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Family Adaptation 18 Months After Traumatic Brain Injury in Early Childhood

Stancin, Terry PhD*†; Wade, Shari L. PhD‡; Walz, Nicolay C. PhD§; Yeates, Keith Owen PhD¶∥; Taylor, H. Gerry PhD**††

Journal of Developmental & Behavioral Pediatrics: May 2010 - Volume 31 - Issue 4 - pp 317-325
doi: 10.1097/DBP.0b013e3181dbaf32
Original Article

Objective: The purpose of this study was to examine family adaptation to a traumatic brain injury (TBI) in young children during the first 18-month postinjury, when compared with children who had an orthopedic injury.

Methods: A concurrent cohort/prospective research design was used with repeated assessments of children aged 3 to 6 years with TBI or orthopedic injury requiring hospitalization and their families. Shortly after injury and at 6-, 12-, and 18-month postinjury, parents of 99 children with TBI (20 severe, 64 moderate, 15 mild) and 117 with orthopedic injury completed standardized assessments of family functioning, parental distress and coping, injury-related burden, and noninjury-related parent stressors and resources. Mixed models analyses examined group differences in parental burden and distress adjusted for race and social demographic factors.

Results: Both moderate and severe TBI were associated with higher levels of injury-related stress than orthopedic injury, with stress levels diminishing over time in all groups. Severe TBI was also associated with greater psychological distress on the Brief Symptom Inventory but not with more depressive symptoms. Family functioning and social resources moderated the relationship of TBI severity to injury-related burden and caregiver distress, respectively. Lower child adaptive skills were associated with poorer family outcome but group differences remained even when controlling for this effect.

Conclusions: Severe TBI in young children has adverse consequences for parents and families during the first 18-month postinjury. The consequences lessen over time for many families and vary as a function of social resources.

From the *Department of Psychiatry, Division of Pediatric Psychology, MetroHealth Medical Center; †Case Western Reserve University School of Medicine, Cleveland, OH; ‡Department of Rehabilitation, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine; §Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH; ¶Department of Pediatrics, The Ohio State University; ∥Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH; **Department of Pediatrics, Case Western Reserve University; and ††Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH.

Received August 2009; accepted February 2010.

Supported by grant R01 HD42729 from NICHD, in part by USPHS NIH Grant M01 RR 08084, and by Trauma Research grants from the State of Ohio Emergency Medical Services (to S.L.W.).

This publication was supported by an Institutional Clinical and Translational Science Award, NIH/NCRR Grant Number 1UL1RR026314.

Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Address for reprints: Terry Stancin, PhD, Pediatric Psychology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.