Adaptive functioning following pediatric traumatic brain injury: Relationship to executive function and processing speed.

Abstract

Objective Pediatric traumatic brain injury (TBI) may affect children’s ability to perform everyday tasks (i.e., adaptive functioning). Guided by the American Association for Intellectual and Developmental Disabilities (AAIDD) model, we explored the association between TBI and adaptive functioning at increasing levels of specificity (global, AAIDD domains, and subscales). We also examined the contributions of executive function and processing speed as mediators of TBI’s effects on adaptive functioning. Method Children (ages 8–13) with severe TBI (STBI; n=19), mild-moderate TBI (MTBI; n=50), or orthopedic injury (OI; n=60) completed measures of executive function (TEA-Ch) and processing speed (WISC-IV) an average of 2.7 years post-injury (SD = 1.2; range: 1–5.3). Parents rated children’s adaptive functioning (ABAS-II, BASC-2, CASP). Results STBI had lower global adaptive functioning (η2 = .04–.08) than the MTBI and OI groups, which typically did not differ. Deficits in the STBI group were particularly evident in the social domain, with specific deficits in social participation, leisure, and social adjustment (η2 = .06–.09). Jointly, executive function and processing speed were mediators of STBI’s effects on global adaptive functioning and in conceptual and social domains. In the STBI group, executive function mediated social functioning, and processing speed mediated social participation. Conclusions Children with STBI experience deficits in adaptive functioning, particularly in social adjustment, with less pronounced deficits in conceptual and practical skills. Executive function and processing speed may mediate the effects of STBI on adaptive functioning. Targeting adaptive functioning and associated cognitive deficits for intervention may enhance quality of life for pediatric TBI survivors.

Developmental trajectories of adaptive functioning following early mild traumatic brain injury

“…These results suggest that mild TBI sustained during early childhood may alter the developmental trajectory of social adaptive functioning, but not those of the practical and conceptual domains of adaptive functioning. In children with moderate to severe TBI, reduced adaptive functioning has been reported across all three domains, but social adaptive abilities are the most frequently and profoundly affected (Anderson et al, ; Shultz et al, ). Together, these findings suggest that children's social adaptive functioning may be affected across the range of injury severities, while changes in the practical and conceptual domains perhaps are restricted to more severe injuries.…”

“…These results suggest that mild TBI sustained during early childhood may alter the developmental trajectory of social adaptive functioning, but not those of the practical and conceptual domains of adaptive functioning. In children with moderate to severe TBI, reduced adaptive functioning has been reported across all three domains, but social adaptive abilities are the most frequently and profoundly affected Shultz et al, 2016).…”

“…Studies indicate a dose–response association between TBI and adaptive functioning, with more severe injury associated with poorer adaptive functioning (Anderson et al, ; Catroppa, Anderson, Morse, Haritou, & Rosenfeld, ; Max et al, ; Shultz et al, ; Taylor et al, ; Treble‐Barna et al, ; Wade, Zhang, Yeates, Stancin, & Taylor, ). Longitudinal studies of children with moderate/severe TBI suggest that impairments in adaptive functioning persist over the long term, and may endure into adulthood (Anderson et al, ; Anderson, Brown, Newitt, & Hoile, ; Catroppa et al, ; Shultz et al, ; Taylor et al, ; Treble‐Barna et al, ). Among the three domains of adaptive functioning, social skills appear to be the most profoundly affected after moderate/severe TBI (Anderson et al, ; Shultz et al, ).…”

“…Longitudinal studies of children with moderate/severe TBI suggest that impairments in adaptive functioning persist over the long term, and may endure into adulthood (Anderson et al, ; Anderson, Brown, Newitt, & Hoile, ; Catroppa et al, ; Shultz et al, ; Taylor et al, ; Treble‐Barna et al, ). Among the three domains of adaptive functioning, social skills appear to be the most profoundly affected after moderate/severe TBI (Anderson et al, ; Shultz et al, ).…”

“…We hypothesized that the temporal trajectory of adaptive functioning, particularly in the social domain, would be affected after mTBI in comparison with that of children with orthopedic injuries. This expectation is based on studies reporting reduced adaptive functioning after moderate to severe TBI particularly in the social domain (Anderson et al, ; Shultz et al, ), and on observations suggesting that the adaptive functioning of children with mTBI may not be equivalent to that of control participants (Anderson et al, ; Catroppa et al, ; Max et al, ) and may be subject to stagnation in its development (Anderson, Catroppa, Haritou, et al, ).…”