Long‐term behavioural outcomes of pre‐school mild traumatic brain injury

Abstract

Background Mild traumatic brain injury (MTBI) is a leading cause of injury for children during their pre-school years. However, there is little information regarding the long-term outcomes of these injuries. Method We used fully prospective data from an epidemiological study of a birth cohort to examine behavioural effects associated with MTBI during the pre-school years. Cases of confirmed MTBI were divided into two groups, those that had received outpatient medical attention, and those that had been admitted to hospital for a brief period of observation (inpatient cases). The remainder of the cohort served as a reference control group. Results Mother/teacher ratings for behaviours associated with attention deficit/hyperactivity disorder and oppositional defiant/conduct disorder, obtained yearly from age 7 to 13, revealed evidence of deficits after inpatient MTBI (n = 21), relative to more minor outpatient injury MTBI (n = 55) and the reference control group (n = 852). For the inpatient group there was evidence of increasing deficits over years 7-13. Conclusions More severe pre-school MTBI may be associated with persistent negative effects in terms of psychosocial development. The vulnerability of pre-school children to MTBI signals a pressing need to identify high-risk cases that may benefit from monitoring and early intervention.

Predicting outcome after childhood brain injury: Figure 1:

“…36 This finding has been interpreted as suggesting that the increased behavioural morbidity reported by parents after mild traumatic brain injury may reflect nonspecific emotional reactions to the shock of injury and admission to hospital, or may have been present premorbidly and conferred increased risk of injury. 37 However, a recent prospective national birth cohort study suggests that behavioural morbidity may follow milder traumatic brain injuries in young children, particularly if the injuries are recurrent 38 A recent meta-analysis confirmed 60% prevalence of previous substantial traumatic brain injury among adult offenders. 39 However, issues of causality are complex.…”

“…Accidental injury sustained through misadventure and inflicted injury are both important mechanisms of traumatic brain injury that raise issues of premorbid differences in risk. 40 Attention-deficit/hyperactivity dis order, impulsivity 38,41 and socioeconomic deprivation 42 are overrepresented in populations with traumatic brain injury. Late emotional and behavioural outcomes after traumatic brain injury are modulated by factors independent of the injury and its severity, particularly the social and family milieu to which the child returns.…”

Intellectual, Behavioral, and Social Outcomes of Accidental Traumatic Brain Injury in Early Childhood

“…Research available for this age demonstrate lowered verbal IQ (VIQ), performance IQ (PIQ), and full-scale IQ (FSIQ), 8,19,20 as well as behavior problems. 21 Behavior problems identified include hyperactivity, conduct problems, poor self-control, and internalizing difficulties. 21,22 Few studies have investigated the impact of early childhood TBI on social skills.…”

Behavioral Deficits and Axonal Injury Persistence after Rotational Head Injury Are Direction Dependent

“…This spectrum of locomotion fits with the extremes of apathetic and disinhibited behaviors reported after TBI in human adults and children. [33][34][35][36][37][38] Our animals experiencing sagittal head rotations exhibited apathetic-like behaviors, in contrast to axial plane rotation animals, which exhibited more disinhibited behaviors.…”