Adaptive ability, behavior and quality of life pre and posttraumatic brain injury in childhood

Abstract

Context: Traumatic brain injury (TBI) is a common, acquired childhood disability, which has been shown to have a significant impact on children’s cognitive and educational function. While behavioral problems are also noted, there is ongoing debate about the contribution of preinjury factors in this domain. Few studies have attempted to measure the impact of these preinjury functions on postinjury behavior. Objective: To compare pre and postinjury adaptive ability, behavior, executive function and quality of life (QOL) and to identify factors that contribute to outcomes in these domains including injury severity, socio-demographic and preinjury characteristics. Design: Consecutive recruitments to a prospective, longitudinal study, utilizing a between factor design, with injury severity as the independent variable. Participants and methods: Children admitted to hospital with a diagnosis of TBI aged between 6 and 14 years (n = 205) were divided according to injury severity (mild, moderate and severe). Adaptive behavior (Vineland Adaptive Behavior Scales), child behavior (Child Behavior Checklist), everyday executive functions (Behavior Rating Inventory of Executive Function) and QOL (Child Health Questionnaire) assessed at 6 months post-TBI. Results and conclusions: Severity by time interactions were identified across a range of outcome domains demonstrating that more severe injury is associated with a decrease in functional ability at 6 months post-TBI. This effect was most pronounced for everyday executive skills, social function and internalizing aspects of child behavior. Preinjury function was a consistent predictor of postinjury status. Injury severity contributed little to the prediction of functional outcomes once preinjury functioning was accounted for in the model. Age at injury and family cohesion were relevant to specific outcome domains only. Socio-economic status did not contribute significantly to outcome at 6 months. Preinjury functioning as reported by parents in the acute phase may be a useful predictive tool for identifying children who may be at risk of functioning difficulties 6 months post-TBI.

Implications for Rehabilitation

Childhood traumatic brain injury

• Priorities for intervention: (i) more severe injury; (ii) presence of pre-injury impairment; (iii) younger age at injury and (iv) evidence of family dysfunction.

• Level of functional impairment postinjury rarely meets criteria for a frank diagnosis (e.g. intellectual impairment and psychiatric disorder) and thus children are frequently ineligible for routine community supports.

• Reduced executive skills and social competence and elevated behavioral disturbances indicate that evidence-based interventions addressing these domains are a priority.

Keywords::

• Adaptive behavior
• behavior
• child
• executive function
• quality of life
• traumatic brain injury

Declaration of Interest: NHMRC project grant (Kenardy, Anderson, Bellamy & McKinlay).