Lifetime History of Head or Traumatic Brain Injury Before Age 9 and School Outcomes: Results From the Adolescent Brain Cognitive Development Study.
Dana Waltzman, Juliet Haarbauer-Krupa, Jill Daugherty and 3 others
PMID 39434468WHAT IT FOUND
Head injury before age 9 was linked to poorer grades, grade drops, discipline issues, and special education, mainly in boys.
TBI before age 9 showed poorer grades and grade drops; in girls, it was linked only to recent grade drops.
Key findings
01After adjustment, head injury before age 9 was associated with higher odds of poor parent-rated school performance, poor grades, recent grade drops, special educational services, and detentions or suspensions.
02After adjustment, TBI before age 9 was associated with higher odds of poor parent-rated school performance, poor or average grades, and recent grade drops.
03Head injury associations were driven by boys; girls with TBI showed only a recent grade drop.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a baseline observational analysis, so it cannot show that early head injury caused later school problems. Head injury history, school outcomes, behavior, and sleep were reported by parents or caregivers, and behavior was also reported by teachers, so recall and reporting bias are possible. The TBI definition required loss of consciousness, being dazed, or a memory gap, so other TBI symptoms may have been missed and the TBI count may be low. The Modified OSU TBI Screen has good validity and reliability in adults, but the paper says it has not been assessed in children. The paper says the exposed cohort was limited to injuries before age 9, so results do not apply to all children with head injury or TBI. Prior school performance or prior mental health challenges may have affected both injury likelihood and school outcomes, but were not controlled.
Declared interests
The supplied text does not include a funding or conflict-of-interest statement. The article metadata lists NIH extramural research support.
The easy way to misread this
Do not read these odds ratios as proof that a head injury before age 9 causes poor school outcomes. This is an observational baseline analysis, and injury history and school outcomes relied on parent or teacher reports, so other factors may explain the links.