Although children with severe traumatic brain injury (TBI) exhibit substantial and long-term academic and behavioral residual disability, there is a brighter outlook for children with moderate TBI -- but improvement is greater for children from more advantaged environments.

These findings appear in the January issue of Neuropsychology, published by the American Psychological Association (APA).

H. Gerry Taylor, Ph.D., of Case Western Reserve University and Rainbow Babies & Children's Hospital, led a research team that assessed the academic achievement (measured by teacher ratings along with letter-word identification, calculation and writing tests) and the adaptive, social and classroom behavior of Ohio children four times -- three weeks, six months, 12 months and four years after injury.

Participants were between six and 12 at time of injury. They included 53 children with severe TBI (most often in motor-vehicle accidents); 56 children with moderate TBI (most often in sports and recreational accidents); and a control group of 80 children with orthopedic injuries not involving brain injury.

The team also evaluated the children's families in terms of a commonly used socio-economic index, annual income, and years of maternal education, as well as social stressors and resources that considered Health, Work, Spouse, Extended Family and Friends.

The achievement and behavior scores of young TBI survivors with less stressed and more supportive (in terms of income, education and socioeconomic status) families were significantly higher than those of similarly injured children from more stressed and/or less advantaged families.

In other words, write the authors, "The adverse effects of TBI on behavior and the development of social skills were exacerbated by unfavorable family circumstances."

Taylor et al. speculate that children with severely injured brains are especially vulnerable to family adversity. Both groups had more problems than the children who'd had orthopedic injuries that didn't hurt the central nervous system.

Children with severe TBI clearly had worse problems. Additional data analyses, as yet unpublished, revealed that half of the severe TBI group, after four years, was in a special-education program, compared with only 10 percent of the orthopedic-injury control group. Four years post-injury, about one-third of the children who didn't have behavior problems before they got hurt exhibited behavior problems that had developed post-injury.

The authors speculate that severe TBI seems to hurt children exactly in the kinds of functions they need to succeed.

"The weaknesses shown by children with severe TBI in executive functions and problem solving," the authors write, "may make it difficult for them to meet classroom performance and to learn expectations without individual educational assistance and accommodations." Disadvantaged, more stressed families may find it more difficult to access or obtain this kind of help for their children.

For all the TBI survivors, there was little evidence of recovery after the first post-injury year, with one exception: The moderate TBI group caught up in writing between the 12-month assessment and extended follow-ups, which implies that some functions may recover after the first year, at least in children with less severe injury.

The authors hope that a better understanding of this subject will be useful in identifying high-risk children, raising awareness of ways to facilitate recovery, and providing an "impetus for including family treatment and other environmental modifications as components of rehabilitation."

They call for additional research to define the mechanisms by which less stressed, more advantaged families help their brain-injured children, by anything from greater stimulation and support to better access to remediation and special services.

Taylor and his co-authors also tie their findings to other scientific research on how the environment can modify the brain. They refer to laboratory findings that enriched environments can facilitate behavioral and neural reorganization in animals with experimental brain lesions.

(Reference: "A Prospective Study of Short- and Long-Term Outcomes After Traumatic Brain Injury in Children: Behavior and Achievement," H. Gerry Taylor, Case Western Reserve University and Rainbow Babies & Children's Hospital; Keith Owens Yeates, The Ohio State University and Columbus Children's Hospital; Shari L. Wade, University of Cincinnati and Children's Hospital Medical Center; Dennis Drotar, Case Western Reserve University and Rainbow Babies & Children's Hospital; Terry Stancin, Case Western Reserve University and MetroHealth Medical Center; and Nori Minich, Case Western Reserve University and Rainbow Babies & Children's Hospital, Neuropsychology, Vol, 16, No. 1.)

Full text of the article is available at this URL after January 30.


[Contact: H. Gerry Taylor]

28-Jan-2002