Trajectories of Children's Executive Function After Traumatic Brain Injury

Keenan, Heather T.; Clark, Amy; Holubkov, Richard; Cox, Charles S.; Ewing‐Cobbs, Linda

doi:10.1001/jamanetworkopen.2021.2624

Cited by 28 publications

(35 citation statements)

References 41 publications

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“…Shared vulnerability factors included experiencing a TBI and having more pre-injury executive dysfunction. The increase in Emotional Symptoms and Conduct Problems at 12 months is consistent with prior longitudinal studies reporting increased internalizing and/or externalizing problems during the year after TBI after accounting for pre-injury status ( 12 , 19 , 35 , 59 ). There is limited information regarding whether internalizing and externalizing problems increase systematically as TBI severity increases.…”

Section: Discussionsupporting

confidence: 87%

“…After TBI in early childhood, Narad et al found that greater pre-injury executive dysfunction was associated with greater likelihood of clinically significant EF symptoms persisting up to 7 years after injury ( 39 ). While It is unclear to what extent pre-existing EFs problems shape post-injury cognition and behavior in school-aged children and adolescents, there is a growing body of evidence showing significant and persistent adverse effects of TBI on EFs across the first 2 years after injury, with greater disruption following severe TBI than less severe injuries ( 35 , 38 ). Long term follow up studies examining EF outcomes from 3 to 10 years after injury have also shown persistent problems, with EFs not returning to pre-injury levels ( 35 , 62 – 64 ).…”

Section: Discussionmentioning

confidence: 99%

“…While It is unclear to what extent pre-existing EFs problems shape post-injury cognition and behavior in school-aged children and adolescents, there is a growing body of evidence showing significant and persistent adverse effects of TBI on EFs across the first 2 years after injury, with greater disruption following severe TBI than less severe injuries ( 35 , 38 ). Long term follow up studies examining EF outcomes from 3 to 10 years after injury have also shown persistent problems, with EFs not returning to pre-injury levels ( 35 , 62 – 64 ). Executive dysfunction after TBI has serious consequences for post-traumatic adjustment ( 65 ) and contributes to poorer educational outcomes ( 66 , 67 ) and reduced social competence ( 68 ).…”

Section: Discussionmentioning

confidence: 99%

“…For both spline models, the knot point was set to 12-months, thus the spline models included separate parameters for the slope to capture the change from pre-injury to 12 months post-injury and then from 12 months post to 36-month post-injury. This is a theoretically significant point as substantial recovery occurs by 12 months after TBI ( 35 ) and our goal was to evaluate factors influencing the recovery trajectory after 12 months. Models were performed in Mplus 8.2 using maximum likelihood estimation ( 56 ) with an ML estimator for all analyses to account for missing data.…”

Section: Methodsmentioning

confidence: 99%

“…EF regulate focusing and sustaining attention, resisting distraction, managing frustration, controlling emotional responses, monitoring behavior, considering consequences of behavior, reflecting on past experiences, and planning for the future ( 33 , 34 ). Although it is well-known that TBI disrupts EF ( 35 – 39 ), there is very limited understanding of how the quality of EF prior to injury shapes behavioral outcomes.…”

Section: Introductionmentioning

confidence: 99%

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As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury

et al. 2021

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Objective: To model pre-injury child and family factors associated with the trajectory of internalizing and externalizing behavior problems across the first 3 years in children with pediatric traumatic brain injury (TBI) relative to children with orthopedic injuries (OI). Parent-reported emotional symptoms and conduct problems were expected to have unique and shared predictors. We hypothesized that TBI, female sex, greater pre-injury executive dysfunction, adjustment problems, lower income, and family dysfunction would be associated with less favorable outcomes.Methods: In a prospective longitudinal cohort study, we examined the level of behavior problems at 12 months after injury and rate of change from pre-injury to 12 months and from 12 to 36 months in children ages 4–15 years with mild to severe TBI relative to children with OI. A structural equation model framework incorporated injury characteristics, child demographic variables, as well as pre-injury child reserve and family attributes. Internalizing and externalizing behavior problems were indexed using the parent-rated Emotional Symptoms and Conduct Problems scales from the Strengths and Difficulties questionnaire.Results: The analysis cohort of 534 children [64% boys, M (SD) 8.8 (4.3) years of age] included 395 with mild to severe TBI and 139 with OI. Behavior ratings were higher after TBI than OI but did not differ by TBI severity. TBI, higher pre-injury executive dysfunction, and lower income predicted the level and trajectory of both Emotional Symptoms and Conduct Problems at 12 months. Female sex and poorer family functioning were vulnerability factors associated with greater increase and change in Emotional Symptoms by 12 months after injury; unique predictors of Conduct Problems included younger age and prior emotional/behavioral problems. Across the long-term follow-up from 12 to 36 months, Emotional Symptoms increased significantly and Conduct Problems stabilized. TBI was not a significant predictor of change during the chronic stage of recovery.Conclusions: After TBI, Emotional Symptoms and Conduct Problem scores were elevated, had different trajectories of change, increased or stayed elevated from 12 to 36 months after TBI, and did not return to pre-injury levels across the 3 year follow-up. These findings highlight the importance of addressing behavioral problems after TBI across an extended time frame.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury

et al. 2021

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An update on pediatric traumatic brain injury

Figaji

2023

Childs Nerv Syst

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Introduction Traumatic brain injury (TBI) remains the commonest neurological and neurosurgical cause of death and survivor disability among children and young adults. This review summarizes some of the important recent publications that have added to our understanding of the condition and advanced clinical practice. Methods Targeted review of the literature on various aspects of paediatric TBI over the last 5 years. Results Recent literature has provided new insights into the burden of paediatric TBI and patient outcome across geographical divides and the severity spectrum. Although CT scans remain a standard, rapid sequence MRI without sedation has been increasingly used in the frontline. Advanced MRI sequences are also being used to better understand pathology and to improve prognostication. Various initiatives in paediatric and adult TBI have contributed regionally and internationally to harmonising research efforts in mild and severe TBI. Emerging data on advanced brain monitoring from paediatric studies and extrapolated from adult studies continues to slowly advance our understanding of its role. There has been growing interest in non-invasive monitoring, although the clinical applications remain somewhat unclear. Contributions of the first large scale comparative effectiveness trial have advanced knowledge, especially for the use of hyperosmolar therapies and cerebrospinal fluid drainage in severe paediatric TBI. Finally, the growth of large and even global networks is a welcome development that addresses the limitations of small sample size and generalizability typical of single-centre studies. Conclusion Publications in recent years have contributed iteratively to progress in understanding paediatric TBI and how best to manage patients.

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