Traumatic Brain Injury in Children and Adolescents: Psychiatric Disorders in the First Three Months

doi:10.1097/00004583-199701000-00022

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 36, Issue 1, January 1997, Pages 94-102

https://doi.org/10.1097/00004583-199701000-00022 Get rights and content

ABSTRACT

Objective

To assess predictive factors of psychiatric outcome in the first 3 months after traumatic brain injury (TBI) in children and adolescents.

Method

Subjects were children aged 6 to 14 years at the time they were hospitalized after TBI. The study used a prospective follow-up design. Assessments of preinjury psychiatric, behavioral, adaptive functioning, family functioning, and family psychiatric history status were conducted. Severity of injury was assessed by standard clinical scales and neuroimaging was analyzed. The outcome measure was the development of a psychiatric disorder, never before present (“novel”) in a subject during the first 3 months after the TBI.

Results

Fifty subjects enrolled, and the analyses focused on 37 subjects followed up at 3 months. Increasing severity of injury, presence of a lifetime psychiatric disorder, family psychiatric history, family dysfunction, and lower socioeconomic class/preinjury intellectual function predicted the development of a “novel” psychiatric disorder in the first 3 months of follow-up.

Conclusions

These data suggest that there are children, identifiable through clinical assessment, at increased risk for development of psychiatric disorders in the first 3 months after TBI.

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Mental Health after Unintentional Injury in a Pediatric Managed-Medicaid Population
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The purpose of this study was to compare the rates of mental health diagnoses and psychotropic prescriptions pre- and posthospitalization for injury in a managed-Medicaid population. We hypothesized that children have increased rates of mental health diagnoses and psychotropic prescriptions after injury.
We investigated children (n = 2208) ≤18 years of age treated at a pediatric trauma center from 2005 to 2015 who were enrolled in a managed-Medicaid program at hospital admission and for at least 1 healthcare visit in the preceding year. We used Poisson regression models to estimate rates of mental health diagnoses and psychotropic prescriptions that occurred in the 12 months pre- and postinjury.
The rate of mental health diagnoses preinjury was 95.9 per 1000 person-years, which increased to 156.7 per 1000 postinjury (rate ratio [RR] 1.63, 95% CI 1.39-1.92). Children ages 0-4 years with burns were more likely to have mental health diagnoses postinjury (race and ethnicity adjusted RR [aRR] 8.56, 95% CI 3.30-22.2). Children with head injuries were also more likely to have mental health diagnoses postinjury: ages 0-4 years (aRR 3.87, 95% CI 1.31-11.5); ages 5-9 (aRR 3.11, 95% CI 1.27-7.59); ages 10-14 (aRR 2.17, 95% CI 1.27-3.73); and ages 15-18 (aRR 5.37, 95% CI 2.12-13.6). The rate of psychotropic prescriptions preinjury was 121.7 per 1000 person-years and increased to 310.9 per 1000 postinjury (RR 2.55, 95% CI 2.26-2.89).
We identified increased mental health diagnoses and psychotropic prescriptions in children following hospitalization for injury.
Comparative effectiveness of family problem-solving therapy (F-PST) for adolescents after traumatic brain injury: Protocol for a randomized, multicenter, clinical trial
2018, Contemporary Clinical Trials Communications
Citation Excerpt :
Adolescents will need to have persistent behavior symptoms for at least one month post injury. We chose not to impose a maximum time since injury, given that research [13,34–36], and feedback from families suggest that concerns may not become apparent until months or years post injury and many problems tend to persist or worsen over time. Given substantial differences in management and recovery trajectory between mild TBI/concussion (i.e., typical recovery in <2 weeks) and more severe TBI, we excluded adolescents with uncomplicated mild TBI.
The objective of this manuscript is to describe the methodology that will be used to test the comparative effectiveness, feasibility, and acceptability of three formats of family problem solving therapy (F-PST) for improving functional outcomes of complicated mild to severe adolescent TBI.
Three-arm comparative effectiveness, randomized clinical trial (RCT) design. We describe the protocol of a three-arm RCT comparing the effectiveness of three modalities of F-PST to reduce executive dysfunction and behavior problems following TBI in adolescence. The RCT will compare the relative effectiveness among face-to-face; online and self-directed; and therapist-supported online modes of treatment.
It is anticipated that findings from this work will inform future clinical care practices, with implications for treatment of other patient populations of youth with psychological symptoms arising from neurological conditions. Institutional review board approval will be obtained from all sites prior to commencement of the study.
Neuropsychiatry of Pediatric Traumatic Brain Injury
2014, Psychiatric Clinics of North America
Citation Excerpt :
This article deals sequentially with methodological considerations, preinjury psychiatric status, and new-onset (postinjury) psychiatric disorders. There are only 4 published prospective studies of consecutive hospital admissions of children and adolescents with TBI in which standardized psychiatric interviews were used to assess psychopathology,8–11 and only 2 of these studies had injured control children.8,11,12 This small literature is complemented by a larger corpus that addresses postinjury behavioral changes reported by parents and teachers, typically by questionnaires, which tend not to be specific for the generating of psychiatric diagnoses or psychiatric treatment plans.13–17
Behavioral Predictors of Outpatient Mental Health Service Utilization Within 6 Months After Traumatic Brain Injury in Adolescents
2013, PM and R
Citation Excerpt :
The objectives of this article were to (1) characterize utilization of mental health services within the first 6 months after moderate and severe TBI in a large cohort of adolescents, and (2) determine the association of these services with findings from the CAFAS and CBCL. An examination of the use of mental health services within 6 months after injury is important because there is a high risk of developing novel behavioral problems and psychiatric disorders during this time [5,6,11], and it is a time when children with TBI are commonly transitioning back to home, school, and community activities. Consistent with previous findings, we hypothesized that individuals with clinical elevations on the CBCL and CAFAS would not be receiving mental health services congruent with CBCL and CAFAS scores.
To characterize utilization of mental health services and determine the ability of a behavior problem and clinical functioning assessment to predict utilization of such services within the first 6 months after moderate and severe traumatic brain injury in a large cohort of adolescents.
Multicenter cross-sectional study.
Outpatient setting of 4 tertiary pediatric hospitals, 2 tertiary general medical centers, and 1 specialized children's hospital.
Adolescents age 12-17 years (n = 132), 1-6 months after moderate-to-severe traumatic brain injury.
Logistic regression was used to determine the association of mental health service utilization with clinical functioning as assessed by the Child and Adolescent Functional Assessment Scale and behavior problems assessed by the Child Behavioral Checklist.
Mental health service utilization measured by the Service Assessment for Children and Adolescents.
Behavioral or functional impairment occurred in 37%-56%. Of the total study population, 24.2% reported receiving outpatient mental health services, 8.3% reported receiving school services, and 28.8% reported receiving any type of mental health service. Use of any (school or outpatient) mental health service was associated with borderline to impaired total Child and Adolescent Functional Assessment Scale (odds ratio 3.50 [95% confidence interval, 1.46-8.40]; P < .01) and the Child Behavioral Checklist Total Competence (odds ratio 5.08 [95% confidence interval, 2.02-12.76]; P < .01).
A large proportion of participants had unmet mental health needs. Both the Child and Adolescent Functional Assessment Scale and the Child Behavioral Checklist identified individuals who would likely benefit from mental health services in outpatient or school settings. Future research should focus on methods to ensure early identification by health care providers of adolescents with traumatic brain injury in need of mental health services.
Depression in children and adolescents in the first 6 months after traumatic brain injury
2012, International Journal of Developmental Neuroscience
The objective was to assess the nature, rate, predictive factors, and neuroimaging correlates of novel (new-onset) depressive disorders, both definite and subclinical, after traumatic brain injury (TBI). Children with TBI from consecutive admissions were enrolled and studied with psychiatric interviews soon after injury (baseline), and again 6 months post-injury. Novel definite/subclinical depressive disorders at 6-month follow up occurred in 11% (n = 15) of the children and subsets of children with non-anxious depression (n = 9) and anxious depression (n = 6) were identified. Novel definite/subclinical depressive disorder was significantly associated with older age at the time of injury, family history of anxiety disorder, left inferior frontal gyrus (IFG) lesions, and right frontal white matter lesions. Non-anxious depressions were associated with older age at injury, left IFG and left temporal pole lesions. Anxious depressions were associated with family history of anxiety disorder, Personality Change due to TBI, right frontal white matter lesions, and left parietal lesions. These findings, which are similar to those reported after adult TBI, identify both similarities and differences in non-anxious and anxious depression following childhood TBI with respect to lesion laterality, genetic factors (in the form of family psychiatric history of anxiety disorder), age at injury, and more generalized affective dysregulation.
Acquired brain injury
2008, Psychiatry
Acquired brain injury (ABI) in children can occur at any time from early fetal development to adolescence. Age, severity and type of injury are critical in the determining physical, cognitive, emotional and behavioural sequelae. Families are also profoundly affected. Complex interactions between many variables need to be thoroughly assessed psychometrically, psychologically and functionally. Pre-existing problems, past and present psychosocial environment, interventions and education interact with injury variables in contributing to long-term outcome.

View all citing articles on Scopus

: This research was supported by a NARSAD Young Investigator Award to Dr. Max. The authors acknowledge the helpful comments of Robert Robinson, M.D., and statistical advice from Stephan Arndt, Ph.D.

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SPECIAL ARTICLETraumatic Brain Injury in Children and Adolescents: Psychiatric Disorders in the First Three Months

ABSTRACT

Objective

Method

Results

Conclusions

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Psychiatry

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Lancet

Manual for the Child Behavior Checklist and Revised Child Behavior Profile

Diagnostic and Statistical Manual of Mental Disorders, 3rd edition-revised (DSM-III-R)

The family history method using Research Diagnostic Criteria: reliability and validity

Arch Gen Psychiatry

The UCLA study of mild closed head injury in children and adolescents

The posttraumatic syndrome in children. Characteristics and incidence

Head trauma in children: neurological, behavioral, and intellectual sequelae

A prospective study of children with head injuries: III. Psychiatric sequelae

Psychol Med

The assessment of affective disorders in children and adolescents by semistructured interview: test-retest reliability of the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present Episode version

Arch Gen Psychiatry

The children's orientation and amnesia test: relationship to severity of acute head injury and to recovery of memory

Neurosurgery

SPECIAL ARTICLE
Traumatic Brain Injury in Children and Adolescents: Psychiatric Disorders in the First Three Months