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Predictors of Long-Term Victimization After Early Pediatric Traumatic Brain Injury

Hung, Anna H. PhD; Cassedy, Amy PhD; Schultz, Hanna M. MA; Yeates, Keith Owen PhD; Taylor, Hudson Gerry PhD; Stancin, Terry PhD; Walz, Nicolay Chertkoff PhD; Wade, Shari L. PhD

Journal of Developmental & Behavioral Pediatrics: January 2017 - Volume 38 - Issue 1 - p 49–57
doi: 10.1097/DBP.0000000000000366
Original Articles

Objective: Pediatric traumatic brain injuries (TBIs) adversely affect long-term functional and social outcomes. Limited research suggests children with TBI are more likely to be victimized by peers than noninjured children. Deficits in social information processing (SIP), cognitive ability, and executive functioning (EF) may contribute to increased victimization risk. This study examined rates of peer victimization/bullying in children with early TBI compared with children with orthopedic injuries (OIs) and the role of processing speed, executive function (EF), and SIP as mediators of the association of TBI and peer victimization.

Method: Children ages 10 to 14 years who sustained a complicated mild/moderate or severe TBI (N = 58) or OI (N = 72) during early childhood (ages 3–7 yr) and their parents participated in a longitudinal prospective follow-up 6.8 years postinjury. SIP, EF and processing speed, and peer victimization were assessed.

Results: Parents of children with severe TBI reported greater rates of peer victimization than parents of children with OIs. Children with severe TBI demonstrated greater EF deficits than children with complicated mild/moderate TBI or OI and poorer processing speed than children with OI. No significant indirect relationships were found between groups and any outcome variables to indicate mediation.

Conclusion: Based on parent report, children with severe TBI have higher risk of peer victimization than those with less severe injuries. In addition, children with severe TBI have more impaired EF and cognitive ability than counterparts with less severe TBI. Further research is needed to explore predictors of long-term victimization after early TBI to create interventions aimed at providing social, emotional, and behavioral skill building for victimized youth.

*Department of Psychology, Miami University, Oxford, OH;

Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH;

Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH;

§Departments of Psychology, Pediatrics, and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada;

Department of Pediatrics, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH;

Department of Pediatrics, Case Western Reserve University and MetroHealth Medical Center, Cleveland, OH;

**Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Dr Hung is now at the University of North Carolina at Chapel Hill School of Medicine, Department of Psychiatry.

Address for reprints: Shari L. Wade, PhD, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH 45229-3039; e-mail:

Disclosure: The authors declare no conflict of interest. The research reported here was supported by Grant R01 HD42729 from the National Institute of Child Health and Human Development, in part by U.S. Public Health Service National Institutes of Health Grant M01 RR 08084, and by Trauma Research grants from the State of Ohio Emergency Medical Services. The project described was also supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8 UL1 TR000077-04.

Received April , 2016

Accepted September , 2016

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