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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    • "Other researchers have reported that permissive parenting is associated with poor functioning for children with TBI. In a study of young children (3-7 years), Yeates and colleagues (2010) found that parenting practices moderated the relation between injury status (severe-TBI, moderate TBI, and OI) and adjustment 18 months post-injury. "
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    ABSTRACT: Similarities and differences in parenting practices of children (Mage = 10; range 8-13 years) with traumatic brain injury (TBI) and socially-typical controls were examined. In addition, parenting practices were examined as moderators between injury group status (TBI or socially-typical) and social adjustment in the peer group. Mothers completed assessments of parenting practices; children's peers reported about children's social adjustment. The mothers of children with TBI reported significantly lower levels of nurturance and significantly higher levels of restrictiveness than mothers of socially-typical children. In addition, mothers' nurturance moderated the relation between injury group and peer rejection, such that children with TBI were more rejected by classmates compared to their socially-typical peers at low levels of maternal nurturance. The findings are interpreted as supporting the important role parents play in the development of children with a history of TBI, as well as the implications for family-level interventions. Keywords: traumatic brain injury, parenting, social adjustment, peer rejection
    Full-text · Article · Jan 2016 · Journal of Applied Developmental Psychology
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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.
    Full-text · Article · Jan 2015 · Neuropsychologia
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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.
    Full-text · Article · Mar 2014 · Journal of Child Psychology and Psychiatry
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