For this review, brain injury was limited to incidents of TBI and excluded injuries such as localized lesions, focal stroke, meningococcal meningitis, cerebral palsy, and intraventricular hemorrhage.
Personality change, a disorder of behavioral change resulting from brain damage, was also included. The last search was conducted in February Additional limits used were human participants, original article, publication in English, and all children 0—18y. This search yielded and original articles in PubMed and Web of Knowledge databases respectively. Those meeting eligibility criteria were then assessed for quality.
Reference lists were also searched. Furthermore, because this review focuses on manifestations of behavioral problems, papers reporting on neurocognitive deficits or social skills that may have been evaluated by behavioral ratings e. Information from the included studies was used to assess the risk of bias and methodological quality. Because this review also aims to investigate predictors of outcomes, analyses for confounders and a clear attempt to adjust for potential covariates e.
A maximum score of nine was possible; studies with a score of three or less were excluded from further review.
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If information required for assessment was unavailable from the manuscript, authors were contacted for clarification. The final sample used in this review includes 50 individual studies, but several of these belonged to the same or overlapping cohorts. The authors identified 19 samples from different settings. Information including study design, cohort setting, population demographics, measures, and methodological ratings for the included studies are provided in Table SI online supplementary information.
All studies that categorized severity used the Glasgow Coma Scale 24 as a primary severity index. Most studies also used imaging data when available to confirm severity and assess lesion characteristics; other indicators commonly used to describe the injury included duration of loss of consciousness, posttraumatic amnesia, and days hospitalized.
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One cohort used by several studies 25 - 32 consisted of participants recruited through rehabilitation services. Two other studies also enrolled patients through referrals from the rehabilitation center 33 or a treatment study. Reference groups were matched for age, sex, and sometimes sociodemographic characteristics. Only one study used both hospitalized and healthy comparisons. A range of instruments were used to assess behavioral outcomes; global measures of psychopathology, such the Child Behavior Checklist, 39 were frequently used.
Parents or primary caregivers were the most common informants. Overall, the literature strongly suggests that after brain injury, children are at increased risk of adverse behavioral outcomes. Studies reporting few to no social or behavioral impairments after TBI 25 , 36 , 37 assessed young children whose impairments may have lain dormant for several years or that were not yet identifiable using parent or teacher behavioral ratings.
Attention problems are among the most commonly reported disorders after brain injury. Diagnoses of secondary ADHD are three times more common in children sustaining head injuries than in their uninjured peers. Similar to ADHD, conduct problems are prevalent in pediatric patients with TBI both before and after injury, suggesting they may increase the risk of injury.
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Child Behavior Checklist did not yield any differences between groups; in contrast, measures of aggression based on theoretical frameworks e. Owing to some similar pathophysiology, presentations of novel depression and anxiety disorders often coexist. Children injured at younger ages appear more vulnerable to anxiety disorders. In children, this psychiatric disorder is not characterized by stable personality changes; rather, it is associated with impairing behavioral disturbances and deviations from normal development.
The Behavioural and Emotional Complications of Traumatic Brain Injury
For instance, younger children are more vulnerable to anxiety after TBI, 31 , 64 but older age at injury is predictive of depression. Few studies have focused on the role of injury mechanisms in predicting behavioral outcomes. An exception occurs in studies of infants, who are frequently subjected to inflicted TBI e. Finally, within cases of inflicted TBI, the type of injury e.
Although injury severity is strongly associated with the emergence of certain disorders such as personality change, 53 , 54 the effects of severity are unclear for most behavioral outcomes. Several studies have reported that severe TBI is associated with significantly greater risk in developing externalizing problems, 34 , 37 , 40 anxiety disorders and symptoms, 28 , 63 and attention, 40 , 59 with some studies even reporting little difference between the outcomes of children with mild or moderate TBI and those of comparisons or population norms.
For instance, as behavioral problems become increasingly difficult to control, parents may become more permissive in their parenting approach. This review provides some evidence for the effectiveness of CBT for treatment of acute stress disorder following mild TBI and CBT combined with neurorehabilitation for targeting general anxiety symptomatology in people with mild to moderate TBI.
These findings need to be viewed in light of the small number, small sample size and heterogeneous characteristics of current trials published in this area. More trials focusing on comparable psychological interventions, severity of injury of participants and diagnosis of anxiety disorder s are needed.
Psychological treatments are commonly used in the management of anxiety. Certain types of psychological treatments are well suited to needs of people with traumatic brain injury TBI. We have systematically reviewed studies examining the effectiveness of these approaches for TBI. Additionally, key journals were handsearched and reference lists of included trials were examined to identify further studies meeting inclusion criteria. Randomised controlled trials of psychological treatments for anxiety, with or without pharmacological treatment, for people with TBI were included in the review.
The effect of pediatric traumatic brain injury on behavioral outcomes: a systematic review
Pharmacological treatments for anxiety in isolation without psychological intervention were excluded. Toggle navigation. Start typing to search. What is traumatic brain injury? How common is TBI? How is TBI identified? How do we help people with TBI? Original Psychlopedia article.
Traumatic Brain Injury: An Overview | The Learning Corp
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