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Predictors of family functioning and change 3 years after traumatic brain injury in children
J M Rivara1, K M Jaffe, N L Polissar
1Department of Rehabilitation Medicine, Children's Hospital and Medical Center, Seattle, WA 98105, USA.
Insights
Pediatric traumatic brain injury impacts family functioning long-term, with pre-injury factors predicting outcomes. Families with severe injuries require targeted support for improved coping and resilience.
Area of Science:
- Neuroscience
- Pediatrics
- Family Studies
Background:
- Pediatric traumatic brain injury (TBI) presents significant challenges to family functioning.
- Understanding long-term family adaptation post-TBI is crucial for developing effective interventions.
Purpose of the Study:
- To analyze changes in family functioning from injury up to 3 years post-pediatric TBI.
- To identify predictors of family outcomes at 3 years and factors promoting positive changes over time.
Main Methods:
- A prospective cohort study involving 81 children (ages 6-15) with closed head injuries.
- Data collected using multiple validated scales assessing family environment, life events, and well-being at baseline and 3 months, 1 year, and 3 years post-injury.
- Injury severity (mild, moderate, severe) and pre-injury functioning were key variables.
Main Results:
- Pre-injury family functioning was the strongest predictor of 3-year outcomes.
- Families of children with severe TBI showed greater deterioration in functioning over 3 years compared to mild/moderate groups.
- Specific family characteristics like low control and high expressiveness correlated with better outcomes in the severe TBI group.
Conclusions:
- Families at risk for adverse outcomes following pediatric TBI can be identified early.
- Proactive support and resources are essential to help these families develop enhanced coping mechanisms and improve long-term functioning.
Objectives:
To examine changes in family functioning from injury to 3 years after pediatric traumatic brain injury; to determine factors most predictive of family outcomes at 3 years and variables that promote positive outcomes and changes over time.
Design:
Prospective cohort study.
Setting:
Two regional tertiary care centers: cases followed for 3 years into community.
Participants:
Families of 81 children, ages 6 to 15 years, who sustained closed head injury and loss of consciousness (mild = 43, moderate = 20, severe = 18), consecutively enrolled over 15 months.
Main Outcome Measures:
Family Environment Scale, Family Assessment Device, Family Inventory of Life Events, Health Insurance Survey-General Well-Being, NYU Problem Checklist for Significant Others, Family Interview Rating Scale, Family Global Assessment Scale. All were obtained initially and at 3 months, 1 year, and 3 years postinjury. Predictor variables were selected from the instruments above, as well as from the parent and teacher versions of the Child Behavior Checklist, socioeconomic status, and injury severity.
Results:
Preinjury functioning was the best predictor of 3-year outcomes. Fewer changes in family functioning were reported over 3 years in the mild or moderate groups, whereas more deterioration occurred in the severe group. At 3 years, one third to one half of parents in either the moderate or severe groups reported medium to high strain in 19 of 34 problem areas. Low levels of family control and high levels of expressiveness correlated with better outcomes for severe group. Positive change for the severe group was marked by better preinjury levels of communication, expressiveness, problem solving, use of resources, role flexibility, greater activity orientation, and less conflict, control, and stress. Preinjury variables and severity explained from 26% to 69% of the variation in 3-year outcomes.
Conclusions:
Families at risk for poorer outcomes can be prospectively identified and should be supported and encouraged in their efforts to develop new coping resources.