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Predictors of Long-Term Sibling Behavioral Outcome and Self-Esteem Following Pediatric Traumatic Brain Injury

Sambuco, Melissa DCP; Brookes, Naomi MPsych; Catroppa, Cathy PhD; Lah, Suncica PhD

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

The Journal of Head Trauma Rehabilitation: November/December 2012 - Volume 27 - Issue 6 - p 413–423
doi: 10.1097/HTR.0b013e3182274162
Original Articles

Objectives: To determine predictors of self-esteem and behavioral outcome among siblings of children with traumatic brain injury (TBI).

Design: Cross-sectional.

Participants: Thirty-nine siblings closest in age to a child who sustained moderate to severe TBI.

Measures: Outcome variables: sibling behavior (Child Behavior Checklist-Revised) and self-esteem (The Self-Perception Profile for Children—Global Self-Worth). Predictor variables: social support (The Social Support Scale for Children), knowledge (The Child TBI Knowledge Questionnaire), injured child behavior (Child Behavior Checklist-Revised), injured child adaptive skills (Adaptive Behavior Assessment System II—Practical Component), severity of injury (Glasgow Coma Scale), injured child age at injury, time since injury, family functioning (The Family Adaptability and Cohesion Evaluation Scales II - Cohesion Subscale), and socio economic status.

Results: Significantly reduced self-esteem, but no evidence of behavioral difficulties, were found in siblings of children who had sustained TBI. Sibling self-esteem did not correlate with any other study variables. Behavioral outcome correlated with: sense of social support, knowledge about TBI and injured child behavior. Nevertheless, simultaneous regression analyses revealed that only knowledge about TBI and sense of social support made significant independent contributions to behavioral outcome.

Conclusions: Educating uninjured siblings about TBI and raising awareness of their needs in members of their social support network may be important in facilitating sibling behavioral outcome.

School of Psychology, The University of Sydney, New South Wales, Australia (Drs Sambuco and Lah); Brain Injury Rehabilitation Program, Sydney Children's Hospital, Randwick, New South Wales, Australia (Ms Brookes); Royal Children's Hospital and Australian Centre for Child Neuropsychology Studies (Dr Catroppa), Murdoch Children's Institute, Melbourne, Victoria, Australia.

Corresponding Author: Suncica Lah, PhD, Mungo Mac Callum Building (A19), School of Psychology, The University of Sydney, NSW 2006, Australia. (

This research was in part supported by the research scholarship, University of Sydney Postgraduate Award (UPA), awarded to Melissa Sambuco.

The authors declare no conflicts of interest.

The authors thank Professor Vicki Anderson for comments given to an earlier manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.