Academic and Behavioral Outcomes in School-Age South African Children Following Severe Traumatic Brain Injury

Abstract

Background: Children who have sustained severe traumatic brain injuries (TBIs) demonstrate a range of post-injury neurocognitive and behavioral sequelae, which may have adverse effects on their academic and behavioral outcomes and interfere with school re-entry, educational progress, and quality of life. These post-TBI sequelae are exacerbated within the context of a resource-poor country like South Africa (SA) where the education system is in a somewhat precarious state especially for those from disadvantaged backgrounds.Objectives: To describe behavioral and academic outcomes of a group of school-aged SA children following severe TBI.Methods: The sample included 27 school-age children who were admitted to the Red Cross War Memorial Children's Hospital (RXH), SA, between 2006 and 2011 for closed severe TBI and who received intracranial monitoring. We collected behavioral data using the Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF) and academic information sourced from the BRIEF, CBCL, medical folders, and caregivers. Analyses include descriptive statistics and bivariate correlation matrices.Results: The descriptive results show that (1) more than half of the participants experienced clinically-significant behavioral problems across the CBCL scales, (2) the working memory BRIEF subscale appeared to be the most problematic subdomain, (3) two thirds of the sample were receiving some form of, or were in the process of being placed in, special needs education, (4) there was a three-fold increase in the use of special education services from pre- to post-injury, and (5) more than half (n = 16) of the sample repeated at least one grade after returning to school post-injury. Correlation analyses results suggest that children with increased externalizing behavioral problems and executive dysfunction are more likely to repeat a grade post-injury; and that children with executive dysfunction post-TBI are more likely to require some form of special educational services.Conclusion: While there is a vast amount of literature on pediatric TBI (pTBI) academic and behavioral outcomes, little literature exists on the pTBI population from the developing world and SA specifically. This is important to address given unique challenges that face the country and its educational system, and its implications for the management and care of children post-TBI.

Psychosocial Quality of Life After Traumatic Brain Injury Among Children in Uganda 

“…Notably, severe injury in children is associated with poorer physical, social, psychological, and academic outcomes as compared to mild TBI. Dollman et al reported that more than two-thirds of South African children managed for severe TBI reported signi cant academic de cits requiring special needs education services (17). Even if our study didn't assess the use of special educational services post TBI, we established that the impact of severity of injury on school functioning of children was signi cant.…”

“…Anderson et al noted a decline in general intellectual functioning following TBI in children, up to 5 and 10 years post-injury (16). In South Africa, Dollman et al examined the academic performance of children following TBI and found that there was a threefold increase in the use of educational services following TBI (17). Unfortunately, we did not assess the pre-injury school performance of children in our study, and hence our results were only based on the opinion of parents of their children at the time of the interviews.…”

Memory functioning 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l’Enfant study

“…Memory deficits after severe pediatric TBI interact with multiple other factors, such as language deficits, behavior problems, and other cognitive impairments [11,34,35].…”

Effective connectivity in the default mode network after paediatric traumatic brain injury

“…Children who experience a TBI are at risk for a range of negative cognitive and psychological health outcomes depending on TBI severity—more severe TBI is associated with poorer outcomes in terms of cognition, academic performance and psychosocial/behavioural problems (see Babikian & Asarnow, 2009 and Babikian et al, 2015 for review). Paediatric TBI may continue to disrupt daily functioning after full physical recovery is achieved (Dollman et al, 2017; Yeates et al, 2005, 2009). Research identifying the mechanisms responsible for negative outcomes, such as disrupted neural circuitry, is necessary to advance early prevention and intervention efforts.…”