Executive Functions Following Traumatic Brain Injury in Young Children: A Preliminary Analysis

Abstract

To examine executive processes in young children with traumatic brain injury (TBI), we evaluated performance of 44 children who sustained moderate-to-severe TBI prior to age 6 and to 39 comparison children on delayed response (DR), stationary boxes, and spatial reversal (SR) tasks. The tasks have different requirements for holding mental representations in working memory (WM) over a delay, inhibiting prepotent responses, and shifting response set. Age at the time of testing was divided into 10- to 35- and 36- to 85-month ranges. In relation to the community comparison group, children with moderate-to-severe TBI scored significantly lower on indexes of WM/inhibitory control (IC) on DR and stationary boxes tasks. On the latter task, the Age x Group interaction indicated that performance efficiency was significantly reduced in the older children with TBI relative to the older comparison group; performance was similar in younger children irrespective of injury status. The TBI and comparison groups did not differ on the SR task, suggesting that shifting response set was not significantly altered by TBI. In both the TBI and comparison groups, performance improved with age on the DR and stationary boxes tasks. Age at testing was not significantly related to scores on the SR task. The rate of acquisition of working memory (WM) and IC increases steeply during preschool years, but the abilities involved in shifting response set show less increase across age groups (Espy, Kaufmann, & Glisky, 2001; Luciana & Nelson, 1998). The findings of our study are consistent with the rapid development hypothesis, which predicts that skills in a rapid stage of development will be vulnerable to disruption by brain injury.

Epidemiology and Outcomes of Pediatric Traumatic Brain Injury

“…In a study of children less than 6 years of age, an age effect was seen in executive functioning (working memory and inhibitory control), with children injured at a younger age exhibiting more problems. As executive functioning is rapidly developing in the preschool years, this supports the theory that skills in a rapid stage of development may be more vulnerable to TBI [56] . Young children with inflicted injuries appear to have a high prevalence of poor outcomes and may have worse outcomes than children with noninflicted injuries [3,7,41] ; however, there are currently no definitive studies comparing longer-term outcomes of children with similar age and injury severity.…”

Working Memory and Corpus Callosum Microstructural Integrity after Pediatric Traumatic Brain Injury: A Diffusion Tensor Tractography Study

“…[1][2][3][4] Deficits in working memory (WM) are a common consequence of pediatric TBI [5][6][7][8][9][10] and are believed to contribute to difficulties in a range of cognitive and academic domains, including discourse and reading comprehension, mathematics, complex learning, and reasoning. [11][12][13] Neural networks in WM WM is the capacity-limited ability to monitor, process, and maintain task-relevant information online to respond to immediate environmental demands.…”

Inhibition of Myosin Light-Chain Kinase Attenuates Cerebral Edema after Traumatic Brain Injury in Postnatal Mice

“…2,3 Injured children less than 8 years of age may be especially vulnerable to declines in intelligence and executive functioning, causing difficulty in achieving their full potential and resulting in loss of future revenues. [4][5][6] TBI is a complex injury that leads to a cascade of events that result in compromise of the cognitive and physical functioning of the body. The primary injury is followed by a secondary injury, which extends the area of involved brain, worsening the initial injury.…”