TBI in Early Childhood: Impact of Early Intervention on Childhood Development

TBI in Early Childhood: Impact of Early Intervention on Childhood Development Traumatic brain injury (TBI) is a growing concern for children in their preschool years. Children of young ages undergo many developmental changes during the ages of two through five. These changes are significant for their growth and maturity. They include cognitive, social, and behavioral development as well as development in executive functioning. Sustaining a traumatic brain injury during these years can pose as a direct risk of developmental deficits in any or all of these areas. After an extensive literature review, it was found that most of the previous research resulted in areas of consensus. These areas compare the how TBI severity and the age of the TBI effect developmental. Results from multiple studies show that the more sever the TBI, the more prevalent the developmental deficiencies (Gerrard-Morris, A., Taylor, H., Yeates, K., Walz, N., Stancin, T., Minich, N., & Wade, S., 2009; McKinlay, A., Grace, R., Horward, L., Fergusson, D., & MacFarlane, M., 2008; Morse, S., Haritou, F., Ong, K., Anderson, V., Catroppa, C., & Rosenfeld, J., 1999; Taylor, H., Swartwout, M., Yeates, K., Walz, N., Stancin, T., & Wade, S., 2008). It is also found that children injured in early childhood are more vulnerable to developmental deficits, According to Taylor et. al (2008), a younger age at the time of injury is a predictor of worse outcomes. Although many researchers in this field have shared the previous findings, there have also been gaps in research on the topic of childhood TBI and development. Certain discrepancies include effects of family characteristics on development following TBI, and effects of TBI on language performance. Previous research has included child and family demographic information when assessing a possible relationship with TBI recovery, however, most of these measured relied on parental questionnaires versus actual at home observation. A study done by Gerrard-Morris et. al (2009), on the other hand, did include extensive family observation. In this study, they used family environment to predict cognitive outcomes following TBI. In order to measure family environment, they used a HOME assessment (Home Observation Measurement for Family Environment). This assessment was used to evaluate the parental stimulation and the parental support to the child. The observations were video-taped so they could be later referenced. Using this extensive observation as a measurement on effect of TBI recovery made the results more reliable. The results showed that families that exhibited more support and received higher observation ratings had more of a positive impact on their child’s TBI recovery in relation to cognitive development. Other studies have attempted to measure family environment and did not find the same statistically significant results. This was due to the fact that their measurement device used to measure family environment created a limitation because it was not accurate enough. Another discrepancy in the research findings includes the effects of childhood TBI on language development. A very detailed study performed by Morse et. al (1999) examined anguage performance following a traumatic brain injury This study consisted of 15 participants ages 4-6, who had experienced a TBI. The researchers measured the effects of the severity and the age of TBI on language performance. Severity was measured using the Glasgow Coma Scale (GCS) and images from CT and MRI scans. Each participant was involved in a pre-injury functionality screening called the Vineland Adaptive Behavior Scale (VABS). This was a questionnaire completed by the parents that was used to measure the child’s abilities before the injury in comparison to post-injury, however, there was no statistically significant result found from this assessment. All participants also underwent a series of post injury assessments to measure language performance. These assessments measures both language performance and intellectually performance. Assessments that evaluated intellectual performance included the WPPSI-R, FIQ, PIQ, and VIQ. Assessments that measured language performance (both receptive and expressive) included the PPVT-R, TACL-R, EOWPT, and a Bus Story. Based upon data collected from these assessments, results showed that the more severe the TBI, the lower the scores on intellectual assessments and also the more significantly lower scores on verbal comprehension. Based upin the in-depth methodology of this study, it was seem as though these results would be reliable and representative of the population. However, because of the small sample size and the fact that post-injury assessments were only measured up to three months following the injury and based upon results in previous research, it is known that over time, new deficits in development can arise following TBI, it is impossible to deem these results reliable.

References
Gerrard-Morris, A., Taylor, H., Yeates, K., Walz, N., Stancin, T., Minich, N., & Wade, S. (2009). Cognitive development after traumatic brain injury in young children. Journal of the International Neuropsychological Society, 16(1), 157-169.
This study looked at post-injury cognitive development in young children with Traumatic Brain Injury compared to a group of young children with orthopedic injury. The focus of this study examined the role of the family environments in predicting cognitive outcomes. The study found that , while cognitive deficits persisted or emerged across follow-up, more optimal family environments were associated with higher scores for both groups.
Feeney, T., Ylvisaker, M. (2008). Context-sensitive cognitive-behavioral supports for young children with TBI. Journal of Positive Behavior Interventions, 10(2), 115-128. This article replicated four previous studies and investigated the effects of a multi-component cognitive-behavioral intervention that targeted challenging behavior of young children after traumatic brain injury. The frequency and intensity of aggressive behaviors decreased, and the amount of work accomplished increased in a single-subject reversal design study involving two elementary-age boys who had suffered TBI. Intervention was a combination of eight supports added to the daily routine.
McKinlay, A., Grace, R., Horward, L., Fergusson, D., & MacFarlane, M. (2008). Long-term behavioral outcomes of pre-school mild traumatic brain injury. Child: Care, Health, and Development, 36(1), 22-30.
According to Mckinlay et al. (2008), Mild Traumatic Brain Injury (MTBI) is a leading cause of injury for children during their preschool years. Data from an epidemiological study was used to examine behavioral effects associated with mild traumatic brain injury that occurred during the preschool years. For children who were treated and received inpatient care (indicating a more severe injury) there was evidence of increasing deficits over years 7-13.
Morse, S., Haritou, F., Ong, K., Anderson, V., Catroppa, C., & Rosenfeld, J. (1999). Early Effects of traumatic brain injury on young children’s language performance: a preliminary linguistic analysis. Journal Pediatric Rehabilitation, 3(4), 139-148.
This study compared the language abilities of 4- 6 year old children with varying degrees of severity of TBI. It was concluded that children with more severe TBI performed most poorly on language tasks. Evaluation of language was proposed as an important component regarding the follow up of the more severely injured children.
Taylor, H., Swartwout, M., Yeates, K., Walz, N., Stancin, T., & Wade, S. (2008). Traumatic brain injury in young children: Post acute effects on cognitive and school readiness skills. Journal of the International Neuropsychological Society, 1459), 734-746.
This study compared three groups of children with varying degrees of severity of TBI and a group of children with orthopedic injuries. The researchers concluded that TBI in early childhood has an adverse effect on cognitive and school-readiness skills. These adverse effects are related to the severity of the injury and the family environment.
Trudeau, N., Poulin-Dubois, D., & Joanette, Y. (2000). Language development following brain injury in early childhood: a longitudinal case study. International Journal of Language & Communication Disorders, 35(2), 227-249.
This article presents a case study that investigates TBI occurring in the second year of like and its impact on subsequent language development. Results found that despite an initial decrease in vocabulary there was no lasting significant impairment on any measure of grammatical development.
Walz, N., Yeates, K., Taylor, H., Stancin, T., & Wade, S. (2009). First-order theory of mind skills shortly after traumatic brain injury in 3- to 5- year old children. Developmental Neuropsychology, 34(4), 507-519.
The study focused on assessing Theory-of-Mind tasks in children who experience TBI in early childhood. Theory-of-Mind tasks measure a child’s ability to take another child’s point of view into account, and to use this information to understand and predict behavior. This study suggested that children who experience TBI in early childhood are more likely to demonstrate deficits in Theory-of-Mind skills. It also suggests that further research of this assessment group is required to see if Theory-of-Mind skills worsen, remain stable, or improve over time.
Wetherington, C., Hooper, S. (2006). Preschool traumatic brain injury: A review for the early childhood special educator. Exceptionality, 14(3), 155-170.
This article examines literature concerning the developmental outcomes of children who experience a TBI in early childhood. Because a TBI usually disrupts typical development, these authors recommend a developmental approach to address difficulties in overall abilities.
Ylvisaker, M., Turkstra, L., Coelho, C. (2005). Behavioral and social interventions for individuals with traumatic brain injury: A summary of the research and clinical implications. Seminars in Speech and Language, 26(4), 256-267.
This article provides a summary of research findings regarding intervention for disorders of behavioral self-regulation and social interactions and social competence after TBI. Two main approaches to behavioral intervention (applied behavior analysis and positive behavior supports) are described and compared. Research shows that social competence and behavior regulation are both commonly impaired by TBI. Evidence in both domains support intervention.

References
American Psychological Association (2009). Publication Manual of the American Psychological Association (6th ed.). Washington, DC: American Psychological Association.