Shultz Emily L, Hoskinson Kristen R, Keim Madelaine C, Dennis Maureen, Taylor H Gerry, Bigler Erin D, Rubin Kenneth H, Vannatta Kathryn, Gerhardt Cynthia A, Stancin Terry, Yeates Keith Owen
Research Institute at Nationwide Children's Hospital.
Department of Pediatrics.
Neuropsychology. 2016 Oct;30(7):830-40. doi: 10.1037/neu0000288. Epub 2016 May 16.
Pediatric traumatic brain injury (TBI) may affect children's ability to perform everyday tasks (i.e., adaptive functioning). Guided by the American Association for Intellectual and Developmental Disabilities (AAIDD) model, we explored the association between TBI and adaptive functioning at increasing levels of specificity (global, AAIDD domains, and subscales). We also examined the contributions of executive function and processing speed as mediators of TBI's effects on adaptive functioning.
Children (ages 8-13) with severe TBI (STBI; n = 19), mild-moderate TBI (MTBI; n = 50), or orthopedic injury (OI; n = 60) completed measures of executive function (TEA-Ch) and processing speed (WISC-IV) an average of 2.7 years postinjury (SD = 1.2; range: 1-5.3). Parents rated children's adaptive functioning (ABAS-II, BASC-2, CASP).
STBI had lower global adaptive functioning (η2 = .04-.08) than the MTBI and OI groups, which typically did not differ. Deficits in the STBI group were particularly evident in the social domain, with specific deficits in social participation, leisure, and social adjustment (η2 = .06-.09). Jointly, executive function and processing speed were mediators of STBI's effects on global adaptive functioning and in conceptual and social domains. In the STBI group, executive function mediated social functioning, and processing speed mediated social participation.
Children with STBI experience deficits in adaptive functioning, particularly in social adjustment, with less pronounced deficits in conceptual and practical skills. Executive function and processing speed may mediate the effects of STBI on adaptive functioning. Targeting adaptive functioning and associated cognitive deficits for intervention may enhance quality of life for pediatric TBI survivors. (PsycINFO Database Record
小儿创伤性脑损伤（TBI）可能会影响儿童执行日常任务的能力（即适应性功能）。以美国智力与发育障碍协会（AAIDD）模型为指导，我们在越来越高的特异性水平（整体、AAIDD领域和子量表）上探索了TBI与适应性功能之间的关联。我们还研究了执行功能和处理速度作为TBI对适应性功能影响的中介作用。
患有重度TBI（STBI；n = 19）、轻度至中度TBI（MTBI；n = 50）或骨科损伤（OI；n = 60）的儿童（8 - 13岁）在受伤后平均2.7年（标准差 = 1.2；范围：1 - 5.3）完成了执行功能（TEA - Ch）和处理速度（WISC - IV）的测量。家长对儿童的适应性功能进行了评分（ABAS - II、BASC - 2、CASP）。
STBI组的整体适应性功能低于MTBI组和OI组（η2 = 0.04 - 0.08），MTBI组和OI组通常没有差异。STBI组在社会领域的缺陷尤为明显，在社会参与、休闲和社会适应方面存在特定缺陷（η2 = 0.06 - 0.09）。执行功能和处理速度共同作为STBI对整体适应性功能以及概念和社会领域影响的中介。在STBI组中，执行功能介导社会功能，处理速度介导社会参与。
患有STBI的儿童在适应性功能方面存在缺陷，尤其是在社会适应方面，而在概念和实践技能方面的缺陷不太明显。执行功能和处理速度可能介导STBI对适应性功能的影响。针对适应性功能和相关认知缺陷进行干预可能会提高小儿TBI幸存者的生活质量。（PsycINFO数据库记录
