Predictors of family functioning after traumatic brain injury in children and adolescents

Objective: To assess factors predictive of family outcome in the first 2 years after traumatic brain injury (TBI) in children and adolescents. Method: Subjects were children aged 6 to 14 at the time they were hospitalized after TBI. The study used a prospective follow-up design. Assessments of preinjury factors (psychiatric, family functioning, and family life events), injury factors (severity of injury), and postinjury factors (coping and development of a psychiatric disorder, rower before present, i.e., 'novel') were conducted using standard clinical scales. The outcome measure was family function as assessed with standardized family functioning interviews (at 12 and 24 months after TBI) and primary caretaker self-report questionnaires (at 3 and 6 months after TBI). Results: Fifty subjects enrolled, and the analyses focused on 37, 41, 43, and 42 subjects assessed at the 3-, 6-, 12-, and 24- month follow-up evaluations, respectively. The strongest influences on family functioning after childhood TBI are preinjury family functioning, the development of a 'novel' psychiatric disorder in the child, and preinjury family life events or stressors. Conclusions: These data suggest that there are families, identifiable through clinical assessment, at increased risk for family dysfunction after a child's TBI. Early identification and treatment of the child's psychopathology and family dysfunction may attenuate the associated morbidity.