Emotional and Behavioral Outcomes of Traumatic Brain Injury in Children and Adolescents

Each year in the United States more than one-quarter million children suffer a traumatic brain injury. Previously published research has shown that children who survive a TBI event are more likely to exhibit symptoms of emotional and behavioral disorders in the months and years following their injury. This research seeks to add to the field by examining the prevalence of clinically significant symptoms of these outcome disorders and identify factors related to the presence of these disorders. Through a three-manuscript format, this dissertation examines the prevalence of depression, anxiety, Attention-Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) symptoms in the young injury survivors as well as depression, anxiety, and poor quality of life in their primary caregivers. This study aimed to describe the distribution of the symptoms of these disorders and identify factors related to both the injury and home recovery environment that are associated with their presence. The first manuscript, focusing on depression and anxiety in the injured youth, found a 5.9% prevalence of both depression and anxiety. More severe injury is associated with increased depressive symptoms. Anxiety symptoms in the child are positively correlated with depression symptoms in the caregiver. The second manuscript found a 35.7% prevalence of ADHD in this cohort, a rate higher than expected in the general population. While no factors were significantly associated with ADHD, this is a significant finding because several years had passed since the injury event. No child was reported having symptoms of ODD/CD. Lastly, the third manuscript focused on the primary caregivers of the brain-injured youth. More than half of all caregivers in this study reported symptoms of a low or very low quality of life. This work has public health significance in that the identification of factors associated with worse outcomes can improve public health by identifying patients and families who may need additional follow-up because of their increased risk. Additionally, these measures will help to improve long-term outcomes in survivors of TBI, and identify caregivers who may need additional assistance in their caregiving responsibilities and may face poor outcomes as well