The family environment as a moderator of psychosocial outcomes following traumatic brain injury in young children

Department of Pediatrics, Ohio State University, Columbus, OH, USA.
Neuropsychology (Impact Factor: 3.27). 05/2010; 24(3):345-56. DOI: 10.1037/a0018387
Source: PubMed


This study sought to determine whether the family environment moderates psychosocial outcomes after traumatic brain injury (TBI) in young children.
Participants were recruited prospectively from consecutive hospital admissions of 3- to 6-year-old children, and included 19 with severe TBI, 56 with complicated mild/moderate TBI, and 99 with orthopedic injuries (OI). They completed 4 assessments across the first 18 months postinjury. The initial assessment included measures of parenting style, family functioning, and the quality of the home. Children's behavioral adjustment, adaptive functioning, and social competence were assessed at each occasion. Mixed model analyses examined the relationship of the family environment to psychosocial outcomes across time.
The OI and TBI groups differed significantly in social competence, but the family environment did not moderate the group difference, which was of medium magnitude. In contrast, group differences in behavioral adjustment became more pronounced across time at high levels of authoritarian and permissive parenting; among children with severe TBI, however, even those with low levels of permissive parenting showed increases in behavioral problems. For adaptive functioning, better home environments provided some protection following TBI, but not over time for the severe TBI group. These 3-way interactions of group, family environment, and time postinjury were all of medium magnitude.
The findings indicate that the family environment moderates the psychosocial outcomes of TBI in young children, but the moderating influence may wane with time among children with severe TBI.

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Available from: H. Gerry Taylor, Oct 09, 2015
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    • "More specifically, the model postulates that various injury and non-injury-related risk and resilience factors may independently or interactively contribute to social outcome after childhood TBI. While environmental factors, such as interventions and better family functioning, represent sources of resilience that may buffer against the neurological consequences of TBI (Ryan et al., 2014; Yeates et al., 2010), injury factors, including injury severity and lesion location, are conceptualized as risk factors that increase the likelihood of impaired social information processing and communication (Yeates et al., 2007). "
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    ABSTRACT: Theory of Mind (ToM) forms an integral component of socially skilled behavior, and is critical for attaining developmentally appropriate goals. The protracted development of ToM is mediated by increasing connectivity between regions of the anatomically distributed ‘mentalizing network’, and may be vulnerable to disruption from pediatric traumatic brain injury (TBI). The present study aimed to evaluate the post-acute effects of TBI on first-order ToM, and examine relations between ToM and both local and global indices of macrostructural damage detected using susceptibility-weighted imaging (SWI). 104 children and adolescents with TBI and 43 age-matched typically developing (TD) controls underwent magnetic resonance imaging including a susceptibility-weighted imaging (SWI) sequence 2–8 weeks post-injury and were assessed on cognitive ToM tasks at 6-months after injury. Compared to TD controls and children with mild-moderate injuries, children with severe TBI showed significantly poorer ToM. Moreover, impairments in ToM were related to diffuse neuropathology, and parietal lobe lesions. Our findings support the vulnerability of the immature social brain network to disruption from TBI, and suggest that global macrostructural damage commonly associated with traumatic axonal injury (TAI) may contribute to structural disconnection of anatomically distributed regions that underlie ToM. This study suggests that SWI may be a valuable imaging biomarker to predict outcome and recovery of social cognition after pediatric TBI.
    Neuropsychologia 01/2015; 66:32-38. DOI:10.1016/j.neuropsychologia.2014.10.040 · 3.30 Impact Factor
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    • "Behavioural interventions such as positive behaviour support and contingency management may be considered evidenced-based treatment options following paediatric ABI; however, most reported research consists of uncontrolled trials or case studies, and the majority of interventions have been delivered by professionals in clinics, schools or residential facilities (Ylvisaker et al., 2007). Given the critical role of nurturing home environments in recovery from ABI (Yeates et al., 2010), as well as child development in general (Biglan, Flay, Embry, & Sandler, 2012), parenting practices are an important clinical target to facilitate environmental enrichment and optimise outcome. A recent systematic review found only a limited number of RCTs of interventions for paediatric ABI that included behavioural parent training (Brown, Whittingham, Boyd, & Sofronoff, 2013a), and each study trialled an ABI-specific, multielement family intervention, with behaviour management constituting a small component. "
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    ABSTRACT: Background Persistent behavioural difficulties are common following paediatric acquired brain injury (ABI). Parents and families also experience heightened stress, psychological symptoms and burden, and there is evidence of a reciprocal relationship between parent and child functioning, which may be mediated by the adoption of maladaptive parenting practices. Despite this, there is currently a paucity of research in family interventions in this population. The aim of this study was to determine the efficacy of Stepping Stones Triple P: Positive Parenting Program (SSTP), with an Acceptance and Commitment Therapy (ACT) workshop, in improving child outcomes and parenting practices following paediatric ABI.Methods Fifty-nine parents of children (mean age 7 years, SD 3 years, 1 month; 35 males, 24 females) with ABI (Traumatic injuries 58%, Tumour 17%, Encephalitis or meningitis 15%, Cardiovascular accident 7%, Hypoxia 3%) who were evidencing at least mild behaviour problems were randomly assigned to treatment or care-as-usual conditions over 10 weeks. Mixed-model repeated-measures linear regression analyses were conducted to compare conditions from pre- to postintervention on child behavioural and emotional functioning (Eyberg Child Behavior Inventory, Strengths and Difficulties Questionnaire) and dysfunctional parenting style (Parenting Scale). Assessment of maintenance of change was conducted at a 6-month follow-up. The trial was registered on Australian New Zealand Clinical Trials Registry (ID: ACTRN12610001051033, time-by-condition interactions were identified on number and intensity of child behaviour problems, child emotional symptoms and parenting laxness and overreactivity, indicating significant improvements in the treatment condition, with medium-to-large effect sizes. Most improvements were maintained at 6 months.Conclusions Group parenting interventions incorporating Triple P and ACT may be efficacious in improving child and parenting outcomes following paediatric ABI.
    Journal of Child Psychology and Psychiatry 03/2014; 55(10). DOI:10.1111/jcpp.12227 · 6.46 Impact Factor
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    • "Once this cerebral development is interrupted in the early stage, sustained deficits seem to reduce the child’s ability to acquire knowledge and skills to manage or minimize the impairment [9,10]. In contrast to this suggestion, other studies found that the association of injury severity and outcome deficits diminishes with increasing time since injury in children [6,10,13], suggesting other influencing factors like rehabilitation [14] and family environment being more important than the sustained injury [9,15]. "
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    ABSTRACT: Several studies have indicated that younger age is associated with worse recovery after pediatric traumatic brain injury (TBI) compared to elder children. In order to verify this association between long-term outcome after moderate to severe TBI and patient's age, direct comparison between different pediatric age groups as well as an adult population was performed. This investigation represents a retrospective cohort study at a level I trauma center including patients with moderate to severe, isolated TBI with a minimum follow-up of 10 years. According to their age at time of injury, patients were divided in pre-school (0-7 years), school (8-17 years) and adult (18-65 years) patients. Physical examination and standardized questionnaire on physical and psychological aspects (Glasgow Outcome Scale, Barthel Index, Impact of Event Scale, Hospital Anxiety and Depression Scale, short form 12) were performed. 135 traumatized patients were included. Physical and psychological long-term outcome was associated with injury severity but not with patients' age at time of injury. Outcome recovery measured by Glasgow Outcome Scale was demonstrated with best results for pre-school aged children (p = 0.009). According to the Hospital Anxiety and Depression Scale an increased incidence of anxiety (p = 0.010) and depression (p = 0.026) was evaluated in older patients. Long-term outcome perceptions after moderate to severe TBI presented in this study question current views of deteriorated recovery for the immature brain. The sustained TBI impact seemed not to reduce the child's ability to overcome the suffered impairment measured by questionnaire based psychological, physical and health related outcome scores. These results distinguish the relevance of rehabilitation and family support in the long term.
    Health and Quality of Life Outcomes 02/2014; 12(1):26. DOI:10.1186/1477-7525-12-26 · 2.12 Impact Factor
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