Cognitive outcome in children and adolescents following severe traumatic brain injury: Influence of psychosocial, psychiatric, and injury-related variables

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than psychiatric or psychosocial factors as correlates of cognitive outcomes. We addressed this concern by recruiting a consecutive series (N = 24) of children age 5 through 14 years who suffer ed a severe TBI, a matched group who sustained a mild TBI, and a second mat ched group who sustained an orthopedic injury. Standardized intellectual, m emory, psychiatric, family functioning, family psychiatric history, neurolo gical, and neuroimaging assessments were conducted at an average of 2 years following injury. Severe TBI, when compared to mild TBI and orthopedic inj ury, was associated with significant decrements in intellectual and memory function. A principal components analysis of independent variables that sho wed significant (p < .05) bivariate correlations with the outcome measures yielded a nc neuropsychiatric factor encompassing severity of TBI indices a nd postinjury psychiatric disorders and a psychosocial disadvantage factor. Both factors were independently and significantly related to intellectual and memory function outcome. Postinjury psychiatric disorders added signifi cantly to severity indices and family functioning and family psychiatric hi story added significantly to socioeconomic status in explaining several spe cific cognitive outcomes. These results may help to define subgroups of chi ldren who will require more intensive services following their injuries.