PREDICTORS OF FAMILY FUNCTIONING AND CHANGE 3 YEARS AFTER TRAUMATIC BRAIN INJURY IN CHILDREN

Objectives: To examine changes in family functioning from injury to 3 years after pediatric traumatic brain injury; to determine factors mos t predictive of family outcomes at 3 years and variables that promote positive outcomes and changes over time. Design: Prospective cohort st udy Setting: Two regional tertiary care centers; cases followed for 3 years into community. Participants: Families of 81 children, ages 6 to 15 years, who sustained closed head injury and loss of consciousness (mild=43, moderate=20, severe=18), consecutively en rolled over 15 mon ths. Main Outcome Measures: Family Environment Scale, Family Assessmen t Device, Family Inventory of Life Events, Health Insurance Survey-Gen eral Well-Being, NYU Problem Checklist for Significant Others, Family Interview Rating Scale, Family Global Assessment Scale. All were obtai ned initially and at 3 months, 1 year, and 3 years postinjury. Predict or variables were selected from the instuments above, as well as from the parent and teacher versions of the Child Behavior Checklist, socio economic status, and injury severity. Results: Preinjury functioning w as the best predictor of 3-year outcomes. Fewer changes in family func tioning were reported over 3 years in the mild or moderate groups, whe reas more deterioration occurred in the severe group. At 3 years, one third to one half of parents in either the moderate or severe groups r eported medium to high strain in 19 of 34 problem areas. Low levels of family control and high levels of expressiveness correlated with bett er outcomes for severe group. Positive change for the severe group was marked by better preinjury levels of communication, expressiveness, p roblem solving, use of resources, role flexibility, greater activity o rientation, and less conflict, control, and stress. Preinjury variable s and severity explained from 26% to 69% of the variation in 3-year ou tcomes. Conclusions: Families at risk for poorer outcomes can prospect ively identified and should be supported and encouraged in their effor ts to develop new coping resources. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medici ne and Rehabilitation.