Concluding Comments

Pediatric TBI results in a complex array of neuro-pathological and neurochemical changes as well as multiple medical complications. The management of these children typically requires an interdisciplinary approach, which frequently involves mental health professionals. These consultants need to have a working knowledge of the acute and post-acute medical complications of TBI as well as the underlying mechanisms that drive the emotional, behavioral, and cognitive difficulties that these children often experience. This chapter provides a brief review of these medical factors.

Children with TBI experience a wide variety of neurobehavioral sequelae affecting functioning in multiple domains, including cognitive, behavioral, social, adaptive, and academic outcomes, and across multiple environmental contexts, including home, school, and recreational settings. Traditional psychiatric diagnoses may not capture the broad array of emotional and behavioral problems that often occur after TBI, although children with TBI often display symptoms of specific externalizing and internalizing disorders. Injury severity is a strong predictor of cognitive outcomes, whereas behavioral outcomes are often also related to environmental factors, such as family functioning (Fletcher et al. 1990). For this reason, consultants need to obtain information regarding both injury severity and family functioning. Child and family premorbid functioning should also be documented as soon as possible, because pre-injury functioning is also a predictor of many outcomes of TBI (Bloom et al. 2001; Catroppa and Anderson 2007; Yeates et al. 2005).

Treatments for the negative sequelae of TBI have only recently begun to become a focus of empirical investigation. These treatment methods include pharmacological, rehabilitative, behavioral, and cognitive approaches. The use of psychotropic medications for pediatric TBI has received equivocal empirical support, and further research is needed. Direct remediation of cognitive deficits may be effective in some cases, but research also supports the inclusion of family members and school officials in TBI rehabilitation. School reintegration is also a crucial step in the long-term management of pediatric TBI. Thus, the literature supports a biopsychosocial model of the outcomes of TBI that can only be addressed through multiple levels of intervention.

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