title: Longitudinal outcome and recovery of social problems after pediatric traumatic brain injury (TBI): Contribution of brain insult and family environment.
abstract: Pediatric traumatic brain injury (TBI) can result in a range of social impairments, however longitudinal recovery is not well characterized, and clinicians are poorly equipped to identify children at risk for persisting difficulties. Using a longitudinal prospective design, this study aimed to evaluate the contribution of injury and non-injury related risk and resilience factors to longitudinal outcome and recovery of social problems from 12- to 24-months post-TBI. 78 children with TBI (injury age: 5.0-15.0 years) and 40 age and gender-matched typically developing (TD) children underwent magnetic resonance imaging including a susceptibility-weighted imaging (SWI) sequence 2-8 weeks post-injury (M=39.25, SD=27.64 days). At 12 and 24-months post- injury, parents completed questionnaires rating their child's social functioning, and environmental factors including socioeconomic status, caregiver mental health and family functioning. Results revealed that longitudinal recovery profiles differed as a function of injury severity, such that among children with severe TBI, social problems significantly increased from 12- to 24-months post-injury, and were found to be significantly worse than TD controls and children with mild and moderate TBI. In contrast, children with mild and moderate injuries showed few problems at 12-months post-injury and little change over time. Pre-injury environment and SWI did not significantly contribute to outcome at 24-months, however concurrent caregiver mental health and family functioning explained a large and significant proportion of variance in these outcomes. Overall, this study shows that longitudinal recovery profiles differ as a function of injury severity, with evidence for late-emerging social problems among children with severe TBI. Poorer long-term social outcomes were associated with family dysfunction and poorer caregiver mental health at 24-months post injury, suggesting that efforts to optimize the child's environment and bolster family coping resources may enhance recovery of social problems following pediatric TBI.
authors.affiliation: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia. Electronic address: nicholas.ryan@mcri.edu.au.
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Ryan
authors.affiliation: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Loeka
authors.initials: L
authors.lastname: van Bijnen
authors.affiliation: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Cathy
authors.initials: C
authors.lastname: Catroppa
authors.affiliation: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Psychology, University of Montreal, Montreal, Canada; Ste-Justine Research Center, Montreal, Quebec, Canada.
authors.forename: Miriam H
authors.initials: MH
authors.lastname: Beauchamp
authors.affiliation: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Crossley
authors.affiliation: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hearps
authors.affiliation: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Vicki
authors.initials: V
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000000981:diagnostic imaging / Q000451:nursing; D017028:Caregivers / Q000523:psychology*; D016022:Case-Control Studies; D002648:Child; D004777:Environment; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007361:Intelligence Tests; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D020127:Recovery of Function / Q000502:physiology*; D012720:Severity of Illness Index; D012920:Social Behavior Disorders / Q000209:etiology*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
keywords: Brain injuries; Magnetic resonance imaging; Neurobiology; Pediatrics; Social problems