Article
Family functioning and children's academic performance and behavior problems in the year following traumatic brain injury

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Abstract

This study examined the roles of preinjury family and child functioning and injury severity in predicting 1-year outcomes and changes in academic performance and behavioral problems following childhood traumatic brain injury (TBI). Families of 94 children (ages 6 to 15) with TBI (mild = 50, moderate = 25, severe = 19) were consecutively enrolled from emergency departments of two regional medical centers. Standardized measures of family and child functioning and interviewer ratings were completed within 3 weeks of injury (measuring preinjury status), at 3 months, and 1 year. Mean ratings of preinjury child functioning were within normal range. Whereas injury severity was associated with substantial declines in academic functioning, there was no association of injury severity with change in behavior problems. Interview ratings showed declines at all severity levels, however. Poor academic and cognitive outcomes at 1 year were associated with injury severity and, to a lesser degree, poor preinjury family and child functioning. In contrast, most of the variation in behavioral outcomes was explained by preinjury child or family factors. Preinjury functioning must be assessed and support services provided for optimal academic and behavioral outcomes following childhood TBI.

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      They found that suboptimal home environments and both overly permissive and disciplinary parenting amplified the negative effects of TBI on child functioning. The family environment is also found to affect school performance after pediatric TBI [26,27]. In a recent prospective study, Durber et al. [28] found that home environments characterized by greater provision of learning materials and instructional activities predicted better academic outcomes and classroom behavior post-TBI.

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      Studies examining health-related quality of life have shown that all severities of TBI can decrease these measures (Rivara et al., 2011). Cognition and communication may be impaired, especially in children who are comatose or obtunded on admission (Rivara et al., 1994; Yeates et al., 2001; Ewing-Cobbs and Barnes, 2002; Levin et al., 2008). Children with TBI may have lower social well-being with difficulties in interpersonal relationships, decreased activity level and community participation, lower academic or work performance, impaired driving, and increased substance abuse (Rivara et al., 1994, 2011).

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    This research supported by Centers for Disease Control grant R49/CCR002299.

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