1 Department of Pediatrics, University of Utah , Salt Lake City, Utah.
2 Department of Pediatric Surgery, University of Texas Medical School at Houston , Houston, Texas.
J Neurotrauma. 2018 Jan 15;35(2):286-296. doi: 10.1089/neu.2017.5265. Epub 2017 Oct 16.
Time since traumatic brain injury (TBI) and developmental stage at injury may affect the trajectory of outcomes associated with adjustment and school success. We prospectively enrolled a cohort of 519 children with either TBI or orthopedic injury (OI) age 2.5-15 years to examine children's psychosocial and executive function outcomes at 3- and 12-months post-injury. Outcome measures included the Child Behavior Checklist (CBCL), Strengths and Difficulties Questionnaire (SDQ), and Behavior Rating Inventory of Executive Function (BRIEF) ratings. Controlling for pre-injury ratings and using the OI group as the reference, children with TBI, regardless of age or injury severity, had affective, anxiety, and attention-deficit/hyperactivity disorder (ADHD) problems on the CBCL. Symptom trajectories differed both by injury severity and age at injury. Children with mild and complicated mild TBI had a decreasing anxiety trajectory, whereas children with severe TBI had increasing symptoms. Children 6-11 years of age had high ADHD and affective scores; however, the youngest children had increasing symptoms over time. On the SDQ, peer relationships and prosocial behaviors were not significantly affected by TBI but were associated with family environment. Children with severe TBI had the worst executive function scores; however, mild and complicated mild/moderate TBI groups had clinically important working memory deficits. Hispanic ethnicity and strong social capital were positively associated with multiple outcomes. Children's recovery trajectories differed by injury severity, time since injury, and developmental stage when injured. Schools need to reassess children's skills over time as new problems in behavior and learning may emerge.
创伤性脑损伤 (TBI) 后的时间和损伤时的发育阶段可能会影响与适应和学业成功相关的结果轨迹。我们前瞻性地招募了一组年龄在 2.5-15 岁的 TBI 或骨科损伤 (OI) 患儿，以检查患儿受伤后 3 个月和 12 个月时的社会心理和执行功能结果。结果测量包括儿童行为检查表 (CBCL)、长处和困难问卷 (SDQ) 和行为评定量表执行功能 (BRIEF) 评分。在控制损伤前评分的情况下，以 OI 组为参照，无论年龄或损伤严重程度如何，TBI 患儿在 CBCL 上均有情感、焦虑和注意力缺陷/多动障碍 (ADHD) 问题。症状轨迹不仅因损伤严重程度而且因受伤年龄而异。轻度和复杂轻度 TBI 患儿的焦虑症状呈下降趋势，而重度 TBI 患儿的症状则呈上升趋势。6-11 岁的患儿 ADHD 和情感评分较高；然而，最小的孩子随着时间的推移症状逐渐增加。在 SDQ 上，TBI 并未显著影响同伴关系和亲社会行为，但与家庭环境有关。严重 TBI 患儿的执行功能评分最差；然而，轻度和复杂轻度/中度 TBI 组存在临床显著的工作记忆缺陷。西班牙裔和强大的社会资本与多种结果呈正相关。患儿的恢复轨迹因损伤严重程度、受伤后时间和受伤时的发育阶段而异。随着时间的推移，学校需要重新评估孩子的技能，因为可能会出现新的行为和学习问题。
