Pediatric TBI: Prevalence and Functional Ramifications

Abstract

The current article serves as an introduction to this special issue on the assessment and treatment of traumatic brain injury (TBI) in children and adolescents. The article provides a brief review of the importance of this topic to neuropsychology while stressing the importance of evaluating factors related to assessment and treatment not only from an injury severity and developmental perspective but also the importance of familial and social functioning. Neuropsychologists' knowledge and professional skills involving psychological skills and neurocognitive principles make them most adept at treating children with TBI and their families for a variety of issues addressed in the special issue.

Key words:

• assessment
• pediatric
• TBI
• treatment

Traumatic brain injury (TBI) remains a leading cause of death and acquired disabilities in children and adolescents (Anderson, Catroppa, Morse, Haritou, & Rosenfeld, 2001). It represents a constellation of residual deficits (i.e., syndrome) that are the end result of biomechanical forces, as well as secondary neural and vascular events, acting on the head and brain (Gennarelli & Graham, 1998). The initiating event and resulting deficits can vary tremendously. TBI can be diffuse or focal; it can result from closed, open, or combined injuries. The interaction of these artifacts is often the determining factor in regard to functional influence and outcome. Pathology, severity, and environmental factors all play a role in the variability in TBI symptom profiles and patterns of recovery (Dykeman, 2003; Masson et al., 1996). As such, there is no pure form.

Although the antecedent event is usually sudden, occurring in the blink of an eye, the residual deficits may be experienced for months, years, or a lifetime. Long-term impairments may manifest in a variety of ways, ranging from physical and cognitive deficits to diminished psychosocial functioning (Butler, Rourke, Fuerst, & Fisk, 1997; Donders & Warschausky, 1997). When this occurs in childhood, the effects can prove detrimental in direct and indirect ways. Primary deficits may beget secondary deficits which may beget tertiary deficits. The burden of adjusting to TBI and the associated residuals is not experienced solely by the child or adolescent—it is an affliction experienced by family, friends, and school personnel. If not addressed properly, it can truly derail a child and their family's life. This special issue is directed at highlighting and discussing foundational concepts and contemporary advances in our knowledge of pediatric TBI. From its neuropathological and pathophysiological roots, to ways in which neuropsychological practice can serve as a beacon of hope for those children and families coping everyday with its residual effects, pediatric TBI constitutes a neurological entity that if understood and studied, functional outcomes and quality of life may improve for the vast majority of those who seek help from neuropsychology professionals.

In the articles that follow, the application of neuropsychological practice within the pediatric TBI population will be discussed. Specifically, articles will focus on the manner in which TBI in children and adolescents can be more appropriately assessed and addressed.