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Family functioning and injury severity as predictors of child functioning one year following traumatic brain injury
J B Rivara1, K M Jaffe, G C Fay
1Department of Rehabilitation Medicine, School of Social Work, Children's Hospital and Medical Center, University of Washington, Seattle.
Insights
Children with severe traumatic brain injury (TBI) showed significant declines in functioning, especially older children from at-risk families. Early identification and support are crucial for better recovery outcomes after pediatric TBI.
Area of Science:
- Pediatric Neuropsychology
- Child Development
- Rehabilitation Medicine
Background:
- Traumatic brain injury (TBI) in children can impact long-term functioning and social competence.
- Understanding pre-injury factors and injury characteristics is vital for predicting post-TBI outcomes.
Purpose of the Study:
- To examine changes in children's functioning one year after TBI.
- To identify pre-injury family and injury factors predicting adaptive functioning and social competence.
Main Methods:
- Ninety-four children (6-15 years) with mild, moderate, or severe TBI were enrolled.
- Data collected included pre-injury status, injury severity, and family functioning at baseline, 3 months, and 1 year post-injury.
- Standardized measures and interviewer ratings assessed child functioning.
Main Results:
- Children with severe TBI experienced the most significant declines in functioning, with limited improvement over one year.
- Older children (≥12 years) with worse pre-injury functioning and those from poorly functioning families showed greater deterioration.
- Injury severity and pre-injury family functioning predicted 25-39% of the variation in 1-year functioning, increasing to 57% with pre-injury child status.
Conclusions:
- Children at risk for poor adaptation post-TBI can be identified early.
- Tailored support services are essential for optimizing recovery and improving outcomes for children following TBI.
Abstract:
This study examined changes in children's functioning in the year following traumatic brain injury (TBI) and the preinjury family and injury factors most predictive of children's overall adaptive functioning and social competence at 1 year. Ninety-four children with TBI (mild = 50, moderate = 25, severe = 19) and their families were consecutively enrolled from two regional medical centers. The age range was from 6 years to 15 years. Interviewer ratings and standard measures of family and child functioning were completed within 3 weeks of injury (measuring preinjury status), at 3 months and 1 year. Mean preinjury parent and teacher ratings of child functioning were within normal range. Older children (> or = 12 years) had worse preinjury functioning than younger children. Declines in child functioning were significantly associated with injury severity. Mild and moderately injured children had few declines in overall functioning. Severely injured children had the most dramatic early declines and improved only slightly between 3 months and 1 year; however, older children from poorly functioning families deteriorated in the same period. Injury severity and preinjury family functioning explained from 25% to 39% of the variation in child functioning at 1 year and up to 57% when the child's preinjury status was included. Children at risk for poorer adaptation following TBI can be identified and for optimal recovery should receive appropriate support services for optimal recovery.