This five-year study will test two specific hypotheses regarding sequelae of TBI for children and their families. Hypothesis 1 is that moderate-to- severe TBI will adversely affect the family social environment and will lead to more parental psychological distress than traumatic orthopedic injuries not involving insult to the central nervous system (CNS). Hypothesis 2 is that post-injury family characteristics will predict outcomes for children with TBI, even after injury severity and pre-injury behavior and school performance are taken into account. Although family factors are also hypothesized to predict outcomes in children with orthopedic injuries, the more negative family consequences of TBI is expected to contribute to group differences in sequelae. The design for the project is a prospective follow-up study involving repeated assessments of family functioning and child outcomes in 116 children with moderate-to-severe TBI. Results of preliminary analyses of data show that families of children with orthopedic injury are under significant stress during hospitalization and that stress continues through the immediate post-discharge period and 6-month and 12-month follow-ups. By the 6 and 12 months follow-ups, quite substantial differences between the two groups are emerging in terms of ratings of family impact or burden of injury. Whereas the distress of families of orthopedically injured children has begun to diminish by the first follow-up, the distress of families of children with TBI has not. The GCRC psychometrist assists with the follow-up assessments.
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