Cognitive and psychological sequelae 3 and 6 months after traumatic brain injury in childhood

Rian Dob (2011). Cognitive and psychological sequelae 3 and 6 months after traumatic brain injury in childhood PhD Thesis, School of Psychology, The University of Queensland.

       
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Author Rian Dob
Thesis Title Cognitive and psychological sequelae 3 and 6 months after traumatic brain injury in childhood
School, Centre or Institute School of Psychology
Institution The University of Queensland
Publication date 2011-06
Thesis type PhD Thesis
Supervisor Professor Justin Kenardy
Professor Vicki Anderson
Emeritus Professor Gina Geffen
Total pages 248
Total black and white pages 248
Language eng
Subjects 17 Psychology and Cognitive Sciences
Abstract/Summary Traumatic brain injury (TBI) in children has been associated with deficits in physical, cognitive, social, and emotional functioning. A dose-response effect of TBI severity has been shown for cognitive outcome and, to a lesser extent, emotional/behavioural outcome, with children with more severe TBI showing poorer outcomes in both areas. Previous studies have also provided evidence for a significant influence of premorbid cognitive skills and behavioural/ emotional functioning on outcome post-TBI. Few studies, however, have investigated both cognitive and emotional/behavioural outcome in the same sample of children. The current study aimed to investigate the combined effects of TBI and emotional/ behavioural factors on cognitive outcome in children, 3 and 6 months after injury. This thesis presents data from a longitudinal, prospective project documenting cognitive, behavioural, and emotional sequelae of mild, moderate, and severe TBI in a total 86 children, aged 6 – 14 years at the time of injury. Parents completed baseline questionnaires (CBCL, BRIEF) within two months of the child’s accident. Children underwent assessment of cognitive (TEA-Ch, Digit Span, Coding, CMS Word Pairs, CNT) and emotional (TSCC-A) functioning at 3 and 6 months after TBI, and parents completed the questionnaires (CBCL, BRIEF) again at 6 months post-TBI. All analyses were based on scaled scores. Severity effects were identified on all cognitive tests at 3 months after TBI, with results on speed of processing and visual selective attention remaining significant at 6 months after TBI. As expected, significant improvements in cognitive performance were shown over time, although there was some variability between TBI severity groups. There were no effects of gender on cognitive outcome. Baseline CBCL scores also did not affect cognitive outcome. In contrast, baseline measures of executive behaviour (BRIEF) did show a significant association with cognitive outcome at 3 and 6 months. A Cognitive Composite score was generated by summarising the outcomes of the five individual neuropsychological tests. Similar to the effects reported for the individual cognitive tests, greater TBI severity predicted poorer outcome at 3 and 6 months after TBI. Gender did not affect outcome. The baseline measure of executive behaviour (BRIEF) was significantly correlated with outcome, whereas the baseline measure of behaviour problems (CBCL) was not. Based on these findings, it was concluded that the Cognitive Composite was appropriate for use as a single summary of cognitive outcome after TBI in childhood. Behavioural and emotional outcomes were varied: At 6 months after TBI, the attention problems subscale of the CBCL showed higher frequencies of scores in the clinical range than expected based on normative data. For the BRIEF, the working memory and plan/organise subscales, the metacognition index, and the global executive composite showed higher frequencies of scores in the clinical range than expected based on normative data. This was not the case for the TSCC-A scales at 3 and 6 months after TBI. In fact, scores in the clinical range were significantly less frequent in this sample than expected based on the normative data for this questionnaire. Severity effects were most pronounced on the BRIEF, which recorded significantly higher scores for the severe TBI group than the mild or moderate TBI groups on several of its subscales, and this represented an increase in problems from baseline levels. For the CBCL data, there was a trend towards more attention problems in the severe TBI group, again representing an increase from baseline scores. No severity effects were found for the TSCC-A subscales. No gender effects were identified for any of these questionnaires. Several regression models for the prediction of cognitive outcome at 3 and 6 months were proposed based on the above findings, and tested. A model including TBI severity and baseline BRIEF working memory scores reached a total of 32% and 21% explained variance for cognitive outcome at 3 and 6 months, respectively. The premorbid BRIEF working memory scores explained 9% and 10% variance in addition to the prediction based on TBI severity alone. This indicates that measures of premorbid executive behaviour constitute a valuable addition in the prediction of cognitive outcome after TBI in childhood. The study findings also show that TBI severity exerts its greatest influence upon cognitive outcome within the early stages after TBI, while the influence of premorbid executive behaviour remains at a stable level from the 3-month assessment to the 6-month follow-up.
Additional Notes Landscape pages: 27-28, 40-44, 47-52, 54-57, 60-64, 69-75, 82-92, 118, 155-158, 232, 244-245, 247

 
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Created: Thu, 24 Nov 2011, 19:18:08 EST by Ms Rian Dob on behalf of Library - Information Access Service