Attitudes of children towards peers with acquired brain injury (ABI)

School professionals' knowledge about pediatric traumatic brain injury: an international study

OBJECTIVE

To determine Spanish-speaking school professionals' level of knowledge and attitudes regarding pediatric TBI.

METHODS

School professionals(n = 2,238) from 19 countries completed an online-survey regarding their training, knowledge and misconceptions, attitudes and perceptions about TBI.

RESULTS

Of the full sample 75% (n = 1689) knew what TBI was, though only 18% (n = 350) reported having experience with a student with TBI. Only 7.7% (n = 143) and 3% (n = 55) of participants could identify all of the common short- and long-term TBI sequelae, respectively. Special education professionals, those with experience with a student with TBI, and those who had received training regarding TBI showed greater knowledge in these areas. Although participants showed high levels of knowledge in 6/24 misconceptions of TBI, they endorsed others. Group, sex, experience with students with TBI, training in TBI, and number of years working were significantly linked to some misconceptions about TBI; however, the effect sizes were small.

CONCLUSION

The knowledge and experience that Spanish-speaking school professionals have regarding childhood TBI are minimal. It is therefore critical that these professionals receive a more comprehensive education during their academic training and the practice of their profession about TBI.

Delineating the Nature and Correlates of Social Dysfunction after Childhood Traumatic Brain Injury Using Common Data Elements: Evidence from an International Multi-Cohort Study

Although childhood traumatic brain injury (TBI) has been linked to heightened risk of impaired social skills and behavior, current evidence is weakened by small studies of variable methodological quality. To address these weaknesses, this international multi-cohort study involved synthesis of data from two large observational cohort studies of complicated mild-severe child TBI in Australia and North America. Both studies adopted a unified approach to data collection and coding procedures, providing the opportunity to merge datasets from multiple, well-characterized cohorts for which gold standard measures of social outcomes were collected during the chronic recovery phase. The study involved 218 children, including 33 children with severe TBI, 83 children with complicated mild-moderate TBI, 59 children with orthopedic injury, and 43 age- and sex-matched typically developing control children. All injured children were recruited from academic children's hospitals and underwent direct cognitive assessments including measures of theory of mind (ToM) at least 1-year post- injury. Parents rated their child's social adjustment using standardized measures of social skills, communication and behavior. Results showed a brain-injury specific effect on ToM abilities, such that children with both complicated mild to moderate and severe TBI displayed significantly poorer ToM than children without TBI. In mediator models, poorer ToM predicted poorer parent-rated self-direction and social skills, as well as more frequent behavioral symptoms. The ToM mediated the effect of severe TBI on parent ratings of communication and social skills, as well as on overall behavior symptoms. The findings suggest that deficits in ToM are evident across the spectrum of TBI severity and represent one mechanism linking severe child TBI to long-term social adjustment difficulties. The findings underscore the value of large-scale data harmonization projects to increase the quality of evidence regarding the outcomes of TBI. Clinical and scientific implications are discussed.

Traumatic brain injury and co-occurring problems in prison populations: A systematic review

BACKGROUND

A growing body of epidemiological research suggests high rates of traumatic brain injury (TBI) in prisoners. The aim of this review is to systematically explore the literature surrounding the rates of TBI and their co-occurrences in a prison population.

METHODS

Six electronic databases were systematically searched for articles published between 1980-2014. Studies were screened for inclusion based on pre-determined criteria by two researchers who independently performed data extraction. Study quality was appraised based on a modified quality assessment tool.

RESULTS

Twenty-six studies were included in this review. Quality assessment ranged from 20% (poor) to 80% (good), with an overall average of 60%. Twenty-four papers included TBI prevalence rates, which ranged from 5.69-88%. Seventeen studies explored co-occurring factors including rates of aggression (n = 7), substance abuse (n = 9), anxiety and depression (n = 5), neurocognitive deficits (n = 4) and psychiatric conditions (n = 3).

CONCLUSIONS

The high degree of variation in TBI rates may be attributed to the inconsistent way in which TBI was measured, with only seven studies using valid and reliable screening tools. Additionally, gaps in the literature surrounding personality outcomes in prisoners with TBI, female prisoners with TBI and qualitative outcomes were found.

Parent management of the school reintegration needs of children and youth following moderate or severe traumatic brain injury

PURPOSE

School reintegration following children's traumatic brain injury (TBI) is still poorly understood from families' perspectives. We aimed to understand how both unique and common experiences during children's school reintegration were explained by parents to influence the family.

METHODS

Data came from an investigation using descriptive phenomenology (2005-2007) to understand parents' experiences in the first five years following children's moderate to severe TBI. Parents (N = 42 from 37 families in the United States) participated in two 90-min interviews (first M = 15 months; second M = 27 months). Two investigators independently coded parents' discussions of school reintegration using content analysis to understand the unique and common factors that parents perceived affected the family.

RESULTS

Parents' school negotiation themes included the following: (1) legal versus moral basis for helping the child; (2) inappropriate state and local services that did not consider needs specific to TBI; and (3) involvement in planning, implementing and evaluating the child's education plan. Parents perceived that coordinated and collaboration leadership with school personnel lessened families' workload. Families who home-schooled had unique challenges.

CONCLUSIONS

School reintegration can add to family workload by changing roles and relationships and by adding to parents' perceived stress in managing of the child's condition.

IMPLICATIONS FOR REHABILITATION

Moderate to severe traumatic brain injury is assumed to be the primary cause of children's morbidities post-injury. Despite laws in the United States meant to facilitate children's school reintegration needs, parents often perceived that policies and practices differed from the intentions of laws and added to the family workload and stress. The school environment of the child (physical, cultural or psychological setting) plays an important long-term role in shaping family roles, relationships and management of the child's condition.

Educational professionals' understanding of childhood traumatic brain injury

PRIMARY OBJECTIVES

To determine the understanding of educational professionals around the topic of childhood brain injury and explore the factor structure of the Common Misconceptions about Traumatic Brain Injury Questionnaire (CM-TBI).

RESEARCH DESIGN

Cross-sectional postal survey.

METHODS AND PROCEDURES

The CM-TBI was posted to all educational establishments in one region of the UK. One representative from each school was asked to complete and return the questionnaire (n = 388).

MAIN OUTCOMES AND RESULTS

Differences were demonstrated between those participants who knew someone with a brain injury and those who did not, with a similar pattern being shown for those educators who had taught a child with brain injury. Participants who had taught a child with brain injury demonstrated greater knowledge in areas such as seatbelts/prevention, brain damage, brain injury sequelae, amnesia, recovery and rehabilitation. Principal components analysis suggested the existence of four factors and the discarding of half the original items of the questionnaire.

CONCLUSIONS

In the first European study to explore this issue, it is highlighted that teachers are ill-prepared to cope with children who have sustained a brain injury. Given the importance of a supportive school environment in return to life following hospitalization, the lack of understanding demonstrated by teachers in this research may significantly impact on a successful return to school.

Parents' experiences following children's moderate to severe traumatic brain injury: a clash of cultures

Little is understood about parents' experiences following children's moderate to severe traumatic brain injury (TBI). Using descriptive phenomenology, we explored common experiences of parents whose children were diagnosed with moderate to severe TBI. Parents from across the United States (N = 42, from 37 families) participated in two semistructured interviews (~ 90 minutes in length and 12 to 15 months apart) in the first 5 years following children's TBI. First interviews were in person. Second interviews, done in person or by phone, facilitated updating parents' experiences and garnering their critique of the descriptive model. Parent themes were (a) grateful to still have my child, (b) grieving for the child I knew, (c) running on nerves, and (d) grappling to get what my child and family need. Parents reported cultural barriers because of others' misunderstandings. More qualitative inquiry is needed to understand how the knowledge, attitudes, beliefs, and culture-based expectations of others influence parents' interactions and the family's adjustment and well-being.