Do Children Who Sustain Traumatic Brain Injury in Early Childhood Need and Receive Academic Services 7 Years After Injury?
Kathleen M Kingery, Megan E Narad, H Gerry Taylor and 3 others
PMID 28953005WHAT IT FOUND
Years after preschool TBI, many children with potential need for school services were not receiving them.
Severe TBI had the highest need, but moderate TBI showed high unmet need, and behavior or executive concerns were less likely to trigger services than IQ or achievement scores.
Key findings
01At long-term follow-up, potential need for academic services was 37.50% in the orthopedic injury group, 64.29% in the moderate TBI group, and 81.25% in the severe TBI group.
02Severe TBI had significantly higher academic service utilization than the other groups, but utilization did not differ significantly among children who met criteria for potential need.
03Parent- and teacher-reported need were the domains most likely to be unmet, and IQ/achievement need was the only significant predictor of receiving services.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only 78 children had valid teacher reports, and children with teacher reports differed from children without teacher reports in age, socioeconomic status, and race. Service receipt was based on parent and teacher report at the long-term follow-up visit, not school records, so the type and duration of services were not known. Potential need was defined using cut-off scores, and the authors state that this may over-identify need when reported problems were being managed by parents or teachers. The comparison group was children with orthopedic injury, not non-injured peers, and the orthopedic injury group had high need rates. Children with uncomplicated mild TBI were excluded, so the study does not address that group. The study is observational, so it cannot show that academic services improved outcomes or that any single factor caused service receipt. Many children were injured between ages 3 and 7 and may not have been in formal school during acute recovery, which limits what service receipt at that time can show.
The easy way to misread this
Do not read the 46.2% to 63.0% unmet need rate as evidence that a treatment works or fails. It is an observational service-gap finding at the long-term follow-up, and service receipt was based on parent and teacher report rather than school records.