Parental and Family Functioning as Predictors of Longitudinal Trajectories of Postconcussive Symptoms Following
Leah Chadwick1,2,3, Sheri Madigan1,2,3, Brandy L Callahan1,3
1Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
Insights
Parental factors significantly influence pediatric mild traumatic brain injury (mTBI) recovery. This study identified distinct post-injury symptom trajectories and linked them to family functioning, guiding targeted interventions for better child outcomes.
Area of Science:
- Pediatric neurology and rehabilitation
- Child psychology and development
- Family systems and intervention research
Background:
- Family environment is crucial for pediatric traumatic brain injury (TBI) recovery, yet parental and family factors in mild TBI (mTBI) are understudied.
- Conventional analyses of postconcussive symptoms (PCS) assume homogeneity in pediatric mTBI, overlooking diverse recovery patterns.
- Distinct symptom trajectories over time are likely in children following mTBI.
Purpose of the Study:
- To identify distinct trajectories of postconcussive symptoms (PCS) in children and adolescents after mild traumatic brain injury (mTBI).
- To examine the association between these PCS trajectories and parental/family functioning.
- To inform the development of family-based interventions for pediatric mTBI recovery.
Main Methods:
- Group-based multitrajectory modeling was employed to identify latent clusters of children with similar PCS patterns.
- 506 children (8-16 years) with mTBI were recruited from emergency departments; data collected on injury, PCS, and family functioning.
- Validated measures assessed family functioning, parental adjustment, social support, and parental responses to symptoms over 6 months.
Main Results:
- Six distinct PCS trajectories were identified, including 'low acute/resolved', 'low acute/declining', 'moderate acute/elevated cognitive', 'moderate acute/declining', 'high acute/declining', and 'high acute/persisting'.
- Parental adjustment, protectiveness, and perceived social support independently predicted trajectory membership.
- These parental factors remained significant predictors after controlling for demographic and injury characteristics.
Conclusions:
- Children exhibit diverse PCS trajectories following mTBI, challenging the assumption of a homogenous recovery.
- Specific aspects of parental and family functioning are critical predictors of these symptom trajectories.
- Findings support the development of family-centered treatments to target children at risk for prolonged recovery after pediatric mTBI.
Abstract:
The family environment plays an important role in children's recovery from traumatic brain injury (TBI); however, parental and family factors have not been examined in-depth in pediatric mild TBI (mTBI). Existing research on postconcussive symptoms (PCS) typically employs conventional statistical analyses that assume that children with mTBI are a homogenous group. However, children may display distinct trajectories of PCS across time after mTBI. Group-based multitrajectory modeling can identify latent clusters of individuals following similar trajectories across multiple indicators of an outcome. This study sought to: (1) identify trajectories of PCS after mTBI in children, and (2) examine their association with parental and family functioning. Participants were 506 children and adolescents aged 8- to 16-years-old who were recruited during emergency department (ED) visits within 48 h of injury at five Pediatric Emergency Research Canada hospitals. Injury information was collected in the ED, and parental and family functioning was measured at approximately 7 days postinjury. Child and parent PCS ratings were obtained weekly to 3 months and biweekly to 6 months postinjury using the Health and Behavior Inventory. Parental and family functioning were assessed using validated measures of family functioning, parental adjustment, perceived social support from parents, and parental responses to children's symptom complaints. Group-based multitrajectory modeling was used to classify individual children into distinct trajectories of child- and parent-reported cognitive and somatic PCS over time and to examine predictors of those trajectories. Six distinct trajectories were identified: "low acute/resolved PCS" (n = 98), "low acute/declining PCS" (n = 64), "moderate acute/elevated cognitive PCS" (n = 106), "moderate acute/declining PCS" (n = 118), "high acute/declining PCS" (n = 88), and "high acute/persisting PCS" (n = 32). Parental adjustment, protectiveness, and social support were independent predictors of trajectory membership after adjusting for demographic and injury characteristics. The identification of different symptom trajectories and specific aspects of parental and family functioning as predictors of these trajectories provides guidance for developing family-based treatments and targeting treatments to children at risk for poor recovery.
