儿童期创伤性脑损伤后执行功能的轨迹：损伤后最初 81 个月的教师评定。
Trajectories of Executive Functions After Early Childhood Traumatic Brain Injury: Teacher Ratings in the Initial 81 Months Postinjury.
机构信息
Neuropsychological Services of New Mexico, Albuquerque, New Mexico (Dr Rempe); Children's Hospital Colorado and the University of Colorado School of Medicine, Department of Rehabilitation Medicine, Aurora, Colorado (Dr Petranovich); Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Narad); Department of Psychology, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Alberta, Calgary (Dr Yeates); Abigail Wexner Research Institute, Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio (Dr Taylor); MetroHealth Medical Center, Cleveland, Ohio (Dr Stancin); Department of Rehabilitation, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Wade).
出版信息
J Head Trauma Rehabil. 2023;38(3):E203-E211. doi: 10.1097/HTR.0000000000000833. Epub 2022 Oct 14.
OBJECTIVE
To explore teacher-rated trajectories of executive functioning (EF) after early childhood traumatic brain injury (TBI) and to identify injury-related, academic, and family factors associated with growth trajectories using latent class growth analysis.
PARTICIPANTS
A total of 121 children who sustained a TBI or orthopedic injury (OI) between the ages of 3 and 7 years were recruited from 3 tertiary care children's hospitals and a general hospital in Ohio, including 57 with moderate or severe TBI and 64 with OI.
DESIGN
Assessments were completed at baseline (0-3 months postinjury) and an average of 6, 12, 18, and 81 months postinjury. Changes in teacher-rated EF were modeled across time and heterogeneity in recovery and moderating factors was examined.
MEASURES
Study variables included participant demographics, teacher-rated EF (Behavior Rating Inventory of Executive Function), family functioning (McMaster Family Assessment Device), and parenting style (Parenting Practices Questionnaire).
RESULTS
Analysis of teacher-rated EF yielded 2 trajectories: Normative (64.71%) and At-Risk (35.29%). Traumatic brain injury was a weak predictor of membership in the At-Risk trajectory ( P = .05). Membership in the At-Risk trajectory (compared with Normative category) was associated with a higher incidence of Individualized Education Programs, higher baseline EF concerns, increased endorsement of authoritarian parenting, lower socioeconomic status, and non-White race.
CONCLUSION
Teacher-rated EF after pediatric TBI differs from OI. Increased EF concerns over time were associated with increased baseline EF and characteristics of the home and school environment. These findings extend previous research on recovery of EF to educational settings and outline potentially modifiable risk factors that can maximize success in the school settings for children who experience early-childhood traumatic injury.
目的
使用潜在类别增长分析，探索幼儿期创伤性脑损伤（TBI）后教师评定的执行功能（EF）轨迹，并确定与增长轨迹相关的损伤相关、学术和家庭因素。
参与者
共有 121 名儿童在俄亥俄州的 3 家三级儿童保健医院和一家综合医院因 TBI 或骨科损伤（OI）而在 3 至 7 岁之间受伤，其中 57 名儿童患有中度或重度 TBI，64 名患有 OI。
设计
在基线（受伤后 0-3 个月）和平均 6、12、18 和 81 个月后进行评估。对教师评定的 EF 进行了跨时间建模，并检查了恢复和调节因素的异质性。
措施
研究变量包括参与者的人口统计学数据、教师评定的 EF（行为评定量表）、家庭功能（麦克马斯特家庭评估设备）和养育方式（育儿实践问卷）。
结果
对教师评定的 EF 进行分析得出 2 个轨迹：正常（64.71%）和高危（35.29%）。TBI 是高危轨迹（P=0.05）的弱预测因子。与正常类别相比，高危轨迹（高危类别）的成员与更高的个别教育计划发生率、更高的基线 EF 问题发生率、更强烈的专制养育方式、较低的社会经济地位和非白种人种族有关。
结论
儿科 TBI 后教师评定的 EF 与 OI 不同。随着时间的推移，EF 问题的增加与基线 EF 增加以及家庭和学校环境的特点有关。这些发现将 EF 恢复的先前研究扩展到教育环境，并概述了可能改变的风险因素，这些因素可以最大限度地提高在学校环境中经历幼儿期创伤性损伤的儿童的成功。
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