title: The family environment as a moderator of psychosocial outcomes following traumatic brain injury in young children.
abstract: OBJECTIVE
  This study sought to determine whether the family environment moderates psychosocial outcomes after traumatic brain injury (TBI) in young children.
  
  
  METHODS
  Participants were recruited prospectively from consecutive hospital admissions of 3- to 6-year-old children, and included 19 with severe TBI, 56 with complicated mild/moderate TBI, and 99 with orthopedic injuries (OI). They completed 4 assessments across the first 18 months postinjury. The initial assessment included measures of parenting style, family functioning, and the quality of the home. Children's behavioral adjustment, adaptive functioning, and social competence were assessed at each occasion. Mixed model analyses examined the relationship of the family environment to psychosocial outcomes across time.
  
  
  RESULTS
  The OI and TBI groups differed significantly in social competence, but the family environment did not moderate the group difference, which was of medium magnitude. In contrast, group differences in behavioral adjustment became more pronounced across time at high levels of authoritarian and permissive parenting; among children with severe TBI, however, even those with low levels of permissive parenting showed increases in behavioral problems. For adaptive functioning, better home environments provided some protection following TBI, but not over time for the severe TBI group. These 3-way interactions of group, family environment, and time postinjury were all of medium magnitude.
  
  
  CONCLUSIONS
  The findings indicate that the family environment moderates the psychosocial outcomes of TBI in young children, but the moderating influence may wane with time among children with severe TBI.
authors.affiliation: Department of Pediatrics, Ohio State University, Columbus, OH, USA. keith.yeates@nationwidechildrens.org
authors.forename: Keith Owen
authors.initials: KO
authors.lastname: Yeates
authors.forename: H Gerry
authors.initials: HG
authors.lastname: Taylor
authors.forename: Nicolay Chertkoff
authors.initials: NC
authors.lastname: Walz
authors.forename: Terry
authors.initials: T
authors.lastname: Stancin
authors.forename: Shari L
authors.initials: SL
authors.lastname: Wade
mesh_terms: D000223:Adaptation, Psychological; D001930:Brain Injuries / Q000523:psychology*; D002648:Child; D002652:Child Behavior / Q000523:psychology*; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D005190:Family; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D010290:Parents; D011446:Prospective Studies; D012919:Social Behavior; D012931:Social Environment; D016896:Treatment Outcome