Outcomes of Traumatic Brain Injury in Children

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DESCRIPTION (provided by applicant): The applicant is seeking a K02 (Independent Scientist Award) to continue building a program of research focusing on the outcomes of childhood traumatic brain injury (TBI). His objectives are (1) to investigate how children's development following TBI is related to severity of injury, age at injury, and time since injury; (2) to examine the role of environmental factors as moderators of recovery from TBI; and (3) to study the relationships between focal brain lesions, cognitive and social problem-solving skills, and "real world" social functioning following TBI. He has been a Co-Investigator on a prospective, longitudinal study of moderate to severe TBI in school-age children, and currently is Principal Investigator on an NICHD-funded research grant to study the outcomes of mild closed head injuries (CHI) in children and adolescents (see below). His future research efforts will include studies of TBI in preschool children and of the effects of TBI on children's social development. His proposed career development plan will enhance his skills in statistical methods pertinent to his research, including (a) analysis of longitudinal data, (b) treatment of missing data, and (c) robust statistical methods. He also will obtain additional training in the responsible conduct of research. The specific aims of the research are to examine the (1) natural history, (2) prediction, and (3) consequences of post-concussive symptoms in children with mild CHI. The study will involve 200 8 to 15 year old children with mild CHI and 100 with mild orthopedic injuries not involving the head in a concurrent cohort/prospective research design. The children and their families are assessed four times during the first year post injury (i.e., at 1 week, 1 month, 3 months, and 12 months post-injury). Post-concussive symptoms are assessed using rating scales and interviews, with both children and parents as informants. Predictors of post-concussive symptoms include injury characteristics, cognitive abilities, and non-injury related child and family variables. Outcomes include school performance, health utilization, and other aspects of child and family functioning. The study will examine three major hypotheses: (1) Children with mild CHI display more post-concussive symptoms than children with mild orthopedic injuries. (2) The incidence of post-concussive symptoms is related to (a) injury characteristics, (b) impairments in cognitive skills, and (c) non-injury related child and family factors. (3) Severe post-concussive symptoms are associated with more child disability. The findings will help resolve the scientific controversy regarding the outcomes associated with mild CHI, and will assist physicians and other health care providers in identifying and managing the sequelae of mild CHI.