title: Prevalence and predictors of affective lability after paediatric traumatic brain injury.
abstract: OBJECTIVE
  Paediatric severe traumatic brain injury (TBI) is associated with significant post-injury affective and behavioural problems. Few studies have examined the prevalence and characteristics of affective lability after paediatric TBI.
  
  
  METHODS
  Ninety-seven children with severe TBI were evaluated 1 year post-injury for the presence of affective lability using the Children's Affective Lability Scale (CALS). Demographic, clinical and brain lesion characteristics were also assessed.
  
  
  RESULTS
  Affective lability significantly increased after injury. Eighty-six children had a pre-injury CALS score of 1 SD or less from the group pre-injury mean (M = 8.11, SD = 9.31), of which 35 and 15 children had a 1 SD and 2 SD increase in their CALS score from pre- to post-injury, respectively. A variety of affective shifts manifested post-injury including anxiety, silliness, dysphoria and irritability. The most severe symptoms were irritability and unpredictable temper outbursts. Risk factors for affective lability included elevated pre-injury affective lability and psychosocial adversity as well as greater damage to the orbitofrontal cortex. Post-injury affective lability was most frequently associated with a post-injury diagnosis of attention-deficit hyperactivity disorder.
  
  
  CONCLUSIONS
  Affective lability is common after paediatric TBI and frequently manifests as irritability and unpredictable outbursts. Early intervention is needed to improve psychiatric outcomes.
authors.affiliation: Kennedy Krieger Institute , Baltimore, MD , USA .
authors.forename: Roma A
authors.initials: RA
authors.lastname: Vasa
authors.forename: Stacy J
authors.initials: SJ
authors.lastname: Suskauer
authors.forename: Julia M
authors.initials: JM
authors.lastname: Thorn
authors.forename: Luther
authors.initials: L
authors.lastname: Kalb
authors.forename: Marco A
authors.initials: MA
authors.lastname: Grados
authors.forename: Beth S
authors.initials: BS
authors.lastname: Slomine
authors.forename: Cynthia F
authors.initials: CF
authors.lastname: Salorio
authors.forename: Joan P
authors.initials: JP
authors.lastname: Gerring
mesh_terms: D000293:Adolescent; D000342:Affective Symptoms / Q000175:diagnosis* / Q000209:etiology; D001007:Anxiety / Q000175:diagnosis* / Q000209:etiology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D018592:Cross-Over Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D007508:Irritable Mood; D008297:Male; D009483:Neuropsychological Tests; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Affective lability; children; irritability; outbursts; traumatic brain injury