Functional impairments (adaptive, behavioral, educational) are common after preschool traumatic brain injury (TBI). In comparison with cognitive outcome, functional outcomes have received limited attention, with little evidence to determine whether these difficulties persist in the long term. The aim of this study was to examine functional outcomes at 10 years post-injury and identify predictors of outcome. The study compared children with a diagnosis of TBI (n=40) to a healthy age-, gender-, and socioeconomic status (SES)-matched control group (n=19) at 10 years post-injury. Outcomes and predictors of functional skills were investigated. Poorer adaptive skills were evident for those with more severe injury. Behavioral difficulties were present regardless of injury severity. Post-injury, arithmetic skills were the most compromised in the longer term. Pre-injury status, interventions accessed, and acute intellectual function were significant predictors of outcome. These results highlight the importance of monitoring functional skills in the long term, especially for those children presenting with risk factors.

Limited research has investigated specific attentional sequelae following pediatric traumatic brain injury (TBI), such as sustained, selective, and shifting attention, as well as speed of processing. Little is known about the pattern of recovery of these skills or their interaction with ongoing development. The present study examined attentional abilities at acute, 6-, 12-, and 24-month time points postinjury in a group of 71 children who had sustained a mild, moderate, or severe TBI. Results indicated that children who sustained a severe TBI generally performed poorest, but showed most recovery over time. The pattern of recovery was dependent on the attentional component being measured. Specifically, deficits were most evident on more complex and timed tasks. While a number of areas showed recovery over time, for some attentional components, difficulties persisted to 24 months postinjury. (JINS, 2005,11, 84–98.)

While a number of research papers have reported findings on memory deficits following traumatic brain injury (TBI), only limited studies have monitored the recovery of these skills over time. The present study examined memory ability and its effect on academic success in a group of children who had sustained a mild, moderate, or severe traumatic brain injury (TBI). Results showed that the severe TBI group exhibited greater deficits on memory tasks, irrespective of modality, in the acute, 6-, 12-, and 24-month postinjury stages, in comparison to mild and moderate TBI groups. Performance on academic measures was dependent on both injury severity and task demands. Preinjury academic ability and verbal memory indices best predicted academic success.

Objective: To date no study has reported findings regarding attentional deficits following pre-school paediatric traumatic brain injury (TBI), as long as 10 years post-injury. It was predicted that more severe TBI would be associated with generalized deficits at 10 years post-TBI, particularly for skills not mastered at time of injury. Research design: The sample comprised 40 prospectively-recruited children (42% of the original sample) who had sustained a mild, moderate or severe traumatic brain injury (TBI) between the ages of 1–7 years and 19 non-injured control participants. Children were assessed 10 years post-TBI, with a focus on measures of attentional ability. Outcomes/results: While attentional deficits were not evident across all components of attentional ability, both early- and later-established attention skills were compromised, particularly following severe TBI. Environmental predictors were generally not successful predictors of attentional outcome at 10 years post-TBI. Age at injury and acute IQ were identified as contributing to attention at 10 years. Conclusions/implications: The present study shows that attentional deficits do occur and persist to 10 years following serious TBI. Clinicians may be able to screen for such deficits and so intervene in order to prevent or lessen the consequences of such difficulties.

Primary objective: To determine the predictive value of structural neuroimaging in the clinical setting following TBI. Research design: Prospective between-group design, comparing groups with regard to: (i) the presence or absence of cerebral pathology and (ii) the location of cerebral pathology. The predictive value of injury variables was investigated using hierarchical regressions. Methods and procedures: Thirty-six children, between 6 and 14 years, who sustained a moderate to severe TBI 5 years previously participated in this study. Children's performances on five measures of attentional control were examined in relation to the presence, location and severity of their lesions, as coded by the Coffey classification system . Main outcomes and results: Frontal lesion severity was not predictive of performance on any of the measures. However, generalized (frontal and extrafrontal) and extrafrontal lesion severity was predictive of poor performance. Conclusions: These findings support the argument that functional organization in children may differ from that in adults, suggesting that multiple cerebral regions, or a diffuse cerebral network, may mediate children's executive functions (EF). Results are also consistent with the hypothesis that the amount of damaged brain tissue, rather than its location, may be more predictive of neurobehavioural outcome following early TBI.