title: Caregiver ratings of long-term executive dysfunction and attention problems after early childhood traumatic brain injury: family functioning is important.
abstract: OBJECTIVE
  To evaluate the relationship of family and parenting factors to long-term executive dysfunction and attention problems after early childhood traumatic brain injury (TBI). We hypothesized that the magnitude of executive dysfunction and attention problems would be moderated by family and parenting factors.
  
  
  METHODS
  A multicenter, prospective cohort study that included an orthopedic injury (OI) reference group.
  
  
  METHODS
  Three tertiary academic children's hospital medical centers and one general medical center.
  
  
  METHODS
  Children, ages 3-7 years, hospitalized for OI, moderate TBI, or severe TBI. METHODS AND OUTCOME MEASUREMENTS: Parental ratings of family functioning and parenting styles were obtained 18 months after the injury occurred. The main outcome measurements, which were parental ratings of children's executive function and attention, were performed at least 24 months after the injury occurred (mean, 39 months; range, 25-63 months).
  
  
  METHODS
  Group comparisons were conducted with use of t-tests, χ(2) analysis, analysis of variance, and Pearson and Spearman correlations. Regression analysis was used to examine associations of the outcomes with family functioning and parenting styles and to test moderating effects of these factors on group differences.
  
  
  RESULTS
  Participants with severe TBI demonstrated increased executive dysfunction and attention problems compared with those who sustained moderate TBI or OI. Lower levels of family dysfunction were associated with better executive function and attention across groups but did not moderate group differences. However, attention deficits after severe TBI were exacerbated under conditions of more permissive parenting relative to attention deficits after OIs.
  
  
  CONCLUSIONS
  Executive function and attention problems persisted on a long-term basis (>24 months) after early childhood TBI, and positive global family functioning and nonpermissive parenting were associated with better outcomes. Better characterization of the optimal family environment for recovery from early childhood TBI could help target future interventions.
authors.affiliation: Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue Cincinnati, OH 45229, USA. brad.kurowski@cchmc.org
authors.forename: Brad G
authors.initials: BG
authors.lastname: Kurowski
authors.forename: H Gerry
authors.initials: HG
authors.lastname: Taylor
authors.forename: Keith Owen
authors.initials: KO
authors.lastname: Yeates
authors.forename: Nicolay C
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: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000209:etiology*; D001930:Brain Injuries / Q000150:complications / Q000523:psychology*; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D056344:Executive Function; D006801:Humans; D016487:Parenting