Psychological adjustment characteristics of children before and after moderate to severe traumatic brain injury

Objective: To examine the pre- and postinjury patterns of behavioral and psychosocial adjustment in children with moderate to severe traumatic brain injury, and to identify variables that predict adjustment outcome. Design: Premorbid and follow-up parental ratings of children's adjustment were compared. Outcome predictor variables were identified through stepwise regression analysis. Setting: Pediatric program at a regional comprehensive rehabilitation center. Patients: 50 children with moderate to severe traumatic brain injury, selected from a SG-month series of consecutive clinical inpatient referrals. Measure: Achenbach Child Behavior Checklist. Results: Premorbid behavioral or psychosocial deficits were no more common than in the general population. Level of psychosocial adjustment deteriorated significantly after traumatic brain injury (P < .0001). Significant predictors of psychosocial adjustment at follow-up included premorbid psychosocial adjustment (P < .01), diffuse lesion on computed tomography/magnetic resonance imaging scan (P < .001), and length of coma (P < .10). Conclusions: Postinjury psychosocial impairments are common in children with moderate to severe traumatic brain injury and are related to injury severity. In the majority of the cases, such problems cannot be attributed exclusively to premorbid dysfunction.