Association of Parent Ratings of Executive Function With Global- and Setting-Specific Behavioral Impairment After Adolescent Traumatic Brain Injury

Abstract

Objective To determine the association of primary caregiver-rated behavioral and metacognitive aspects of executive function (EF) with impaired functioning after adolescent traumatic brain injury (TBI). Design Multicenter cross-sectional study. Setting Outpatient. Participants Primary caregivers and children (N = 132) aged 12 to 17 years who sustained a moderate or severe TBI within the past 1 to 6 months. Interventions Not applicable. Main Outcome Measures Primary caregiver ratings of EF, tests of memory and processing speed (PS), and a structured parent interview to assess clinical impairments in behavioral functioning were used. Logistic regression was used to examine the relation of ratings of EF with clinical ratings of impairment in global adolescent functioning and in functioning in the home, school, and community settings after controlling for sex, race, socioeconomic status, injury severity, and performance on the tests of memory and PS. Results Caregiver ratings of poor EF were associated with impairment in both global behavioral functioning (odds ratio [OR] = 4.73; 95% confidence interval [CI], 1.54–14.52; P<.01) and community functioning (OR = 13.28; 95% CI, 1.94–90.87; P<.01). Conclusions Caregiver ratings of deficits in EF were associated with impaired behavioral functioning after adolescent TBI and were independent of performance on tests of memory and processing speed. Understanding the relation of EF with clinical impairments as manifested in different settings will help hone assessment batteries and focus treatments where they are needed most.

Long-Term Neuropsychological Profiles and Their Role as Mediators of Adaptive Functioning after Traumatic Brain Injury in Early Childhood

“…34,[39][40][41] Several studies have reported associations between neuropsychological impairments and a variety of functional outcomes within a few months to 2 years following childhood TBI. Parent ratings of executive functions are associated with lower levels of adaptive, social, and school functioning, 11,42,43 lower scores on measures of memory and executive functions with poorer academic achievement, 44 substandard communication skills and processing speed with difficulties in social adjustment and participation, 45 and weaknesses in cognitive control with problems in adaptive and communication functioning. 46 Poorer verbal learning and memory and slower speed of information processing also predict placement in special education.…”

Behavioral Predictors of Outpatient Mental Health Service Utilization Within 6 Months After Traumatic Brain Injury in Adolescents

“…The Child and Adolescent Functional Assessment Scale (CAFAS) has been used to assess impairment in behavior functioning and treatment effects in children with serious emotional disturbances but has not been studied with children post TBI [18-20]. The CBCL assesses behavior and emotional symptoms generally, whereas the CAFAS focuses more on impaired functioning in home, school, and community settings [21]. The two measures thus provide complementary information about behavioral outcomes after TBI.…”

“…The two measures thus provide complementary information about behavioral outcomes after TBI. Executive dysfunction after pediatric TBI is associated with behavior impairment as assessed by the CAFAS [21]; however, the association of the CAFAS with the CBCL and with the utilization of mental health resources after TBI in children has not been investigated.…”

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

“…Given that certain adaptive functioning skills (e.g., social participation in leisure activities) are likely to rely on planning and organizational skills as well as responding to complex and evolving stimuli (e.g., functional communication, social problem solving), children with impaired executive function and slower processing speed may experience difficulty with such tasks. Caregiver behavior ratings of difficulties in executive function are related to other indications of poor overall behavioral functioning following pediatric TBI (Kurowski et al, 2013). Considering the potential limitations in relying on caregiver report of executive function (Toplak, West, & Stanovich, 2013), our study addresses the need for further exploration of the relationship between adaptive functioning in children with TBI and their performance on direct measures of executive function and processing speed.…”