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More to the story than executive function: Effortful control soon after injury predicts long-term functional and social outcomes following pediatric traumatic brain injury in young children

Published online by Cambridge University Press:  14 September 2022

Julia Smith-Paine ,
Emily L. Moscato Open the ORCID record for Emily L. Moscato [Opens in a new window] ,
Megan E. Narad ,
Josh Sensenbaugh ,
Brandt Ling ,
H. Gerry Taylor ,
Terry Stancin ,
Keith Owen Yeates  and
Shari L. Wade
Julia Smith-Paine
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
Emily L. Moscato
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, USA University of Cincinnati, Cincinnati, USA
Megan E. Narad
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, USA University of Cincinnati, Cincinnati, USA
Josh Sensenbaugh
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, USA Wright State University, Dayton, USA
Brandt Ling
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, USA Wright State University, Dayton, USA
H. Gerry Taylor
Affiliation:
Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
Terry Stancin
Affiliation:
Case Western Reserve University, Cleveland, USA MetroHealth Medical Center, Cleveland, USA
Keith Owen Yeates
Affiliation:
University of Calgary, Calgary, Canada
Shari L. Wade*
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, USA University of Cincinnati, Cincinnati, USA
*
Corresponding author: Shari L. Wade, email: shari.wade@cchmc.org
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Abstract

Objective:

To examine the impact of early traumatic brain injury (TBI) on effortful control (EC) over time and the relationship of EC and executive functioning (EF) to long-term functional and social outcomes.

Method:

Parents of children (N = 206, ages 3–7) with moderate-to-severe TBI or orthopedic injuries (OIs) rated EC using the Child Behavior Questionnaire at 1 (pre-injury), 6, 12, and 18 months post-injury. Child functioning and social competence were assessed at 7 years post-injury. Mixed models examined the effects of injury, time since injury, and their interaction on EC. General linear models examined the associations of pre-injury EC and EC at 18 months with long-term functional and social outcomes. Models controlled for EF to assess the unique contribution of EC to outcomes.

Results:

Children with severe TBI had significantly lower EC than both the OI and moderate TBI groups at each post-injury time point. Both pre-injury and 18-month EC were associated with long-term outcomes. Among those with low EC at baseline, children with moderate and severe TBI had more functional impairment than those with OI; however, no group differences were noted at high levels of EC. EC had main effects on parent-reported social competence that did not vary by injury type.

Conclusions:

Findings suggest that EC is sensitive to TBI effects and is a unique predictor of functional outcomes, independent of EF. High EC could serve as a protective factor, and as such measures of EC could be used to identify children for more intensive intervention.

Keywords

brain injuryself-regulationexecutive functionbrain injuries – traumaticsocial adjustmentsocial competence
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 29 , Issue 4 , May 2023 , pp. 325 - 335
Copyright
Copyright © INS. Published by Cambridge University Press, 2022

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