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

Abstract

The objectives of the study were to characterize long-term neuropsychological outcomes following traumatic brain injury (TBI) sustained during early childhood, and determine whether identified neuropsychological impairments mediated the effect of TBI on long-term adaptive functioning. Participants included 16 children with severe TBI, 42 children with moderate TBI, and 72 children with orthopedic injuries (OI) sustained between ages 3 and 7 years. Children completed neuropsychological tests and caregivers completed a structured interview of child adaptive functioning at 6.9 (±1.10) years post-injury. Profile analysis and multiple mediator modeling were employed. Children with severe TBI demonstrated poorer fluid reasoning and inhibitory control than both children with moderate TBI and OI, as well as slower processing speed than the OI group. Both fluid reasoning and processing speed were significant independent mediators of the effect of severe TBI on adaptive functioning. No neuropsychological measure significantly mediated the effect of moderate TBI on adaptive functioning. Children sustaining early severe TBI demonstrate persisting neuropsychological impairments into adolescence and young adulthood. The impact of severe TBI on children's long-term adaptive functioning is mediated in part by its effects on fluid reasoning and processing speed.

Long-term classroom functioning and its association with neuropsychological and academic performance following traumatic brain injury during early childhood.

“…The results suggest that fluid reasoning skills are protective or facilitative for academic functioning in children with TBI but less essential for children with OI, who may be able to succeed academically despite lower fluid reasoning skills. The importance of fluid reasoning for academic functioning is consistent with our recent investigation in the same cohort of neuropsychological mediators of adaptive functioning (Treble-Barna et al, 2016). Along with processing speed, fluid reasoning was a significant independent mediator of the effect of injury on adaptive functioning.…”

“…Developing an understanding of how such children function in the longer term, as they enter adolescence and early adulthood, will help determine the public health impact of early childhood TBI, as well as assist in predicting which individuals will go on to have functional deficits in everyday performance that limit their educational attainment, psychological adjustment, and eventual vocational and adaptive functioning in adulthood. Children who sustain severe TBI in early childhood demonstrate persistent long-term (≥2 years post-injury) impairments in various aspects of neuropsychological (Anderson, Godfrey, Rosenfeld, & Catroppa, 2012; Catroppa, Anderson, Godfrey, & Rosenfeld, 2011; Treble-Barna et al, 2016) and adaptive (Catroppa, Godfrey, Rosenfeld, Hearps, & Anderson, 2012; Wade, Zhang, Yeates, Stancin, & Taylor, 2016) functioning into adolescence and adulthood. Acquiring an education is one of the major tasks of childhood, and one that predicts future vocational success and quality of life following TBI (Anderson, Brown, & Newitt, 2010).…”

Age-Dependent Responses Following Traumatic Brain Injury

“…The 0-4-year-olds were found to suffer the worst clinical outcome, comparatively. These and other findings analyzed the long-term behavioral outcomes in children who sustained a moderate to severe head injury [33]. Moreover, given the longevity of white matter development and maturation, TBI negatively impacts white matter integrity in the chronic (13-19 post-injury) but not acute (1-5 months) phase of injury which was linked to cognitive impairments in patients at 8-19 years of age [34,35].…”

Developmental trajectories of adaptive functioning following early mild traumatic brain injury

“…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, ).…”