The objective of this proposal is to perform prospective longitudinal neurobehavioral follow-up studies of children ages 0-71 months who sustained either accidental (n=30) or nonaccidental (e.g., physical abuse traumatic brain injuries (n=30). A major challenge in studying developmental outcomes of child maltreatment is separation of the specific effects of maltreatment from the general effects of adverse socioenvironmental conditions. There are few studies of the role of CNS injury in physically abused children and little influence of environmental factors on cognitive and behavioral outcomes, comparison groups of children who (1) sustained physical abuse without CNS involvement (n=30) and (2) normal controls (n=30) will be evaluated. Intelligence, motor, receptive and expressive language, adaptive behavior, social competence, exploratory play, and behavioral disturbance will be evaluated during the initial hospitalization as well as 3 and 12 months following resolution of post-traumatic amnesia to determine the influence of cerebral injury on cognitive, social, and motor development. MRI will be obtained to document locus and type of CNS insult. Parental adjustment and a variety of environmental process variables will be evaluated to determine whether these variables moderate or buffer the effect of cerebral injury in very young children. Of particular interest is whether brain injury and adverse environmental circumstances have an additive or an interactive effect on development. This study will permit evaluation of (1) the relationship of neuropsychological outcome data to indices of acute and secondary brain injury; (2) the nature of impaired cognitive and behavioral functioning following accidental versus nonaccidental brain injury; (3) changes in the rate of skill development over time; (4) the influence of age at the time of brain injury on acute neuropathological findings and developmental outcome; and (5) family, and environmental data through a multidimensional model, the effects of accidental and nonaccidental head injury on the degree and rate of development can be addressed in the context of issues concerning recovery of function after early brain injury.
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