title: Long-Term Neuropsychological Profiles and Their Role as Mediators of Adaptive Functioning after Traumatic Brain Injury in Early Childhood.
abstract: The objectives of the study were to characterize long-term neuropsychological outcomes following traumatic brain injury (TBI) sustained during early childhood, and determine whether identified neuropsychological impairments mediated the effect of TBI on long-term adaptive functioning. Participants included 16 children with severe TBI, 42 children with moderate TBI, and 72 children with orthopedic injuries (OI) sustained between ages 3 and 7 years. Children completed neuropsychological tests and caregivers completed a structured interview of child adaptive functioning at 6.9 (±1.10) years post-injury. Profile analysis and multiple mediator modeling were employed. Children with severe TBI demonstrated poorer fluid reasoning and inhibitory control than both children with moderate TBI and OI, as well as slower processing speed than the OI group. Both fluid reasoning and processing speed were significant independent mediators of the effect of severe TBI on adaptive functioning. No neuropsychological measure significantly mediated the effect of moderate TBI on adaptive functioning. Children sustaining early severe TBI demonstrate persisting neuropsychological impairments into adolescence and young adulthood. The impact of severe TBI on children's long-term adaptive functioning is mediated in part by its effects on fluid reasoning and processing speed.
authors.affiliation: 1 Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio.
authors.forename: Amery
authors.initials: A
authors.lastname: Treble-Barna
authors.affiliation: 2 Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio.
authors.forename: Huaiyu
authors.initials: H
authors.lastname: Zang
authors.affiliation: 2 Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio.
authors.forename: Nanhua
authors.initials: N
authors.lastname: Zhang
authors.affiliation: 3 Division of Developmental and Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center , Rainbow Child Development Center, Cleveland, Ohio.
authors.forename: H Gerry
authors.initials: HG
authors.lastname: Taylor
authors.affiliation: 4 Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada .
authors.forename: Keith Owen
authors.initials: KO
authors.lastname: Yeates
authors.affiliation: 1 Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio.
authors.forename: Shari
authors.initials: S
authors.lastname: Wade
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000293:Adolescent; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000523:psychology*; D002648:Child; D015331:Cohort Studies; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D013997:Time Factors
keywords: cognitive function; neuropsychology; outcome measures; pediatric brain injury