Longitudinal outcome and recovery of social problems after pediatric traumatic brain injury (TBI): Contribution of brain insult and family environment

Abstract

Pediatric traumatic brain injury (TBI) can result in a range of social impairments, however longitudinal recovery is not well characterized, and clinicians are poorly equipped to identify children at risk for persisting difficulties. Using a longitudinal prospective design, this study aimed to evaluate the contribution of injury and non-injury related risk and resilience factors to longitudinal outcome and recovery of social problems from 12- to 24-months post-TBI. 78 children with TBI (injury age: 5.0-15.0 years) and 40 age and gender-matched typically developing (TD) children underwent magnetic resonance imaging including a susceptibility-weighted imaging (SWI) sequence 2-8 weeks post-injury (M=39.25, SD=27.64 days). At 12 and 24-months post- injury, parents completed questionnaires rating their child's social functioning, and environmental factors including socioeconomic status, caregiver mental health and family functioning. Results revealed that longitudinal recovery profiles differed as a function of injury severity, such that among children with severe TBI, social problems significantly increased from 12- to 24-months post-injury, and were found to be significantly worse than TD controls and children with mild and moderate TBI. In contrast, children with mild and moderate injuries showed few problems at 12-months post-injury and little change over time. Pre-injury environment and SWI did not significantly contribute to outcome at 24-months, however concurrent caregiver mental health and family functioning explained a large and significant proportion of variance in these outcomes. Overall, this study shows that longitudinal recovery profiles differ as a function of injury severity, with evidence for late-emerging social problems among children with severe TBI. Poorer long-term social outcomes were associated with family dysfunction and poorer caregiver mental health at 24-months post injury, suggesting that efforts to optimize the child's environment and bolster family coping resources may enhance recovery of social problems following pediatric TBI.

Age-Dependent Responses Following Traumatic Brain Injury

“…Indeed, DTI coupled with functional MRI and perhaps other imaging strategies would greatly advance our understanding of the age-related mechanisms of repair and plasticity following TBI [36][37][38][39]. White matter dysregulation after childhood TBI may also affect motor recovery and social cognitive skills which are realized once the skills reach maturity [40][41][42][43]. Therefore, given the lengthy developmental course of myelination and synaptogenesis, TBI may disrupt the maturation of functions that support higher-order cognitive outcomes later in life [39,44,45].…”

Misconceptions about traumatic brain injury among probation services

“…Children suffering from TBI can experience wide ranging cognitive and behavioural deficits, with more severe injuries linked to poorer outcomes and more persistent difficulties (8). Added to this is the risk of late-emerging deficits in social cognition as the child moves into adolescence (9). In a longitudinal study of 118 children, 78 of which had TBI's of varying severity and 40 of which had no past TBI, those with severe injuries displayed a disrupted recovery profile (9).…”

“…Added to this is the risk of late-emerging deficits in social cognition as the child moves into adolescence (9). In a longitudinal study of 118 children, 78 of which had TBI's of varying severity and 40 of which had no past TBI, those with severe injuries displayed a disrupted recovery profile (9). As these children struggled to adapt to their cognitive and physical limitations over time, their failure to make ageappropriate gains may have contributed to their prolonged social difficulties.…”

“…As these children struggled to adapt to their cognitive and physical limitations over time, their failure to make ageappropriate gains may have contributed to their prolonged social difficulties. Among those most at risk of long term social dysfunction were children living in difficult family environments where poor mental health and family dysfunction was persistent (9). Recent research has attempted to draw a link between such post-injury deficits and subsequent antisocial and offending behaviour (10).…”

Equestrian-Related Traumatic Brain Injury in the Pediatric Population

“…In addition, equestrian activities demonstrate higher mortality rates than football, rugby, motor racing, and skiing [4]. Overall, equestrian-related TBI can pose significant socioeconomic ramifications related to hospital costs and neurocognitive disabilities [1,8,9,10]. …”