Article

OBJECTIVE: To evaluate the relationship of family and parenting factors to
long-term executive dysfunction and attention problems after early childhood
traumatic brain injury (TBI). We hypothesized that the magnitude of executive
dysfunction and attention problems would be moderated by family and parenting
factors. DESIGN: A multicenter, prospective cohort study that included an
orthopedic injury (OI) reference group. SETTING: Three tertiary academic
children's hospital medical centers and one general medical center. PARTICIPANTS:
Children, ages 3-7 years, hospitalized for OI, moderate TBI, or severe TBI.
METHODS AND OUTCOME MEASUREMENTS: Parental ratings of family functioning and
parenting styles were obtained 18 months after the injury occurred. The main
outcome measurements, which were parental ratings of children's executive
function and attention, were performed at least 24 months after the injury
occurred (mean, 39 months; range, 25-63 months). ANALYSIS: Group comparisons were
conducted with use of t-tests, chi(2) analysis, analysis of variance, and Pearson
and Spearman correlations. Regression analysis was used to examine associations
of the outcomes with family functioning and parenting styles and to test
moderating effects of these factors on group differences. RESULTS: Participants
with severe TBI demonstrated increased executive dysfunction and attention
problems compared with those who sustained moderate TBI or OI. Lower levels of
family dysfunction were associated with better executive function and attention
across groups but did not moderate group differences. However, attention deficits
after severe TBI were exacerbated under conditions of more permissive parenting
relative to attention deficits after OIs. CONCLUSIONS: Executive function and
attention problems persisted on a long-term basis (>24 months) after early
childhood TBI, and positive global family functioning and nonpermissive parenting
were associated with better outcomes. Better characterization of the optimal
family environment for recovery from early childhood TBI could help target future
interventions.
CI - Copyright (c) 2011 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS