Assessing the effects of traumatic brain injury on family functioning: conceptual and methodological issues

Family involvement in rehabilitation programmes for children and adolescents with acquired brain injury: A scoping literature review

Paediatric acquired brain injury (ABI) can adversely impact families, and it is widely accepted that families should be involved in the rehabilitation of children/adolescents with ABI. However, there is limited guidance about how to best involve families in paediatric ABI rehabilitation. Several programmes involving the families of children/adolescents with ABI have been developed, but there are no published reviews outlining their characteristics. This scoping literature review aimed to synthesize information about these programmes and develop an understanding of how families are involved in them. Four databases were systematically searched to identify sources of evidence that described programmes in paediatric ABI rehabilitation that involve family members. One hundred and eight sources of evidence describing 42 programmes were included. Programmes were categorized as: service coordination (n = 11), psychosocial (n = 17), support groups (n = 4), training/instruction (n = 9), and education (n = 1). Families' involvement in these programmes varied across programme development, delivery, and evaluation stages. The findings of this scoping literature review outline how families can be involved in paediatric ABI rehabilitation. While this review outlines many approaches to supporting families, it also highlights the need for models of family-centred care to better articulate how clinicians and services can involve families in paediatric ABI rehabilitation.

A mixed-methods analysis examining child and family needs following early brain injury

Purpose:To understand child and family needs following TBI in early childhood, 22 caregivers of children who were hospitalized for a moderate to severe TBI between the ages of 0 and 4 within the past 10 years (M = 3.27 years; Range = 3 months to 8 years) participated in a needs assessment.Methods: Through a convergent study design, including focus groups (FG), key informant interviews (KII), and standardized questionnaires, caregivers discussed challenges and changes in their child's behaviors and functioning in addition to resources that would be helpful post-injury. Standardized questionnaires assessing current psychological distress and parenting stress in addition to open-ended questions about their general experience were completed.Results: Results indicated some families continue to experience unresolved concerns relating to the child's injury, caregiver wellbeing, and the family system after early TBI, including notable variation in caregiver reported psychological distress and parenting stress. Caregivers noted unmet needs post-injury, such as child behavior management and caregiver stress and coping.Conclusion: Early TBI can have a long-term impact on the child, caregivers, and family system. Addressing the needs of the whole family system in intervention and rehabilitation efforts may optimize outcomes following early TBI. Study results will inform intervention development to facilitate post-injury coping and positive parenting.IMPLICATIONS FOR REHABILITATIONEarly TBI can result in unmet needs that have a lingering impact on the child, caregiver, and family.Caregivers need information and resources that address their own distress and stressors related to changes in the child post-injury.Our study suggests that stress management and self-care skills are possible targets of intervention for caregivers of children who experienced an early TBI.

Family function and its relationship to injury severity and psychiatric outcome in children with acquired brain injury: a systematized review

AIM

The psychological and psychiatric outcome of children with acquired brain injury is influenced by many variables. A review was undertaken to clarify the contribution of family function, how it relates to injury severity, and what particular aspects of family function influence psychological outcome in this group.

METHOD

A systematized review of the literature of studies published between 1970 and 2012 from OvidMedline, PsychoInfo, PsycARTICLES, and Cochrane was undertaken focusing on family function, injury severity, and psychiatric outcome.

RESULTS

Thirty-six papers met the inclusion criteria. Injury severity was linked to the development of organic personality change. Family function before injury, measured by the Family Assessment Device or the Clinical Rating Scale, had a statistically significant effect on general psychological functioning in six out of eight studies. Family function had a significant effect for oppositional defiant disorder and secondary attention-deficit-hyperactivity disorder. The effects of family function may differ depending on the age of the child and the severity of the injury. Some styles of parenting moderated recovery. After injury, family function was related to the child's contemporaneous psychiatric symptoms. The level of evidence for these papers was 3 or 4 (Oxford Centre for Evidence-based Medicine criteria).

INTERPRETATION

Screening for some aspects of family functioning before injury and family function during the rehabilitation phase may identify children at risk of psychiatric disorders.

Family Resiliency, Family Needs, and Community Reintegration in Persons With Brain Injury

Purpose:The purpose of the study was to measure predictors of community reintegration and empirically test the resiliency model of family stress, adjustment, and adaptation in persons with traumatic brain injury (TBI). The study also aimed to measure family needs by surveying caregiving family members through the use of the Family Needs Questionnaire (FNQ). Primary caregivers of those with TBI were surveyed using a convenience sample accessed through the Brain Injury Association of Florida.

Methods:Participants were asked to complete a multiple-choice questionnaire in exchange for a gift card. The questionnaire comprises demographic questions and five standardized instruments (Family Crisis Oriented Personal Evaluation Scales, Family Inventory of Resources for Management, Family Coping Coherence Index, FNQ, and Community Integration Questionnaire).

Results:Results of the study validate the resiliency model and place emphasis on family coherence as the strongest predictor within the model. Results similarly support the importance of all other factors of family resiliency and addressing needs of the family specific to TBI.

Conclusion:In closing, the article provides recommendations for counselors working with families with members with TBI.

Children, Brain Injury and the Resiliency Model of Family Adaptation

The Resiliency Model of Family Stress, Adjustment and Adaptation is a theoretical framework used in this article to understand how families adapt when their child has had a traumatic injury. This article describes the Resiliency Model in relation to the findings of studies on families where a child has sustained a brain injury. Identifying the factors impacting on the family and the adaptation process they experience provides valuable insight and information for the provision of family-centred services.

Personal Experiences of Families of Children With a Traumatic Brain Injury in the Transition From Hospital to Home

For the families of children with traumatic brain injury (TBI) the transition from hospital to home, school and community can be a very stressful time for everyone involved. The present phenomenological study explored the experiences and perceptions of parents of children with TBI during this important transition time with the aim to better inform health-workers involved in discharge management and rehabilitation. Six family representatives were interviewed, with the format of interviews being semistructured. An interview guide was used that outlined key issues to be explored with each participant. The primary analytical approach was inductive and thematic content analysis was used. The themes which emerged related to the emotional journey experienced by the family, the impact of significant relationships in the process of adjustment, along with service provision and coping strategies. These themes are highlighted with respect to how they can influence intervention strategies. Implications for service referral and the communication style of health professionals are also addressed.

An evaluation of the paediatric acquired brain injury community outreach programme (PABICOP)

PRIMARY OBJECTIVE

To examine the utility of a coordinated, family/community-focused programme (PABICOP) vs. a standard approach for improving outcomes for children with ABI and their families.

RESEARCH DESIGN

Pre-test-post-test design, with comparison group and follow-up.

METHODS AND PROCEDURES

Ninety-six children (64 children receiving PABICOP services and 32 children receiving standard care) participated in the study. Measures were completed at baseline and 3 and 12 months later.

MAIN OUTCOMES AND RESULTS

Parents/caregivers with more than 10 contacts with PABICOP scored significantly higher on an ABI knowledge quiz than either parents/caregivers with 10 contacts or less or the comparison group at post-test and follow-up. Parents/caregivers with 10 contacts or less with PABICOP reported significantly greater improvements in children's school and total competence on the CBCL than either parents/caregivers with more than 10 contacts or the comparison group at post-test and follow-up.

CONCLUSIONS

PABICOP may be more useful for enhancing knowledge of ABI for parents/caregivers and for integrating children into the community over a 1-year period than a standard approach. The amount of service received appears to influence outcomes.

Predicting family burden following childhood traumatic brain injury: a cumulative risk approach

OBJECTIVE

To examine the utility of a cumulative risk index (CRI) in predicting the family burden of injury (FBI) over time in families of children with traumatic brain injury (TBI).

PARTICIPANTS

One hundred eight children with severe or moderate TBI and their families participated in the study.

MEASURES

The measures used in the study include the Socioeconomic Composite Index, Life Stressors and Social Resources Inventory--Adult Form, Vineland Adaptive Behavior Scales, Child Behavior Checklist, Children's Depression Inventory, McMaster Family Assessment Device, Brief Symptom Inventory, and Family Burden of Injury Interview. In addition, information on injury-related risk was obtained via medical charts.

METHODS

Participants were assessed immediately, 6, and 12 months postinjury and at a 4-year extended follow-up.

RESULTS

Risk variables were dichotomized (ie, high- or low-risk) and summed to create a CRI for each child. The CRI predicted the FBI at all assessments, even after accounting for autocorrelations across repeated assessments. Path coefficients between the outcome measures at each time point were significant, as were all path coefficients from the CRI to family burden at each time point. In addition, all fit indices were above the recommended guidelines, and the chi statistic indicated a good fit to the data.

CONCLUSIONS

The current study provides initial support for the utility of a CRI (ie, an index of accumulated risk factors) in predicting family outcomes over time for children with TBI. The time period immediately after injury best predicts the future levels of FBI; however, cumulative risk continues to influence the change across successive postinjury assessments. These results suggest that clinical interventions could be proactive or preventive by intervening with identified "at-risk" subgroups immediately following injury.

Traumatic brain injuries in early childhood: initial impact on the family

OBJECTIVE

The purpose of this study was to examine factors that affect parental burden and distress during the first few months following a traumatic brain injury (TBI) in young children.

METHODS

Participants were consecutively enrolled children ages 3 through 6 years with either a TBI (n = 89; 21 severe, 22 moderate, and 45 complicated mild) or orthopedic injury (OI; n = 119) requiring hospitalization. During the post-acute period, parents provided information regarding the preinjury family environment and current caregiver functioning and injury-related burden.

RESULTS

Compared with parents of young children with OI, parents of children with TBI reported greater overall caregiver burden and greater burden related to the injury. Parents of children with severe TBI also reported more stress with spouses and siblings and higher levels of parental depression and global distress relative to the OI comparison group. Parents of 5- to 6-year-old children reported significantly higher levels of both injury-related burden and distress than parents of 3- to 4-year-old children. Parents of children with mild TBI based on the Glasgow Coma Scale (GCS) who also had positive neuroimaging findings reported greater injury-related burden than parents of children with moderate TBI. Parents reported using a variety of coping strategies, with higher levels of denial and disengagement corresponding with greater injury-related burden and distress.

CONCLUSIONS

Consistent with previous research on family adaptation to TBI in school-age children, chronic life stresses and interpersonal resources accounted for significant variance in measures of acute injury-related burden and parental distress in parents of younger children, although differences were small. TBI severity defined by GCS scores alone may not be sufficient to identify families at risk of increased burden. Findings suggest that services aimed at facilitating family adjustment following TBI in young children may need to consider a broader definition of risk factors when identifying families who would benefit from interventions.

Mother's mental health, mother-child relationship, and family functioning 3 months after a preschooler's head injury

OBJECTIVE

Investigate mothers' mental health, mother-child relationship, and family functioning 3 months after preschool children's head trauma and hospital discharge.

DESIGN

Prospective survey.

SETTING

Seven hospitals; families' homes.

PARTICIPANTS

Eighty mothers of children (ages 3-6) with head trauma.

MEASURES

Perceived injury severity, Mental Health Inventory, Parental Stressor Scale taken in pediatric intensive care unit 24 to 48 hours after admission; Mental Health Inventory, Parenting Stress Index, FACES II, Multidimensional Scale of Perceived Social Support taken at 3 months postdischarge.

RESULTS

Injury severity had negative effects on mothers' mental health at 3 months after discharge, but not on the mother-child relationship and the family's functioning. Mothers' baseline mental health and ongoing support had positive effects on mother-child relationship and family adaptability.

CONCLUSIONS

Mothers with greater stress and poorer mental health during their child's hospitalization may be at risk for negative mother-child and family outcomes. Interventions that decrease parents' stress during hospitalization and promote ongoing social support after discharge may diminish this risk.

Pediatric head trauma: parent, parent-child, and family functioning 2 weeks after hospital discharge

OBJECTIVE

To investigate effects of pediatric head trauma on parent mental health, parent-child relationship and family functioning 2 weeks after discharge.

METHODS

Ninety-seven mothers and 37 fathers of 106 preschool children hospitalized with head injury completed Mental Health Inventory (MHI), Parenting Stress Index, Family Adaptability and Cohesion Evaluation Scales II (FACES II) and Multidimensional Scale of Perceived Social Support (MSPSS) 2 weeks after discharge, and perceived injury severity, Parental Concerns Scale (PCS), Parental Stressors Scale: Pediatric Intensive Care Unit (PSS: PICU), and MHI 24-48 h after hospital admission.

RESULTS

Mental health after discharge was related to social support and baseline mental health. Mothers' parental distress was related to perceived injury severity and social support. Greater family cohesion was related to baseline mental health, social support, and being in a two-parent family for mothers, and to social support for fathers.

CONCLUSIONS

Parents' mental health and social support were important for parent mental health and family cohesion after discharge. Perceived injury severity and parent reactions to hospitalization also played a role.

Putting the pieces together: preliminary efficacy of a family problem-solving intervention for children with traumatic brain injury

OBJECTIVE

To describe a family-centered problem-solving intervention (FPS) for pediatric traumatic brain injury (TBI), and to assess the efficacy of the intervention in a randomized clinical trial.

PARTICIPANTS

Families of 32 school-aged children with moderate to severe TBI randomly assigned to FPS or usual care (UC) group.

MAIN OUTCOME MEASURES

Child Behavior Checklist, Brief Symptom Inventory, Conflict Behavior Questionnaire.

INTERVENTION

Seven-session problem-solving/skill-building intervention delivered over a 6-month period for the participating families.

RESULTS

Parents in the FPS group reported significantly greater improvements in their children in internalizing symptoms, anxiety/depression, and withdrawal than did parents in the UC comparison group.

CONCLUSIONS

FPS holds promise for reducing child behavior problems, the most common and persistent sequelae of TBI.

Longitudinal Changes in Family Outcomes of Very Low Birth Weight

OBJECTIVES

Although children with very low birth weight (VLBW, <1500 g) are at high risk for developmental impairments, we know little about the long-term effects of VLBW on families. This study examined long-term family outcomes and their stability over time.

METHODS

Participants were the families of 64 children with <750 g birth weight, 54 with 750-1499 g birth weight, and 66 term-born controls. Family burden and parental distress were assessed annually as part of longitudinal follow-up of the children from mean ages 11-14 years.

RESULTS

Family burden and parental distress were higher in the <750 g group than in the term-born group, but differences varied with the child's age and family environment.

CONCLUSIONS

The findings document long-term effects of VLBW on families that are moderated by the degree of low birth weight, child's age, and family environment.

A Web-based family problem-solving intervention for families of children with traumatic brain injury

We developed a Web-based intervention for pediatric traumatic brain injury (TBI) and examined its feasibility for participants with limited computer experience. Six families, including parents, siblings, and children with TBI, were given computers, Web cameras, and high-speed Internet access. Weekly videoconferences with the therapist were conducted after participants completed on-line interactive experiences on problem solving, communication, and TBI-specific behavior management. Families were assigned to videoconference with NetMeeting (iBOT cameras) or ViaVideo. Participants ranked the Web site and videoconferences as moderately to very easy to use. ViaVideo participants rated videoconferencing significantly more favorably relative to face-to-face meetings than did NetMeeting participants. Both the Web site and videoconferencing were rated as very helpful. All families demonstrated improved outcomes on one or more target behaviors, including increased understanding of the injury and improved parent-child relationships. All parents and siblings and all but 1 child with TBI said they would recommend the program to others. We conclude that a face-to-face intervention can be successfully adapted to the Web for families with varied computer experience.

A prospective study of long-term caregiver and family adaptation following brain injury in children

OBJECTIVE

We examined long-term differences in family adaptation following traumatic brain injuries (TBI) and orthopedic injuries.

DESIGN

Families of children with severe TBI (n = 53), moderate TBI (n = 56), and orthopedic injuries (n = 80) were assessed at baseline, 6 months, and 12 months post injury and at an extended follow-up an average of 4.1 years post injury. Caregiver and family outcomes were examined using mixed model analysis.

RESULTS

Patterns of adaptation over time varied across groups but indicated long-standing injury-related stress and burden in the severe TBI group.

CONCLUSIONS

Severe TBI results in persistent caregiver stress for a substantial proportion of families.

Child and family functioning 6 and 12 months after a serious pediatric fracture

BACKGROUND

Previous findings indicate that pediatric fractures can have adverse consequences for child adjustment and family functioning immediately after injury. However, longer term effects of the fractures are unknown. The purposes of the present prospective study were to examine the child and family outcomes of pediatric traumatic fractures at 6 months and 1 year after injury, and to identify injury and treatment factors associated with these outcomes.

METHODS

We evaluated 57 children 6 to 12 years of age with traumatic fractures requiring hospitalization. Using standardized measures and parent interview, we obtained measures of pre- and postinjury child and family functioning.

RESULTS

Although outcomes were primarily positive at 1 year after injury, child functional limitations and family stress were observed up to 6 months after injury. Lower extremity fractures had a more negative impact on families across all three assessment points. Children with fracture interventions that involved prolonged immobilization had more functional limitations at 6 months than children who were ambulatory. Family burden was higher at 1 month for the immobilized children, but not at later follow-up.

CONCLUSION

Some children and families experience adverse effects during the year after a serious pediatric fracture, especially if sustained in a lower extremity. Fracture stabilization that allows for greater ambulation may offer some benefits related to functional outcomes and family impact.

The relationship of caregiver coping to family outcomes during the initial year following pediatric traumatic injury

This study identified coping strategies associated with caregiver outcomes following pediatric injury and examined injury type as a moderator of coping efficacy. Families of 103 children with traumatic brain injury (TBI) and 71 children with orthopedic injuries were followed prospectively during the initial year postinjury. The groups had comparable preinjury characteristics and hospitalization experiences but differed on neurological insult. In hierarchical regression analyses, acceptance was associated with lower burden and denial was associated with greater distress in both groups. Active coping resulted in higher distress following TBI but not orthopedic injuries. Conversely, the use of humor was related to diminishing distress following TBI but unrelated to distress following orthopedic injuries. Results are discussed in terms of the implications for intervention following TBI.

Neurobehavioral recovery after pediatric head trauma: injury, pre-injury, and post-injury issues

This article reviews the most significant demographic, neurological, and psychosocial factors affecting the occurrence of and recovery from traumatic head injury (THI) in children and adolescents. Review of the available literature suggests that, as with adults, there is no compelling evidence for persistent neurobehavioral deficits after mild THI in children. In contrast, neurobehavioral deficits are common in children who have sustained moderate to severe THI. This article emphasizes that a long-term developmental perspective that considers in concert injury, pre-injury, and post-injury variables is needed for a proper appreciation of possible sequelae of pediatric THI. Specific pitfalls in forensic assessments of these children are reviewed. Empirical findings are presented to support the position that neuropsychological evaluations of children with THI that do not consider pre-injury status are likely to lead to misattribution errors. Clinical implications are illustrated with a case example.

Prediction of neurobehavioral outcome 1-5 years post pediatric traumatic head injury

OBJECTIVE

To examine the neurobehavioral status of children with traumatic head injury (THI) and to identify variables that predict outcome.

DESIGN

Retrospective chart review, with follow-up 1-5 years after injury. Outcome predictor variables were identified through stepwise regression analysis.

SETTING

Level one trauma center and pediatric rehabilitation program.

PATIENTS

71 Children with THI, selected from a four-year series of consecutive admissions.

MEASURE

Vineland Adaptive Behavior Scales-Survey Edition.

RESULTS

Significant predictors of better neurobehavioral status at follow-up included absence of a premorbid learning problem (p <.01), older age at injury (p <.01), and normal pupillary response (p <.001) and higher cerebral perfusion pressure (p <.0001) during critical care management.

CONCLUSIONS

Neurobehavioral outcome after THI is influenced by premorbid psychosocial variables as well as by critical care management.

The family burden of injury interview: reliability and validity studies

OBJECTIVE

To assess the reliability and validity of a new instrument, the Family Burden of Injury Interview (FBII) was designed to assess the impact of childhood traumatic head injuries (THI) on the family.

PARTICIPANTS

99 Mothers of school-age children who experienced THI.

RESULTS

The FBII Total Score revealed group differences between families of children with severe THI and families of children with moderate THI. The measure also showed concurrent and predictive relationships to measures of the general impact of injury on families and maternal and child functioning.

CONCLUSION

The FBII is a promising tool for measuring the impact of injury-related stressors on the family.

Acute psychosocial impact of pediatric orthopedic trauma with and without accompanying brain injuries

BACKGROUND

The acute psychosocial effects of orthopedic injuries on children and their families are poorly understood. Previous studies have relied on retrospective reports or failed to take into account accompanying brain injuries. The purpose of the present study was to examine prospectively the psychosocial impact of pediatric orthopedic traumatic fractures with and without accompanying brain injuries.

METHODS

Participants were 108 children 6 to 12 years old with orthopedic injuries requiring hospitalization: group 1 (n=80) had fractures only, group 2 (n=28) also had moderate or severe brain injuries. Using standardized measures and parent interviews, we obtained preinjury estimates of family functioning and child behavior problems and postinjury measures of parental distress, family stresses, and child behavior.

RESULTS

Parents reported significant clinical distress (35% in group 1, 57% in group 2), family burdens (group 2 > group 1), and child behavioral changes (41% in group 1, 89% in group 2). Multiple regression analyses indicated that preinjury family status and brain injuries predicted postinjury parental and family distress.

CONCLUSION

Pediatric orthopedic injuries have greater social effects on children with accompanying brain injuries and poorer preinjury family functioning.

Family burden and adaptation during the initial year after traumatic brain injury in children

OBJECTIVE

Traumatic brain injury (TBI) often leads to long-term behavioral and cognitive deficits in children. However, little is known about the burden and psychosocial morbidity of pediatric TBI for families. The purpose of this study was to test the hypothesis that moderate and severe TBI in children has more adverse consequences than orthopedic trauma.

DESIGN

The sample was comprised of children between the ages of 6 and 12 recruited from hospital trauma and inpatient units including 53 with severe TBI, 56 with moderate TBI, and 80 with orthopedic injuries not involving central nervous system insult. Measures of injury-related burden, parental distress, and family functioning were administered to the child's primary caregiver at baseline assessment conducted soon after injury and at 6- and 12-month follow-ups. Multivariate repeated measures analysis of covariance was used to examine group differences in these outcomes over time.

RESULTS

Caregivers in the severe TBI group reported significantly higher levels of family burden, injury-related stress, and parental psychological symptoms than caregivers in the orthopedic injury group (ORTHO). The groups did not differ with respect to marital distress. Caregivers in the severe TBI group were significantly more likely than caregivers in the ORTHO group to exceed the clinical cutoff on the Brief Symptom Inventory and to report clinically significant levels of family dysfunction at follow-up.

CONCLUSIONS

The findings suggest that severe TBI is a source of considerable caregiver morbidity, even when compared with other traumatic injuries. Caregivers in the severe TBI group had persistent stress associated with the child's injury, as well as the reactions of other family members, and a relative risk of clinically significant psychological symptoms nearly twice that of the ORTHO comparison group. These findings underscore the need for interventions that facilitate family adaptation after pediatric TBI.

Assessment of adherence with multiple informants in pre-adolescents with spina bifida: initial development of a multidimensional, multitask parent-report questionnaire

Adherence to medical regimens was assessed in 67 pre-adolescents with spina bifida (8- and 9-year-olds; 37 boys, 30 girls), with mother, father, teacher, and health professional report. The Parent-Report of Medical Adherence in Spina Bifida Scale (PROMASB) was developed and includes multidimensional scales for the following tasks: catheterization, bowel care, skin care, medication, and ambulation. With few exceptions, the PROMASB has adequate psychometric properties. However, findings revealed modest to low correlations between respondents. Mothers and fathers reported significantly more noncompliance than teachers and health professionals. For the most part, all informants reported that most children were compliant across all tasks. Additional analyses based on qualitative data suggest that parents attribute compliance difficulties to motivational as well as attentional-memory factors.

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 adolescents.

METHOD

Subjects were children aged 6 to 14 at the time they were hospitalized 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 postinjury factors (coping and development of a psychiatric disorder, never before present, i.e., "novel") were conducted using standard clinical scales. The outcome measure was family function as assessed with standardized family functioning interviews (at 12 and 24 months after TBI) and primary caretaker self-report questionnaires (at 3 and 6 months after TBI).

RESULTS

Fifty subjects enrolled, and the analyses focused on 37, 41, 43, and 42 subjects assessed at the 3-, 6-, 12-, and 24-month follow-up evaluations, respectively. The strongest influences on family 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 suggest that there are families, identifiable through clinical assessment, at increased risk for family dysfunction after a child's TBI. Early identification and treatment of the child's psychopathology and family dysfunction may attenuate the associated morbidity.

Childhood traumatic brain injury: initial impact on the family

Traumatic brain injury (TBI) is a significant source of morbidity and mortality in children, resulting in a wide range of cognitive and behavioral sequelae. However, little is known about the effects of pediatric TBI and its aftermath on families. The current investigation examined the impact of TBI on families during the first month following injury. Children with orthopedic injuries requiring hospitalization served as a control group. The sample consisted of 44 families of children of severe TBI, 52 families of children with moderate TBI, and 69 families of children with orthopedic injuries not involving the central nervous system (CNS). Families of children with severe TBI experienced significantly more injury-related stress than the other two groups of families. Parents of children with TBI also reported higher levels of psychological symptoms than parents of children with orthopedic injuries. Findings from regression analyses suggested that families facing multiple stressors in addition to the injury and those who cope poorly may be at greatest risk for adverse consequences. Future interventions could provide anticipatory guidance and support to at-risk families.