Behavior Problems Following Childhood TBI: The Role of Sex, Age, and Time Since Injury.
Shari L Wade, Eloise E Kaizar, Megan E Narad and 8 others
PMID 32108717WHAT IT FOUND
Low family income predicted behavior problems more strongly than injury severity did.
Girls injured in adolescence showed higher attention and externalizing symptoms than boys. Social competence improved as time passed, but early deficits were common.
Key findings
01Children of parents with less than a high school education had more than twice the odds of elevated internalizing, externalizing, and total behavior problems compared to those with parents who had some postsecondary education.
02At older ages at injury, girls demonstrated significantly more ADHD symptoms than boys, while at younger ages boys showed more oppositional and PTSD symptoms than girls.
03Forty-four percent of children had significant deficits in total competence, and longer time since injury was associated with higher social competence scores.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study relied solely on parent-report measures (CBCL), without diagnostic interviews or input from teachers, peers, or the children themselves, which may have yielded different results. The design was cross-sectional, so it could not track individual children over time to confirm longitudinal outcomes or causal relationships. Participants were recruited for randomized trials, which may introduce selection bias if families who participate in trials differ systematically from those who do not. The sample included children with complicated mild to severe TBI, so findings may not apply to those with uncomplicated mild concussion. Some children were assessed using the preschool CBCL form, limiting the ability to examine subscales unique to the school-age version.
Declared interests
The authors declared no potential conflicts of interest. The study was supported by the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Disability and Rehabilitation Research (NIDRR).
The easy way to misread this
Do not assume that injury severity is the primary driver of behavioral outcomes. Low parental education was a much stronger predictor of internalizing, externalizing, and total behavior problems than the severity of the brain injury itself.