Neurobehavioral Outcomes

Pediatric TBI is associated with a host of neurobe-havioral problems, although research in this area is often confounded by the high incidence of preinjury behavioral problems in children with TBI (Bloom et al. 2001; Brown et al. 1981). Asarnow and colleagues (Asarnow et al. 1995; Light et al. 1998) found that children with mild TBI displayed higher rates of pre-injury behavioral problems than did children with no injury. In contrast, their preinjury behavioral functioning did not differ from that of children with injuries not involving the head. The latter finding is consistent with previous research suggesting that the presence of premorbid behavioral problems actually increases the likelihood of traumatic injuries (Brown et al. 1981). Thus, although severe head injuries increase the risk of behavioral disturbance, it is also likely that behavioral disturbance increases the risk of head injury. Bloom et al. (2001) found that children with preinjury psychiatric disorders, such as ADHD and anxiety disorders, are more likely to experience a head injury than are children without preinjury psychiatric disorders.

Fletcher et al. (1990) did not find an increased rate of externalizing behavioral problems in children with TBI. Barry et al. (1996) found that children with TBI displayed more somatic, cognitive, and behavioral symptoms than did children with orthopedic injuries and that the total number of symptoms correlated positively with injury severity. Andrews et al. (1998) found an increased rate of aggressive and antisocial behaviors in children with TBI. Yeates et al. (2001) investigated the rate of neurobe-havioral symptoms in the first year following TBI and found high rates of neurobehavioral symptoms. Cognitive/somatic symptoms (e.g., fatigue, headache, inattention) tended to decline in the first year, whereas emotional/behavioral symptoms (e.g., aggression, impulsivity) tended to increase over time, especially in children with severe TBI and in those with poor family functioning. Taylor et al. (2002) found that behavioral problems were more likely to occur following severe TBI and in socially disadvantaged families. Schwartz et al. (2003) investigated the long-term persistence of behavioral problems af ter childhood TBI and found that injury severity, low socioeconomic status, and preinjury behavioral problems predicted the persistence of behavioral problems 4 years post-TBI. Kinsella et al. (1999) found an increased risk of behavioral problems in severe, but not moderate or mild, TBI. In addition, they found that poor parental coping strategies predicted the occurrence of behavioral problems following TBI. Taken together, these studies indicate that behavioral problems are common after childhood brain injury and that the occurrence of these problems varies as a function of injury severity and environmental factors, such as family functioning.

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