Gayle C. Fay

Family functioning and children's academic performance and behavior problems in the year following traumatic brain injury

This study examined the roles of preinjury family and child functioning and injury severity in predicting 1-year outcomes and changes in academic performance and behavioral problems following childhood traumatic brain injury (TBI). Families of 94 children (ages 6 to 15) with TBI (mild = 50, moderate = 25, severe = 19) were consecutively enrolled from emergency departments of two regional medical centers. Standardized measures of family and child functioning and interviewer ratings were completed within 3 weeks of injury (measuring preinjury status), at 3 months, and 1 year. Mean ratings of preinjury child functioning were within normal range. Whereas injury severity was associated with substantial declines in academic functioning, there was no association of injury severity with change in behavior problems. Interview ratings showed declines at all severity levels, however. Poor academic and cognitive outcomes at 1 year were associated with injury severity and, to a lesser degree, poor preinjury family and child functioning. In contrast, most of the variation in behavioral outcomes was explained by preinjury child or family factors. Preinjury functioning must be assessed and support services provided for optimal academic and behavioral outcomes following childhood TBI.

Predictors of family functioning and change 3 years after traumatic brain injury in children

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.

Family functioning and injury severity as predictors of child functioning one year following traumatic brain injury

This study examined changes in childrens functioning in the year following traumatic brain injury (TBI) and the preinjury family and injury factors most predictive of childrens 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 childs 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.

Severity of pediatric traumatic brain injury and neurobehavioral recovery at one year--a cohort study.

As part of an ongoing longitudinal cohort study of children with mild, moderate, and severe traumatic brain injury and their matched controls, the neurobehavioral status of 94 case-control pairs was assessed one year after initial postinjury testing. There was a statistically significant dose-response association of severity with performance in all six domains of neurobehavioral functioning (intelligence, adaptive problem solving, memory, academic performance, motor performance, and psychomotor problem solving) with Spearman correlation coefficients of up to -.35, p < .001. The strongest correlations between severity and outcome were in the domains of intelligence, academic performance, and motor performance. Recovery over the year was also dependent on the severity of brain injury. Because mildly injured cases had negligible initial deficits, recovery was not at issue. However, for moderately and severely injured children, the degree of initial impairment was related to the magnitude of both recovery and residual deficit. Results showed that the use of population normative values to evaluate impairment was misleading. Although the mean scores of all severity groups fell within the normal range of standardized tests, the means for the moderately and severely injured were substantially below those of their matched controls on many tests.

Pediatric traumatic brain injury : acute and rehabilitation costs

Pediatric traumatic brain injury constitutes an enormous public health problem, but little is known about the economic costs of such injury. Using charges as a proxy for cost, we prospectively collected data on initial hospital charges and professional fees for emergency department services, acute inpatient care, and acute inpatient rehabilitation for 96 patients with mild, moderate, and severe traumatic brain injuries. We also examined the relationship between these costs and injury severity and etiology. Acute care and rehabilitation median costs were

Comparison of indices of traumatic brain injury severity as predictors of neurobehavioral outcome in children

5,233 per child,

Neurobehavioral sequelae of severe pediatric traumatic brain injury: a cohort study.

11,478 for hospitalized children, and

Written language production and neuropsychological function in children with traumatic brain injury

230 for those only seen in the emergency department. Median costs for injuries due to motor vehicles, bicycles, and falls were

The Young Disabled Reader: Acquisition Strategies and Associated Deficits:

15,213,

Outcome of pediatric traumatic brain injury at three years: A cohort study

6,311, and