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Symptoms of Persistent Behavior Problems in Children With Mild Traumatic Brain Injury

Taylor, H. Gerry PhD; Orchinik, Leah J. MA; Minich, Nori BS; Dietrich, Ann MD; Nuss, Kathryn MD; Wright, Martha MD; Bangert, Barbara MD; Rusin, Jerome MD; Yeates, Keith Owen PhD

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

The Journal of Head Trauma Rehabilitation: September/October 2015 - Volume 30 - Issue 5 - p 302–310
doi: 10.1097/HTR.0000000000000106
TBI in Children & Adolescents 2015

Objective: To investigate the effects of mild traumatic brain injury (mTBI) in children on symptom ratings of behavior problems across the first-year postinjury.

Setting: Emergency departments of 2 regional children's hospitals.

Participants: Parents of 176 children with mTBI and 90 children with orthopedic injury aged 8 to 15 years.

Design: Group comparisons of postinjury parent and teacher ratings of child behavior problems controlling for background factors.

Main Measures: Child Behavior Checklist and Teacher's Report Form.

Results: For younger but not older children in the sample, children with mTBI compared with children with orthopedic injury had higher postinjury ratings on the Child Behavior Checklist Total Behavior Problem scale (t 264 = 3.34, P < .001) and higher rates of T-scores of 60 or more on this scale (odds ratio = 3.00; 95% confidence interval, 1.33-6.77; P = .008). For children with mTBI, hospitalization, motor vehicle accidents, loss of consciousness, and magnetic resonance imaging abnormality were associated with higher parent or teacher ratings.

Conclusions: School-aged children with mTBI are at risk for persistent symptoms of behavior problems, especially if mTBI is more severe or occurs at a younger age. The findings justify monitoring of behavior long after injury and further research to identify risk factors for these symptoms and their association with clinical disorders.

Departments of Pediatrics (Drs Taylor and Wright and Ms Minich) and Psychological Sciences (Ms Orchinik), Case Western Reserve University, Cleveland, Ohio; Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio (Drs Taylor and Wright); Departments of Radiology and Neurosurgery, University Hospitals Health System, Cleveland, Ohio (Dr Bangert); Departments of Emergency Medicine (Drs Dietrich and Nuss) and Radiology (Dr Rusin) and Center for Biobehavioral Health, The Research Institute (Dr Yeates), Nationwide Children's Hospital, Columbus, Ohio; and Department of Pediatrics, The Ohio State University College of Medicine, Columbus (Dr Yeates). Dr Yeates is now with the Department of Psychology, University of Calgary, Calgary, Alberta, Canada.

Corresponding Author: H. Gerry Taylor, PhD, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, W.O. Walker Bldg, Ste 3150, 10524 Euclid Ave, Cleveland, OH 44106 (

This research was funded by project grants R01 HD39834 and K02 HD44099 from the National Institute of Child Health and Human Development to Dr Yeates. The authors thank Lauren Ayr, Anne Birnbaum, Amy Clemens, Taryn Fay, Amanda Lininger, Katie Pestro, Elizabeth Roth, Elizabeth Shaver, and Heidi Walker for their assistance in carrying out this project.

The authors declare no conflicts of interest.

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