Parenting Behaviors after Moderate - Severe Traumatic Injury in Early Childhood

Australian parent and sibling perspectives on the impact of paediatric acquired brain injury on family relationships during the first 6 weeks at home

This study explores the impact of paediatric acquired brain injury (ABI) on family relationships. Twenty-three families (n = 18 mothers, n = 7 fathers, and n = 4 siblings) of children who sustained an ABI requiring treatment from inpatient acute and rehabilitation services reported on their perceptions regarding changes in family relationships since the injured child's return home. Thematic analysis of survey data was conducted. Family members (parents and siblings) described four themes: (1) negative changes in sibling interactions; (2) role changes arising from an increase in parental expectations of non-injured siblings; (3) family system challenges in balancing needs within the parent-child dyad and sibling subsystems; and (4) supporting emotional responses within the family system. Findings reveal a critical time for families as they resume full care of the injured child at home. Clinical implications for social workers and other rehabilitation clinicians are explored.

More to the story than executive function: Effortful control soon after injury predicts long-term functional and social outcomes following pediatric traumatic brain injury in young children

OBJECTIVE

To examine the impact of early traumatic brain injury (TBI) on effortful control (EC) over time and the relationship of EC and executive functioning (EF) to long-term functional and social outcomes.

METHOD

Parents of children (N = 206, ages 3-7) with moderate-to-severe TBI or orthopedic injuries (OIs) rated EC using the Child Behavior Questionnaire at 1 (pre-injury), 6, 12, and 18 months post-injury. Child functioning and social competence were assessed at 7 years post-injury. Mixed models examined the effects of injury, time since injury, and their interaction on EC. General linear models examined the associations of pre-injury EC and EC at 18 months with long-term functional and social outcomes. Models controlled for EF to assess the unique contribution of EC to outcomes.

RESULTS

Children with severe TBI had significantly lower EC than both the OI and moderate TBI groups at each post-injury time point. Both pre-injury and 18-month EC were associated with long-term outcomes. Among those with low EC at baseline, children with moderate and severe TBI had more functional impairment than those with OI; however, no group differences were noted at high levels of EC. EC had main effects on parent-reported social competence that did not vary by injury type.

CONCLUSIONS

Findings suggest that EC is sensitive to TBI effects and is a unique predictor of functional outcomes, independent of EF. High EC could serve as a protective factor, and as such measures of EC could be used to identify children for more intensive intervention.

Caregivers' and Young Children's Emotional Health Needs After Pediatric Traumatic Injury

Pediatric traumatic injury (PTI) is associated with emotional health difficulties, but most US trauma centers do not adequately address emotional recovery needs. This study aimed to assess families' emotional health needs following PTI and determine how technology could be used to inform early interventions. Individual semi-structured, qualitative interviews were conducted with caregivers of children admitted to a Level I trauma center in the Southeastern United States to understand families' experiences in-hospital and post-discharge. Participants included 20 caregivers of PTI patients under age 12 (M = 6.4 years; 70% male, 45% motor vehicle collision). Thematic analysis was used to analyze data from interviews that were conducted until saturation. Caregivers reported varying emotional needs in hospital and difficulties adjusting after discharge. Families responded enthusiastically to the potential of a technology-enhanced resource for families affected by PTI. A cost-effective, scalable intervention is needed to promote recovery and has potential for widespread pediatric hospital uptake.

An Injustice to the Justice-Involved: A Brief Report on the Impact of Traumatic Brain Injury on Incarcerated Mothers

Traumatic brain injury (TBI) is one of the leading causes of death and long-term disability among young adults worldwide and in the United States. TBIs are often associated with a high prevalence of morbidity, mortality, and other behavioral and cognitive problems. Several studies have shown that women living with TBIs have significantly higher odds of committing criminal acts, yet the impact of TBI on incarcerated women remains an underresearched area. By contrast, the effect of TBI on men is more prevalent in current literature, particularly relating to sports-related injuries. Given that an estimate of 80% of incarcerated women are mothers, we conducted a literature review in two phases focused on TBI in incarcerated mothers. The initial search of TBI in incarcerated mothers returned no results, so we proceeded in two phases. Phase 1 searched maternal outcomes of TBI, using the terms "maternal health" and "traumatic brain injury," whereas Phase 2 searched "traumatic brain injury" and "incarcerated women." Because so little information is available regarding TBI in incarcerated mothers, we used what we could find in these two phases to highlight the scarcity of knowledge about this population. This brief report addresses the knowledge gap that exists for incarcerated mothers living with TBI to encourage regular TBI screening to raise awareness and advocate for accommodated care. Correctional forensic nurses are perfectly placed to do TBI screening and to provide continuous rehabilitation after release to prevent reoffending.

Who is Taking Care of Central American Immigrant Youth? Preliminary Data on Caregiving Arrangements and Emotional-Behavioral Symptoms Post-Migration

Migrant youth are at increased risk for mental health problems. Given increases in families migrating to the U.S. and family separations at the U.S.-Mexico border, understanding migrant youth home environments and impacts of family disruption are growing concerns. This study assessed caregiver arrangements and reports of youth emotional and behavioral symptoms from recently immigrated adolescents (N = 111) and respective caregivers (n = 64). 47.7% of youth indicated living with their mother, father, or both; 24.3% another relative, 2.7% a non-relative, and 25.2% reported no caregiver. 25% indicated caretaking responsibilities of their own. Caregiving arrangements were related to emotional and behavioral symptoms. Caregiver documentation status was related to caregiver-reported conduct problems, prosocial behavior, and total symptoms. The migration process is disruptive for youth and home environments. Many youth experience disrupted caregiving post-migration and caregiver features are significant to youth emotional and behavioral symptoms-which were elevated in this sample. The study provides novel insight into effects of family disruption on migrant youth post-migration.

Kids' Outcomes And Long-term Abilities (KOALA): protocol for a prospective, longitudinal cohort study of mild traumatic brain injury in children 6 months to 6 years of age

INTRODUCTION

Mild traumatic brain injury (mTBI) is highly prevalent, especially in children under 6 years. However, little research focuses on the consequences of mTBI early in development. The objective of the Kids' Outcomes And Long-term Abilities (KOALA) study is to document the impact of early mTBI on children's motor, cognitive, social and behavioural functioning, as well as on quality of life, stress, sleep and brain integrity.

METHODS AND ANALYSES

KOALA is a prospective, multicentre, longitudinal cohort study of children aged 6 months to 6 years at the time of injury/recruitment. Children who sustain mTBI (n=150) or an orthopaedic injury (n=75) will be recruited from three paediatric emergency departments (PEDs), and compared with typically developing children (community controls, n=75). A comprehensive battery of prognostic and outcome measures will be collected in the PED, at 10 days, 1, 3 and 12 months postinjury. Biological measures, including measures of brain structure and function (magnetic resonance imaging, MRI), stress (hair cortisol), sleep (actigraphy) and genetics (saliva), will complement direct testing of function using developmental and neuropsychological measures and parent questionnaires. Group comparisons and predictive models will test the a priori hypotheses that, compared with children from the community or with orthopaedic injuries, children with mTBI will (1) display more postconcussive symptoms and exhibit poorer motor, cognitive, social and behavioural functioning; (2) show evidence of altered brain structure and function, poorer sleep and higher levels of stress hormones. A combination of child, injury, socioenvironmental and psychobiological factors are expected to predict behaviour and quality of life at 1, 3 and 12 months postinjury.

ETHICS AND DISSEMINATION

The KOALA study is approved by the Sainte-Justine University Hospital, McGill University Health Centre and University of Calgary Conjoint Health Research Ethics Boards. Parents of participants will provide written consent. Dissemination will occur through peer-reviewed journals and an integrated knowledge translation plan.

Parenting styles as a predictor of long-term psychosocial outcomes after traumatic brain injury (TBI) in early childhood

Objective: This study sought to determine whether parenting styles predict long-term psychosocial outcomes after traumatic brain injury in young children.Methods: The study involved a concurrent cohort, prospective design, with longitudinal assessments up to early adolescence. Participants included 126 children with moderate to severe traumatic brain injury or orthopedic injury, ages 3 to 6 years 11 months, recruited between 2003 and 2006. Parents rated children's pre-injury behavioral adjustment, social competence, and executive functioning shortly after injury, and again 6.8 years post injury. Parents also rated their parenting styles (permissive, authoritarian, authoritative) at both occasions.Results: After controlling for pre-injury functioning, the groups differed significantly on all three outcomes (ΔR2 0.07 to 0.13). Late but not early parenting styles predicted outcomes in all groups (ΔR2 0.06 to 0.17): more permissive parenting predicted worse outcomes in all domains (β= -0.18, 0.20, 0.27); and more authoritative parenting predicted better social competence and executive functioning (β= -0.17, 0.46). Severe traumatic brain injury interacted with parenting style for several outcomes, with ineffective parenting exacerbating the negative sequelae.Conclusions: Parenting style predicts children's long-term psychosocial functioning after early childhood injury, and may moderate the effects of early traumatic brain injury.Implications for rehabilitationChildren with traumatic brain injury (especially those with severe injuries) are likely to require long-term monitoring and rehabilitation to address their psychosocial functioning.Interventions that focus on parenting may be an important avenue for promoting better psychosocial outcomes among children with severe traumatic brain injury.