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Longitudinal Investigation of the Post—High School Transition Experiences of Adolescents With Traumatic Brain Injury

Todis, Bonnie PhD; Glang, Ann PhD; Bullis, Michael PhD; Ettel, Deborah PhD; Hood, Donald BA

Section Editor(s): Bruce, Caplan PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation: March/April 2011 - Volume 26 - Issue 2 - p 138–149
doi: 10.1097/HTR.0b013e3181e5a87a
Focus on Clinical Research and Practice, Part 1

Objective: To describe outcomes for youth with traumatic brain injury (TBI) transitioning from high school to adulthood.

Design: Longitudinal design using univariate and multivariate analyses, including survival analysis to predict time to outcomes of interest and longitudinal growth modeling to evaluate factors that predict rates and levels of outcomes over time.

Main Outcome Measures: employment, post–secondary education, and independent living status.

Participants: Eighty-nine youth and young adults (aged 19–25 years) with TBI (19 mild–moderate TBI and 70 severe TBI).

Results: Individuals entering adulthood following childhood TBI experienced fluctuations in rates of employment, enrollment in post–secondary education, and independent living. A higher likelihood of being enrolled in post–secondary education following graduation from high school was associated with being female, later age at injury, and higher socioeconomic status. Overall greater likelihood of employment was associated with higher socioeconomic status, while employment upon high school graduation was associated with more severe injury and lack of rehabilitations services. Greater likelihood of independent living was associated with later age at injury and nonreceipt of rehabilitation services, while shorter time until independent living was associated with less severe injury.

Conclusion: Knowledge of how specific factors affect transition outcomes can be used to tailor transition interventions and resources to the needs of students with TBI. Findings related to special education and medical rehabilitation services should be interpreted with caution as the criteria for receipt of both types of services and the links between such services and functional outcomes are unclear.

The Teaching Research Institute (Drs Todis, Glang and Ettel, and Mr Hood) and College of Education, University of Oregon (Dr Bullis), Eugene, Oregon.

Corresponding Author: Bonnie Todis, PhD, The Teaching Research Institute, 99 W 10th Ave, Ste 370, Eugene, OR 97401 (

This study was funded by the US Department of Education, Office of Special Education and Rehabilitation Services Grant H324C980115 Resilience in Students with Traumatic Brain Injury: A Longitudinal Investigation.

The authors thank Emily Havel and Cathy Thomas for the contribution in data collection and analysis, and Gary Bedell, Shari Wade, and Mark Ylvisaker for their reviews of the manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.