Disruptive behaviour disorders and disruptive symptoms after severe paediatric traumatic brain injury.
OBJECTIVE
To determine pre-injury prevalence and post-injury incidence of DSM-III-R oppositional defiant disorder (ODD) and conduct disorder (CD), increase in disruptive symptoms after severe paediatric traumatic brain injury (TBI) and risk factors associated with development of these disturbances.


METHODS
Ninety-four children were followed 1 one year after severe TBI. Assessments of pre-injury and 1-year psychiatric status were ascertained by parent report. The 1-year incidence of disruptive behaviour disorders/symptoms was the main outcome measure.


RESULTS
The pre-injury prevalence of ODD and CD in the TBI sample was 6% and 8%, respectively, the prevalence of pre-injury CD being significantly higher than in a reference population. The incidence of new-onset ODD and CD 1-year post-injury was 9% and 8%, respectively, the incidence of new-onset CD being significantly higher than in a reference population. ODD symptoms and total number of disruptive symptoms increased significantly over the first post-injury year. Significant risk factors for disruptive disorders/symptoms included higher pre-injury psychosocial adversity, delinquency ratings and affective lability.


CONCLUSIONS
Pre-injury conduct disorder is a significant risk factor for post-injury disruptive behaviours. New-onset CD and disruptive symptoms are consequences of TBI at 1-year post-injury. Risk factors for these post-injury disturbances are similar to risk factors in non-TBI populations.
Gerring
Joan P
JP
Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA. jgerring@jhmi.edu
Grados
Marco A
MA
Slomine
Beth
B
Christensen
James R
JR
Salorio
Cynthia F
CF
Cole
Wesley R
WR
Vasa
Roma A
RA
D000293:Adolescent; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D001930:Brain Injuries / Q000523:psychology*; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D002675:Child, Preschool; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009483:Neuropsychological Tests; D010290:Parents / Q000523:psychology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult