Child and Family Sequelae of Preschool Brain Injury

描述(申请人提供)：较小儿童的创伤性脑损伤(TBI)比较大儿童的创伤性脑损伤会导致更严重和更持久的后遗症，对新兴技能的影响最大。然而，关于早期脑外伤对家庭的影响，以及促进或阻碍该年龄段儿童康复的因素，人们知之甚少。研究表明，家庭和社会因素在学龄儿童脑外伤后的长期预后中起着重要作用。目前的研究使用前瞻性队列设计来检查儿童脑外伤后的家庭适应情况，以及随着时间的推移社会环境和儿童康复之间的关系。3至6岁患有中到重度脑外伤的儿童将与因不涉及中枢神经系统的骨科损伤而住院的匹配儿童组进行比较。两组儿童将在受伤后不久以及受伤后6个月、12个月和24个月进行评估。感兴趣的儿童结果包括语言、社交能力和执行功能等领域的新兴技能，这些技能可能对后来的功能产生重要影响。家庭结果包括与伤害相关的负担、照顾者和家庭功能以及亲子互动。我们假设，与患有骨科损伤的儿童的家庭相比，患有TEI的幼儿家庭将表现出更多的负担和照顾者的痛苦，更差的家庭功能，以及更高水平的指导性和限制性与其子女的互动。此外，我们假设伤害前的社会环境和伤害带来的家庭变化都将与儿童的康复有关，并且这些联系将受到伤害严重程度的调节，因此环境对更严重的脑外伤儿童具有更强的影响。我们预计，环境的某些方面(例如，母亲的养育行为)将加速恢复，而其他方面(例如，母亲的指导性)将阻碍脑损伤后的生长。了解环境与脑外伤后儿童康复的相关性，将使我们能够制定干预措施，以改善结果。

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) in younger children results in more severe and persistent sequelae than TBI in older children, affecting emerging skills most. Yet, little is known regarding the effects of early TBI on the family or the factors that facilitate or hinder recovery among children in this age group. Research suggests that family and social factors play an important role in determining longer-term outcome following TBI in school-aged children. The current investigation uses a prospective cohort design to examine family adaptation following TBI in young children and the relationship between the social environment and child recovery over time. Children aged 3 to 6 with moderate to severe TBI will be compared to a matched group of children hospitalized for orthopedic injuries not involving the CNS. Children in both groups will be assessed shortly after the injury and at 6, 12, and 24 months post injury. Child outcomes of interest include emerging skills in the domains of language, social competence, and executive functions that are likely to have important implications for later functioning. Family outcomes include injury-related burden, caregiver and family functioning, and parent-child interactions. We hypothesize that families of young children with TEI will exhibit more burden and caregiver distress, poorer family functioning, and higher levels of directiveness and restrictiveness in interactions with their children than families of children with orthopedic injuries. Further, we hypothesize that both the pre-injury social environment and changes in the family brought about by the injury will be related to the child's recovery, and that these associations will be moderated by injury severity, such that the environment has a stronger influence among children with more severe TBI. We anticipate that certain aspects of the environment (e.g., maternal maintaining behaviors) will accelerate recovery, whereas others (e.g., maternal directiveness) will retard growth following TBI. Understanding the relevance of the environment to the child's recovery following TBI will allow us to develop interventions to improve outcomes.