Paediatric post-concussion symptoms: Predictors and preliminary evaluation of parent and child psychoeducation resources for the prevention of paediatric post-concussion symptoms

Miss Katherine Olsson (). Paediatric post-concussion symptoms: Predictors and preliminary evaluation of parent and child psychoeducation resources for the prevention of paediatric post-concussion symptoms Professional Doctorate, School of Psychology, The University of Queensland.

       
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Author Miss Katherine Olsson
Thesis Title Paediatric post-concussion symptoms: Predictors and preliminary evaluation of parent and child psychoeducation resources for the prevention of paediatric post-concussion symptoms
School, Centre or Institute School of Psychology
Institution The University of Queensland
Thesis type Professional Doctorate
Supervisor Professor Justin Kenardy
Mr. Owen Lloyd
Total pages 263
Abstract/Summary A significant proportion of individuals will experience post-concussion symptoms (PCS) following a mild traumatic brain injury (mTBI) (Kashluba, Paniak, & Casey, 2008; Yeates et al., 1999). In children, persistent PCS are thought to be due to injury characteristics (e.g., severity), post-injury cognitive difficulties, acute PCS, and pre- and post-injury child and parent psychological distress (Yeates & Taylor, 2005). Recently both female gender and younger age at injury have also been associated with increased PCS following mTBI (Carroll et al., 2004; Taylor et al., 2010). Unfortunately persistent PCS are linked with adverse psychosocial outcomes, including increased psychological distress, poorer health related quality of life (HRQOL), and academic functioning (McCauley, Boake, Levin, Contant, & Song, 2001; McCauley et al., 2005, 2007; Yeates & Taylor, 2005). As such, the primary aims of this thesis were (a) to review the theoretical and empirical predictors of PCS and establish the usefulness of these predictors in a paediatric population with mTBI, and (b) to develop and pilot test a child psychoeducation website and parent information booklet for the prevention of persistent paediatric PCS. This thesis is divided into four chapters. Chapter 1 describes key concepts, outcomes of mTBI, and highlights methodological limitations of the literature (e.g., absence of a well accepted definition of mTBI), that will be addressed by this thesis. Chapter 2 aimed to comprehensively review and evaluate theoretical and empirical predictors of PCS at six and 18 months post-mTBI. Children aged 6 – 16 years with uncomplicated (n = 132) and complicated mTBI (n = 18), and their parents were recruited from three tertiary hospitals in Brisbane and Melbourne, Australia. Parents provided retrospective ratings of their child’s pre-injury PCS, HRQOL, and their own pre-injury subjective distress within six weeks of their child’s mTBI. The above measures, as well as children’s self-reported psychological distress and objective measures of children’s cognitive functioning were administered at six and 18 months post-mTBI. Analyses showed that children with complicated mTBI had 2 - 3 PCS, and children with uncomplicated mTBI had 4 PCS throughout the follow-up period. The frequency of post-mTBI PCS did not differ from the pre-injury frequency of PCS. At six months post-mTBI increased paediatric PCS were predicted by higher pre-injury parent distress, increased frequency of pre-injury PCS, and mTBI severity. At 18 months post-mTBI, increased paediatric PCS were predicted by higher pre-injury parent anxiety, higher frequency of pre-injury PCS, and poorer pre-injury paediatric HRQOL. The adverse impact of pre-injury parent distress (hyperarousal symptoms and general anxiety) on children’s PCS decreased between six and 18 months post-mTBI. As a significant proportion of children with uncomplicated mTBI did not undergo neuroimaging, the above analyses were repeated after recoding mTBI severity into three groups; mTBI (no imaging), uncomplicated mTBI (confirmed by imaging), and complicated mTBI. The findings of the re-analyses were similar to the above findings with the following exceptions; at six months post-injury, mTBI severity did not predict PCS. In addition, the relative impact of high levels of pre-injury parent hyperarousal symptoms, but not general anxiety on paediatric PCS, decreased between six and 18 months post-mTBI. These findings highlight the importance of identifying and addressing parent’s pre-injury distress and poorer pre-injury paediatric HRQOL, in order to improve children’s PCS. Suggestions for future research are provided. Chapter 3 aimed to review and evaluate interventions for paediatric PCS. The findings of the literature review indicated that parent and child psychoeducation resources aimed at promoting recovery would likely be effective at reducing adverse post-mTBI outcomes (e.g., PCS, psychological distress) (e.g., Kirkwood et al., 2007; Ponsford et al., 2001; Ponsford et al., 2002). Parents and children with uncomplicated mTBI were recruited from the Royal Children’s Hospital in Brisbane, Australia. Families completed a baseline (within two weeks post-injury) and three month follow-up assessment of parent and child psychological functioning and HRQOL, as well as children’s cognitive functioning and PCS. After the baseline assessment children and their parents were randomly assigned to the prevention group (n = 5) or wait list control (WLC; n = 5). The analyses suggested that the psychoeducation resources were associated with improvements in children’s speed of information processing, verbal learning and recall, and physical HRQOL, as well as decreased parental anxiety, relative to the WLC. There were no significant between group differences with regard to PCS, however the prevention group demonstrated a trend towards increased somatic PCS at post-treatment relative to their pre-treatment ratings. Parents and children rated the psychoeducation resources as easy to read and helpful. Parent’s feedback also suggested that the psychoeducation resources addressed their support/-reassurance and information needs. These findings suggest that the psychoeducation resources are likely to be effective at improving parent’s and children’s post-mTBI outcomes. Higher somatic PCS in the prevention group may be an effect of the small sample size or reflect an effect of parent’s increased awareness of, and hypervigilance to somatic PCS. Chapter 4 provides an integrated discussion of the key findings of this thesis. It is concluded that parent’s functioning is an important determinant of children’s post-mTBI functioning and PCS. Also, the post-mTBI functioning of parents and children can be improved via cost-effective psychoeducation targeted at both parents and children.
Keyword mild traumatic brain injury
post concussion syndrome
Paediatric

 
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Created: Fri, 18 Feb 2011, 18:16:45 EST by Miss Katherine Olsson