Dissertation

Investigating the Relationship between Parental Responsiveness and Outcomes of Very Early Traumatic Brain Injury

LeBlond, Elizabeth

2019

Overview

Pediatric traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children and adolescents. In 2013, over 300,000 children under the age of 5 years presented to emergency departments with a TBI. Very young children (= 3years old) have double the risk of experiencing a TBI than older children. These very young children are at risk for more severe injuries due to both anatomical and environmental factors. Despite the high prevalence of injury in this population, they have traditionally been understudied. TBI in older children and adolescents is associated with deficits across a wide variety of areas, many of which may not become problematic until children have reached school age and are required to take on additional cognitive load. This, in addition to the fact that TBI can be difficult to identify and that young children are more difficult to assess in general when compared to older children and adolescents, may be one of the factors that has led to the majority of research in TBI to focus on older children. Studies in these older populations have illustrated the importance of the family environment and parental warm responsiveness in influencing both cognitive and behavioral outcomes, while studies in this very young population have demonstrated the importance of more distal environmental factors (e.g., social capital.) The current study investigated the potential moderating effect of caregiver warm responsiveness on adaptive, developmental, and health-related quality of life outcome following TBI in 30 children aged 0-2 years old. After being recruited from the emergency department at CCHMC, families returned 1 and 6 months post-injury for follow up visits. Separate linear mixed models examined moderation effects. An interaction was found between injury severity and parental responsiveness on parent-reported fine motor functioning; children with moderate injury severity scored higher than those with a severe injury at low levels of parental responsiveness. This measure was comparable in both groups at high levels of parental responsiveness. An interaction between injury severity and parental responsiveness on general developmental functioning was also found. However, post-hoc analyses were not significant. Finally, a significant interaction between injury severity and parental responsiveness was found on HRQOL; children with moderate injury severity scored higher than those with a severe injury at low levels of parental responsiveness, a result that trended towards significance. HRQOL was similar in both groups at high levels of parental responsiveness. Within the severe group, HRQOL differed significantly between those with high versus low levels of parental responsiveness, children with responsive parents had significantly higher HRQOL than those with less responsive parents. Results indicate the importance of parental responsiveness in recovery from TBI in very young children. Specifically, results suggest that high levels of parental responsiveness are associated with better outcomes in children with both moderate and severe injuries. Additional research is warranted to continue investigating these outcomes in larger samples. As intervention studies in older populations have shown the impact of parental responsiveness on HRQOL, it is possible that similar interventions could be adapted for younger populations.

• Publisher: ProQuest Dissertations & Theses
• Subject: Individual & family studies / Neurosciences
• ISBN: 9781085657365, 1085657361