linked to poorer outcomes, especially in older children, highlighting the need for targeted interventions.
Area of Science:
- Pediatric Neurosciences
- Neurorehabilitation
- Environmental Psychology
Background:
- Severe pediatric traumatic brain injury (TBI) can lead to long-term neurobehavioral deficits.
- The influence of the child's home and neighborhood environment on recovery is not fully understood.
Purpose of the Study:
- To investigate the association between home and neighborhood environments and neurobehavioral outcomes in children following severe TBI.
- To explore how factors like parenting practices, social environment, and neighborhood stressors moderate TBI recovery.
Main Methods:
- A multicenter, observational cohort study involving children (≤18 years) with severe TBI (Glasgow Coma Scale ≤ 8).
- Neurobehavioral outcomes, family functioning, and environmental factors were assessed at 12 months post-injury.
- Mortality risk, parenting practices, social environment, and neighborhood stressors were also evaluated.
Main Results:
- Home and neighborhood environments were associated with neurobehavioral outcomes, including intellectual ability, executive functioning, behavioral adjustment, and quality of life.
- A more vulnerable home/neighborhood environment showed a stronger negative association with neurobehavioral outcomes in older children compared to younger children.
- The impact of mortality risk on neurobehavioral outcomes varied.
Conclusions:
- Parenting practices and the quality of the social and neighborhood environment are significantly associated with neurobehavioral outcomes 12 months after severe pediatric TBI.
- Further research is essential to understand the complex relationship between environmental stressors and TBI recovery to develop effective interventions.
- Future interventions should prioritize addressing parenting and social environment factors in a developmentally appropriate manner for children with TBI.
Objective:
To examine the association of home and neighborhood environment with neurobehavioral outcomes after severe pediatric traumatic brain injury (TBI).
Setting:
Domestic and international children's medical centers.
Participants:
Participants enrolled in the study were 18 years or younger at the time of their severe TBI (Glasgow Coma Scale [GCS] ≤ 8), admitted to the intensive care unit, and underwent placement of an intracranial pressure (ICP) monitor. Exclusionary criteria included less severe injury (GCS > 8), pregnancy, and/or ICP monitor placement occurred at a non-participating hospital.
Design:
A multicenter, observational cohort study.
Main Measures:
Outcomes assessed at 12 months post-injury included measures of global functioning, intellectual ability, caregiver-report measures of family functioning, executive functioning behaviors, behavior problems, and health-related quality of life. We examined mortality risk (assessed acutely after injury), family functioning (assessed at 12 months post-injury) and parenting practices, social environment, and neighborhood stressors (all assessed > 12 months post-injury), as correlates and moderators of the 12-month post-injury outcomes.
Results:
Home and neighborhood factors were associated with neurobehavioral outcomes (ie, intellectual ability, executive functioning, behavioral adjustment, and health-related quality of life) but not with global functioning outcomes. A negative association between a more vulnerable home and neighborhood environment and neurobehavioral outcomes was more consistent in older children compared with younger children, based on age of injury. The influence of mortality risk on neurobehavioral outcomes was variable.
Conclusion:
Parenting practices and quality of social and neighborhood environment are associated with neurobehavioral outcomes 12 months after severe pediatric TBI. More research is needed to better understand the relationship between home/neighborhood stressors and TBI recovery to develop and implement strategies for patients and families to optimize outcomes. Future intervention development should focus on addressing parenting practices and social environment in a developmentally sensitive way for children who have sustained a severe TBI.
