Traumatic Brain Injury in Adolescence: The Relationship between High School Exiting and Future Productivity

Traumatic brain injury (TBI) is the leading cause of death and disability among children and adolescents. Brain injury survivors are often left with persistent impairments that have the potential to impede daily functioning, delay or prevent the attainment of developmental milestones, and subsequently limit future productivity in adulthood. A shared goal of both neurorehabilitation and the educational system is to prepare youth for a productive adulthood with both systems of care having substantial, yet independent, literature bases regarding factors associated with productivity (e.g., engagement in employment or post-secondary education). It is currently assumed that because type of high school exiting (e.g., diploma, GED, dropout) is related to productivity for the general population, it also is related to productivity for adolescents with a serious TBI. It is possible that the factors outlined in the TBI literature account for the majority of the variance in this relationship and that exiting has no unique relationship with future productivity for this neurologically compromised population. As such, the purpose of this study was to explore the intersection of TBI and high school exiting. This study was a secondary analysis of the Traumatic Brain Injury Model Systems (TBIMS) database and featured a sample (n = 202) of 16 to 18-year-olds who were enrolled in high school when they sustained a moderate to severe TBI and subsequently attended inpatient neurorehabilitation. All participants in this study suffered their injuries between 4/1/2003 and 10/1/2010. The first aim of this study was to describe the rates of high school exiting for students with a moderate or severe TBI who attended inpatient neurorehabilitation and to examine group differences (e.g., race, insurance type, injury severity). Currently, there are no known data regarding rates for type of high school exiting (diploma, GED, dropout) or group differences for this population. This study found rates of 83% diploma, 5% GED, and 12% dropout. These rates are striking as they mirror data reported for the general student population. When examining group differences, several factors appeared to be more likely associated with earning a diploma (i.e., White, not receiving Medicaid, no pre-injury learning problem, no pre-injury learning problem, injury severity, higher motor functioning at rehabilitation discharge, acute length of stay) and others with GED (i.e., pre-injury learning problem, pre-injury substance use problem) or dropout (i.e., nonWhite, receiving Medicaid, pre-injury learning problem, lower cognitive functioning at rehabilitation discharge). In this study, variables associated with diploma were conceptualized as protective factors and variables associated with dropout conceptualized as risk factors. Findings from aim one (rates, group differences) are foundational data regarding high school exiting for students with a TBI. These data have the potential to provide normative reference, instill hope, spur collaboration between medicine and education, provide targets for intervention and policy, and serve as the foundation for future research. The second aim of this study was to examine if exiting type has a unique relationship with future productivity. Productivity was defined as hours per week engaged in post-secondary education and/or employment. Results indicated that exiting type (i.e., diploma) had a unique relationship with total productivity and educational productivity but not employment productivity after TBI. Employment productivity was better explained by several established predictors of productivity (race, pre-injury special education status, post-traumatic amnesia, functioning at rehabilitation discharge). The data from this study provide preliminary evidence that for students who attend inpatient neurorehabilitation after a serious TBI, earning a diploma is attainable, successful exiting can be promoted, and that earning a diploma is related to outcome (i.e., productivity). Overall, findings from this study provide foundational data that have the potential to aid in prognostication, serve as targets for intervention, and deserve further scientific inquiry