Long term effects of early childhood traumatic brain injury on narrative discourse gist and psychosocial functioning

Abstract

Purpose: To examine the long-term consequences of early childhood traumatic brain injury (TBI), approximately 6.8 years post-injury, on cognitive communication competency within a complex interplay of individual, contextual, and psychosocial factors. Additionally, we were interested in looking at the association of communication competence with social competence and overall functioning.

Methods: 64 children with orthopedic injury, 40 children with moderate traumatic brain injury, and 14 children with severe traumatic brain injury who were between 3 years and 6 years 11 months at injury completed a narrative discourse task and clinical measures in a single visit at a longer term follow up in early adolescence, an average of 6.8 years post injury. Analyses of covariance were conducted to compare groups on the discourse task, and hierarchical linear regressions were conducted to examine the association of discourse measures with clinical measures of cognitive and psychosocial functioning.

Results: Children with severe traumatic brain injury performed worse than children with moderate traumatic brain injury and orthopedic injury on all discourse indices and clinical measures. Injury severity, pragmatic skills, and socioeconomic status were associated with discourse gist. Discourse gist was the most sensitive measure of communication competence, and it was significantly associated with psychosocial outcomes independent of group.

Conclusion: Children who sustain a severe traumatic brain injury in early childhood are at risk for long-term cognitive communication impairments that may be related to a complex interplay of injury, individual, and social factors.

Implications for rehabilitation

• The assessment and treatment of cognitive communication impairments after traumatic brain injury are complex and require consideration of individual, contextual, and psychosocial factors.

• Discourse, in general, and gist reasoning specifically, is a sensitive measure for detecting cognitive communication competence several years after pediatric traumatic brain injury.

• Treatments to address gist reasoning deficits may support improvements in global and social functioning.

Keywords:

• Cognitive communication disorders
• gist reasoning
• social competence
• everyday functioning

Acknowledgements

The authors wish to acknowledge the contributions of Christine Abraham, Andrea Beebe, Lori Bernard, Anne Birnbaum, Hanna Schultz, Nori Mercuri Minich, Beth Bishop, Tammy Matecun, Karen Oberjohn, Elizabeth Roth, and Elizabeth Shaver in data collection. The Cincinnati Children’s Medical Center Trauma Registry, Rainbow Pediatric Trauma Center, Rainbow Babies & Children’s Hospital, Nationwide Children’s Hospital Trauma Program, and MetroHealth Center Department of Pediatrics and Trauma Registry provided assistance with recruitment. Finally, we acknowledge the statistical experts for the study, which include Amy E. Cassedy, Ph.D., and Nanhua Zhang, Ph.D, from Cincinnati Children’s Hospital Medical Center.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This publication was supported by grant R01 HD42729 from the National Institute of Child Health and Human Development (NICHD) and Trauma Research grants from the State of Ohio Emergency Medical Services. Additional support was provided through Grant 8 UL1 TR000077 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health.