Fact Sheet: Traumatic Brain Injury in Children and Adolescents

Traumatic brain injury (TBI) is diagnosed when a blow to the head or a penetrating head injury results in disruption of normal brain functioning. A TBI can be mild, moderate or severe in nature, depending on the degree of alteration in a child or adolescent’s acute mental status. Individuals who sustain mild to moderate TBI may experience only a brief change in mental status whereas a lengthy period of amnesia and/or unconsciousness may occur in those that experience a severe injury.

Prevalence and Course

More than 500,000 youth in the United States sustain TBI each year; it is the leading cause of death and disability in children. The course can vary greatly depending on severity of injury. Children sustaining mild TBI may have few, if any, residual symptoms; however, a subsample of youth can have persistent consequences. Children with more severe or penetrating injuries may experience adverse long-term changes in functioning.

Health and Psychosocial Consequences

Children who have sustained TBI can experience a variety of symptoms, including headaches, coordination problems, and sensory abnormalities; deficits in attention, memory, and executive functioning; and learning, psychiatric and behavioral disorders.

Evidence-based Assessment

Severity of TBI is most commonly assessed using the Glasgow Coma Scale, as well as other indicators of injury severity such as duration of unconsciousness and neuroimaging findings. A comprehensive neuropsychological assessment that evaluates intellectual functioning, attention, memory, executive functioning, and language abilities is recommended to identify potential deficits and facilitate school re-entry. Injuries in younger children may have cognitive and/or behavioral consequences that are not apparent until the child is older and more advanced executive and social skills are required. Thus, long-term followup is warranted. The sequelae of TBI overlap with other conditions (e.g., ADHD) and symptoms (e.g., sleep disturbances, pain); thus, accurate history taking is critical for identification and intervention.

Culture, Diversity, Demographic and Developmental Factors

National data reveal increased risk of TBI in children under the age of 4 and older adolescents ages 15 to 19 years, and for males as compared to females. However, there are sports (e.g., lacrosse, horse jumping, field hockey) where young women are at higher risk than boys beyond simple participation rates. Low socioeconomic status and familial dysfunction also may negatively influence behavior in children with TBI. Finally, younger age and greater severity of injury are associated with worse functional outcomes.

Evidence-based Interventions

Few psychological interventions for youth with TBI have been evaluated in randomized clinical trials. However, findings from the extant literature indicate that applied behavior analysis (ABA), positive behavioral interventions, and metacognitive training in the areas of attention, memory, and problem-solving abilities, as well as self-monitoring and self-regulation, may provide benefit.

References

Centers for Disease Control (CDC). (2012). Injury prevention & control: Traumatic brain injury.

Faul, M., Xu, L., Wald, M.M., & Coronado, V.G. (2010). Traumatic brain injury in the United States: Emergency department visits, hospitalizations and deaths 2002-2006. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

Catroppa, C., Anderson, V.A., Morse, S.A., Haritou, F., & Rosenfeld, J.V. (2008). Outcome and predictors of functional recovery five years following pediatric traumatic brain injury. Journal of Pediatric Psychology, 33(7), 707-718.

Wade, S. L., Walz, N.C., & Bosques, G. (2009). Pediatric traumatic brain injury and spinal cord injury. In M. C. Roberts & R. G. Steele (Eds.), Handbook of pediatric psychology, Fourth Edition (pp. 334-349). New York: The Guilford Press.

Yeates, K.O. (2010). Mild traumatic brain injury and postconcussive symptoms in children and adolescents. Journal of the International Neuropsychological Society, 16, 953-960.