Child and Family Sequelae of Preschool Brain Injury

描述（由申请人提供）：年幼儿童的创伤性脑损伤（TBI）比年长儿童的创伤性脑损伤会导致更严重和持续的后遗症，对新技能的影响最大。然而，关于早期脑外伤对家庭的影响，以及促进或阻碍这一年龄组儿童康复的因素，人们知之甚少。研究表明，家庭和社会因素在决定学龄儿童脑外伤后的长期预后方面起着重要作用。目前的研究采用前瞻性队列设计来检查幼儿脑外伤后的家庭适应以及社会环境与儿童康复之间的关系。3至6岁的中度至重度TBI儿童将与不涉及中枢神经系统的骨科损伤住院儿童的匹配组进行比较。两组儿童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。儿童的成果包括语言、社会能力和执行功能等领域的新技能，这些技能可能对以后的功能有重要的影响。家庭结果包括伤害相关负担、照顾者和家庭功能以及亲子互动。我们假设患有TEI的幼儿家庭比患有骨科损伤的儿童家庭在与孩子互动时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。此外，我们假设损伤前的社会环境和损伤所带来的家庭变化都与儿童的康复有关，并且这些关联会被损伤的严重程度所调节，因此环境对更严重的TBI儿童的影响更大。我们预计，环境的某些方面（例如，母亲的维护行为）将加速恢复，而其他方面（例如，母亲的指令性）将阻碍创伤性脑损伤后的生长。了解环境与儿童创伤性脑损伤后恢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.