PREDICTORS OF FAMILY FUNCTIONING AFTER TRAUMATIC BRAIN INJURY IN CHILDREN AND ADOLESCENTS

Objective: To assess factors predictive of family outcome in the first 2 years after traumatic brain injury (TBI) in children and adolescent s. Method: Subjects were children aged 6 to 14 at the time they were h ospitalized after TBI. The study used a prospective follow-up design. Assessments of preinjury factors (psychiatric, family functioning, and family life events), injury factors (severity of injury), and postinj ury factors (coping and development of a psychiatric disorder, never b efore present, i.e., ''novel'') were conducted using standard clinical scales. The outcome measure was family function as assessed with stan dardized family functioning interviews (at 12 and 24 months after TBI) and primary caretaker self-report questionnaires (at 3 and 6 months a fter TBI). Results: Fifty subjects enrolled, and the analyses focused on 37, 41, 43, and 42 subjects assessed at the 3-, 6-, 12-, and 24-mon th follow-up evaluations, respectively. The strongest influences on fa mily functioning after childhood TBI are preinjury family functioning, the development of a ''novel'' psychiatric disorder in the child, and preinjury family life events or stressors. Conclusions: These data su ggest that there are families, identifiable through clinical assessmen t, at increased risk for family dysfunction after a child's TBI. Early identification and treatment of the child's psychopathology and famil y dysfunction may attenuate the associated morbidity.