Disruptive Behavior Disorders in Children after Severe TBI: Family and Neighborhood Context

摘要 尽管采取了预防措施，但创伤性脑损伤（TBI）仍然是死亡的主要原因 和残疾儿童。全面研究发病率的数据很少， 人口统计学和影响恢复的背景因素。主要问题在于， 创伤后破坏性行为障碍（DBD）的影响，包括注意力缺陷， 多动症（ADHD）、对立违抗性障碍（ODD）和行为障碍（CD）。 最近的证据表明，家庭和邻里环境发挥了重要作用， TBI后的恢复;然而，这一过程知之甚少。研究发现， TBI后家庭功能和结果之间的相关性，但尚未完全 解释这种关系或确定家庭功能受损是否先于TBI不良 结果。邻里环境被假设为影响社会条件， 机会，影响复苏。相反，贫困的邻里集中是 与健康负相关，包括行为相关后遗症，如ODD和CD。 这项拟议的研究计划提供一个探索的背景下，伤害采取 制定一个更复杂、更全面的框架，以满足 创伤性脑损伤幸存儿童的数据利用《2010年的办法和决定》中的现有数据， 急性儿科TBI（ADAPT）试验（目标入组= 1，000），我们将确定 的DBD的，儿童有发展DBD的风险，家庭的影响，以及影响 服务的可用性和社区环境。该提案的目的是：1）进行 与社区利益相关者的焦点小组，以确定邻里水平的协变量。（二） 描述TBI后DBD的流行病学，以及3）确定 家庭功能和邻里因素对TBI后儿童DBD风险的影响。的 这个R21的首要目标是双重的：1）获得关于这个重要的，未充分研究的信息 过程，以及2）发展这个多学科小组，包括社区合作伙伴， 持份者这将使我们能够提交一个更大的R 01，以更多的建议工作为基础， 精细评估DBD结果并测量邻里影响。

Abstract Despite preventative measures, traumatic brain injury (TBI) remains the leading cause of death and disability in children. Minimal data exists comprehensively studying the incidence, demographics, and contextual factors that affect recovery. Major questions exist regarding the impact of post-injury disruptive behavioral disorders (DBD), which include attention deficit- hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). Recent evidence suggests that family and neighborhood context play an important role in recovery after TBI; however, this process is poorly understood. Studies have found an association between family functioning and outcomes following TBI but have not completely explained the relationship or determined if impaired family functioning precedes poor TBI outcomes. Neighborhood contexts are hypothesized to affect social conditions and opportunities, affecting recovery. Conversely, neighborhood concentration of poverty is negatively associated with health, including behavioral related sequelae such as ODD and CD. The proposed study is planned to provide an exploration of the contexts in which injuries take place in order to develop a more sophisticated, comprehensive framework to address the needs of children who have survived TBI. Using existing data from The Approaches and Decisions in Acute Pediatric TBI (ADAPT) Trial (target enrollment = 1,000), we will determine the incidence of DBD’s, which children are at risk for developing DBD’s, the impact of family, and the influence of service availability and neighborhood context. The aims of the proposal are to: 1) Conduct focus groups with community stakeholders to identify neighborhood level covariates. 2) Describe the epidemiology of DBD following TBI, and 3) Determine the relationship between family functioning and neighborhood factors on risk for DBD of children following TBI. The overarching goal of this R21 is two-fold: 1) to gain information on this important, understudied process, and 2) to develop this multidisciplinary group including community partners and stakeholders. This will allow us to submit a larger R01 to build upon the proposed work by more finely assessing DBD outcomes and measuring neighborhood influence.