Individual Case Analysis of Processing Speed Difficulties in Children With and Without Traumatic Brain Injury

Abstract

Two studies were conducted to determine the frequency of processing speed difficulties relative to estimates of other problem-solving abilities in children with and without traumatic brain injury (TBI). The two samples consisted of 213 normally functioning school-age children and 65 TBI children and 19 trauma controls. All children were administered the WISC-III/IV Vocabulary, Block Design, and Coding subtests. The frequency of children in each sample having a Coding subtest score of 3 or 4 scale points below the Vocabulary or Block Design score (whichever one was lower) was calculated. Using a 3-point scale difference, the presence of processing speed deficits relative to other cognitive abilities in the school sample was low (5.2%), and was equivalent to that demonstrated by trauma controls (5.3%). However, in the TBI sample, 18 out of 65 TBI patients (27.7%) showed this same pattern. Using a 4-point discrepancy scale, 3.3% of normal children and 16.9% of TBI children showed this pattern. The frequency of this pattern increased with severity of TBI, using two different but related classification systems. These preliminary findings require cross validation in a larger sample before definite conclusions can be reached.

The Problem of Not Developing Normally and Pediatric Neuropsychological Rehabilitation

“…In one study, it was between 25% and 30%. 34 Testing normal children, we were also able to further document that the apparent quality of schooling has a clear influence on some aspects of neuropsychological test performance. For example, in more than 200 normally functioning primarily Hispanic school-aged children from low socioeconomic backgrounds, their verbal (animal) fluency scores were comparable with those of children from middle-class, white families in the United States as well as from middle-class children studied in Milan.…”

“…We also found this to be true. 34 However, after severe TBI, there was an increased incidence of such a level of discrepancy. In one study, it was between 25% and 30%.…”

Parental Perspectives on Recovery and Social Reintegration After Pediatric Traumatic Brain Injury

“…19 Individual case analysis, which compares Coding subtest scores with Vocabulary and Block Design subtest scores, may provide a more sensitive measure of processing speed difficulties in children with TBI, particularly after mild-to-moderate injuries. 20 This approach helps estimate changes from premorbid status and ultimately demonstrates larger correlations between processing speed deficits and parents' view of the child's overall recovery.…”

“…20 This classification system was preferred to GCS score alone, as the addition of neuroimaging findings better reflects the true severity of injury. Using this classification system, 7 levels of TBI severity were identified: (1) no TBI, (2) mild uncomplicated TBI, (3) mild complicated TBI, (4) moderate TBI secondary to focal injury, (5) "true" moderate TBI, (6) moderately severe TBI, and (7) severe TBI.…”

Classification of intellectual disability using the Wechsler Intelligence Scale for Children: Full Scale IQ or General Abilities Index?

“…3 However, slowed processing speed is a common characteristic of a variety of neurocognitive disorders. For example, processing speed impairments have been found in reading disabilities, 4,5 traumatic brain injury, 6,7 and attention-deficit–hyperactivity disorder 4,5,8 (ADHD). In addition, working memory weaknesses are commonly found in ADHD, 5,9 traumatic brain injury, 10,11 hydrocephalus, 12,13 myelomenigocele, 14,15 and reading disabilities, 5,16 and in some individuals with intellectual disability.…”