Long-Term School Outcomes of Children and Adolescents With Traumatic Brain Injury

Abstract

Objective-To better understand the impact of age at injury, severity of injury, and time since injury on long-term school outcomes of children with traumatic brain injury (TBI).Participants-Four groups of children: complicated mild/moderate TBI (n=23), severe TBI (n=56), orthopedic injury (n=35), and healthy controls (n=42). Children with TBI were either two years post injury or six years post injury. Design-Cross-sectional designMeasures-School records as well as parental ratings of functional academic skills and school competency.Results-Children with severe TBI had consistently high usage of school services and low school competency ratings than children with orthopedic injuries and healthy controls. In contrast, children with complicated-mild/moderate TBI were significantly more likely to receive school support services and have lower competence ratings at six years than at two years post injury. Students injured at younger ages had lower functional academic skill ratings than those injured at older ages.Conclusions-These findings highlight the increasing academic challenges faced over time by students with complicated-mild/moderate TBI and the vulnerability of younger children to poorer development of functional academic skills.Keywords traumatic brain injury; children; school outcomes; special education Traumatic brain injury (TBI) is a leading cause of death and disability in childhood. Each year in the United States, approximately 475,000 children under the age of 14 years sustain a TBI 1 and approximately 30,000 have long-term disabilities 2 . TBI is viewed as a chronic disease process that initiates ongoing and possibly lifelong changes that affect multiple Address correspondence to: Mary Prasad, Children's Learning Institute, UT Health, 7000 Fannin, Houston, Texas 77030, Mary.R.Prasad@uth.tmc.edu, 713-500-3888. Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Conflict of Interest:The authors have no conflict of interests to disclose. HHS Public AccessAuthor manuscript J Head Trauma Rehabil. Author manuscript; available in PMC 2018 January 01. Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript organ systems 3 . Common consequences of moderate to severe pediatric TBI include chronic, often lifelong, impairments in cognition, psychological health, adaptive behavior, and academic functioning. Academic functioning is particularly important to health related quality of life because mastering the school curriculum is one of the major developmental tasks of childhood. Functional academic deficits often emerge long-term following significant TBI and are characterized by poor school performance, high rates of grade retention, and receipt of special academic support services 4,5 . In this paper, we examine long-term academic outcomes in children with a range of TBI severity using a prospective, multidimensional approach. Time Since Injury, Severity of TBI, and Age at InjuryAcademic deficits, which are among the most significant an...

Volumetric and shape analyses of subcortical structures in United States service members with mild traumatic brain injury

“…In cross-sectional imaging studies of mTBI, TSI is an important clinical factor to consider [16, 54]. A number of studies in both human and animal models demonstrate TSI as one of the more consistent correlates of cognitive and imaging findings [2, 28, 55, 56].…”

DPHMD Board Members

“…With this training, paired with a systematic screening process, plus a procedure for notifying the school that an injury has occurred, CCS significantly increased the numbers of students referred for TBI consultation, from 11 students per year at the start of the program, to an average of 166 students per year in years 4 through 7 . For many children, the eventual effects of a TBI can emerge many years after injury or become more significant over time as the child becomes less able to meet the increasingly complex demands of higher grades (Prasad et al, 2017). To be effective, training for educators must include information about the long-term effects of TBI on learning and behavior and the impact of childhood TBI on the family.…”

Under-Identification of Students with Long Term Disability from Moderate to Severe TBI:

“…Children with TBI who return to school with significantly altered learning abilities present unique challenges for educators. Challenges with memory, executive function, attention, concentration, and processing speed can negatively affect a child's ability to learn and perform in school (Ewing-Cobbs, Prasad, & Kramer, 2006;Prasad, Swank, & Ewing-Cobbs, 2017;Gerrard-Morris, Taylor, Yeates, 2010;Hawley, 2004;Moser, Schatz, & Jordan, 2005). Behavioral challenges, impulsivity, and emotional issues are also common after TBI (Barlow et al, 2010;Li, & Liu, 2013;Limond, Dorris, & McMillan, 2009;Ryan et al, 2016) and can negatively affect school performance, perhaps as long as ten years post-injury (Beauchamp et al, 2011).…”