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

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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.