Bidirectional child-family influences on outcomes of traumatic brain injury in children

Child behavior problems, injury-related family burden, and parent psycholog ical distress were assessed longitudinally over the first year post injury in 40 children with severe traumatic brain injury (TBT), 52 with moderate T BI, and 55 with orthopedic injuries not involving brain insult. Parents rat ed children's preinjury behavior soon after injury. Postinjury child behavi or and family outcomes were assessed at 6- and 12-month follow-ups. Finding s from path analysis revealed both direct and indirect effects of TBI on ch ild behavior and family outcomes, as well as cross-lagged child-family asso ciations. Higher parent distress at 6 months predicted more child behavior problems at 12 months, controlling for earlier behavior problems; and more behavior problems at 6 months predicted poorer family outcomes at 12 months , controlling for earlier family outcomes. Support for bidirectional influe nces is tentative given that limited sample size precluded use of structura l equation modeling. The findings nevertheless provide impetus for consider ing the influences of person-environment interactions on outcomes of TBI.