Dainelys Garcia

Topical Review: Negative Behavioral and Cognitive Outcomes Following Traumatic Brain Injury in Early Childhood

OBJECTIVE To summarize recent research on negative behavioral and cognitive outcomes following early childhood traumatic brain injury (TBI). METHODS Topical review of the literature published since the year 2000 examining behavioral and cognitive difficulties following TBI in early childhood. RESULTS Research findings from the reviewed studies demonstrate a variety of negative behavioral and cognitive outcomes following TBI in childhood, particularly for children <5 years of age. Negative outcomes include problems with externalizing behaviors, attention, language, and cognitive functioning (e.g., IQ, executive functioning). Furthermore, negative outcomes have been shown to persist up to 16 years following the injury. CONCLUSIONS The empirical studies reviewed demonstrate the increased risk for negative behavioral and cognitive outcomes following early childhood TBI. Furthermore, the review highlights current strengths and limitations of TBI research with young children and the need for multidisciplinary work examining outcomes for this vulnerable pediatric population.

Direct and Indirect Effects of Behavioral Parent Training on Infant Language Production

Given the strong association between early behavior problems and language impairment, we examined the effect of a brief home-based adaptation of Parent-child Interaction Therapy on infant language production. Sixty infants (55% male; mean age 13.47±1.31 months) were recruited at a large urban primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Families were randomly assigned to receive the home-based parenting intervention or standard pediatric primary care. The observed number of infant total (i.e., token) and different (i.e., type) utterances spoken during an observation of an infant-led play and a parent-report measure of infant externalizing behavior problems were examined at pre- and post-intervention and at 3- and 6-month follow-ups. Infants receiving the intervention demonstrated a significantly higher number of observed different and total utterances at the 6-month follow-up compared to infants in standard care. Furthermore, there was an indirect effect of the intervention on infant language production, such that the intervention led to decreases in infant externalizing behavior problems from pre- to post-intervention, which, in turn, led to increases in infant different utterances at the 3- and 6-month follow-ups and total utterances at the 6-month follow-up. Results provide initial evidence for the effect of this brief and home-based intervention on infant language production, including the indirect effect of the intervention on infant language through improvements in infant behavior, highlighting the importance of targeting behavior problems in early intervention.

Parent–Child Interaction Therapy and Moderate Pediatric Traumatic Brain Injury: A Case Study

ABSTRACT The objective of this article is to present a case study examining the use of Parent–Child Interaction Therapy (PCIT) for a 5-year-old African American girl from an economically disadvantaged background who sustained a moderate traumatic brain injury. “Victoria’s” preinjury history, family environment, and injury characteristics are detailed along with the results of her baseline, postintervention, and follow-up assessments. Following 11 sessions of PCIT over 7 months, Victoria no longer met diagnostic criteria for oppositional defiant disorder and showed clinically significant decreases in her externalizing behavior problems at the end of treatment. However, maintenance of treatment gains was not observed at the 6-month follow-up assessment. The current case study highlights some of the advantages and challenges associated with the use of PCIT to treat externalizing behavior problems in young children with traumatic brain injury, especially those from economically disadvantaged backgrounds. Further examination of behavioral interventions with larger samples is needed to meet the needs of this high-risk population.