Behavior Problems 7 Years After Severe Childhood Traumatic Brain Injury

What is it about?

Purpose/Objective: To investigate the occurrence of behavioral problems 7 years after severe pediatric traumatic brain injury (TBI), and their evolution from 3 months to 7 years postinjury. Method/Design: Thirty-four participants, 38% girls, M (SD) age at injury 7.6 (4.7) years, age at assessment 15 (4.6) years, underwent comprehensive assessments 7 years after severe TBI from March 2014 to March 2016 and were matched to a control group by age, gender, and parental education. A subgroup of 20 participants had available behavioral assessments at 3, 12, and 24 months postinjury. Internalizing, externalizing, and total behavioral problems were assessed with self- and parent reports of the Achenbach’s Behavioral Checklist. Additional data included sociodemographic background, initial injury severity, and specific outcomes assessed concurrently 7 years postinjury. Results: Compared to controls: (a) a significant proportion of participants with severe TBI fell above the clinical cutoff for self- (42%) and parent-reported (36%) externalizing problems, but not for self- (33%) or parent-reported (45%) internalizing problems; (b) withdrawn/depressed, intrusive behavior, and somatic complaints were significantly higher in selfreports; and (c) rule-breaking behavior, attention, and social problems were significantly higher in parent reports. Parent-reported internalizing problems were associated with older age at injury, whereas externalizing problems correlated with greater injury severity and concurrent levels of greater overall disability, lower intellectual ability, and poorer family functioning. In multiple hierarchical regression analyses, overall disability and worse family functioning significantly predicted externalizing problems. Parent-reported internalizing and externalizing problems persisted over time. Conclusions/Implications: These results highlight the importance of long-term follow-up and individualized behavioral interventions for children who sustained severe TBI.

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Why is it important?

Approximately half of the parents of children who sustained severe pediatric traumatic brain injury (TBI) report clinically significant internalizing and externalizing behavior problems 7-year postinjury, indicating long-term persistence of behavioral issues with significant consequences on participation and overall academic achievement. Concordance between parent- and self-reports assessing internalizing and externalizing behavioral problems is high, suggesting that patients who sustained severe childhood TBI and their parents might perceive and deal more frequently with symptoms related to more overtly noticeable behaviors, such as externalizing symptoms, but might also be particularly aware of symptoms pertaining to withdrawnness, depression, and somatic complaints in the long-term. These internalizing symptoms should not be neglected and appropriate support should be considered, even in the absence of externalized behaviors.

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