Long-term Neuropsychological and Psychosocial Consequences of Pediatric Mild Traumatic Brain Injury
Date
2014-10
Authors
Makelki, Michelle Clareen
Journal Title
Journal ISSN
Volume Title
Publisher
Faculty of Graduate Studies and Research, University of Regina
Abstract
Traumatic brain injury (TBI) is a major health problem affecting thousands of
Canadians and their families each year. Little is known about the long-term
consequences of pediatric mild traumatic brain injury (MTBI) on psychological
functioning in adulthood. There are two major perspectives on this topic. The Kennard
Principle asserts that young brains are more plastic and thus better suited to compensate
following injury. The Early Vulnerability Hypothesis challenges this assertion with the
idea that early damage to the brain may have significant implications for emerging
cognitive and social skills. Executive function and social competence are skills that may
be especially vulnerable to impairment following head injury in children. Executive
function and social competence rely on frontal neural networks, which are particularly
vulnerable to damage from MTBI. As frontal regions underlying executive functions and
social competence are slower to mature, the outcome of these faculties following
pediatric TBI cannot be accurately assessed until brain maturity has been reached.
The present study thus examined the consequences of pediatric MTBI on
executive functions and social skills in adulthood. Participants were undergraduate
students from the University of Regina. A screening survey was administered to 1295
students to identify individuals with a history of head injury and those without. The
study sample consisted of 24 participants with a history of head injury (HI) and 29
participants with no history of head injury. The average age of both groups approximated
20 years and the average time since injury for the HI group was 10.5 years. A comprehensive battery of executive functioning, emotion recognition, and psychosocial
measures was administered to the participants.
The principal results of the study revealed a statistically significant difference
between the HI and Control group on the Global Deficit Score (GDS; a composite score
computed using 22 individual objective and demographically-corrected tests of cognitive
function), with the HI group also falling above the clinical cut-off for neuropsychological
impairment on this measure. In addition, the GDS demonstrated an overall moderate
level of diagnostic accuracy when evaluated using Receiver Operating Curve analysis. In
terms of the individual objective cognitive tests, the HI group performed significantly
more poorly on the PASAT compared to the Control group, suggesting particular
difficulties in the areas of auditory attention and working memory, findings characteristic
of executive dysfunction and the known pathophysiology of traumatic brain injury. On
the Neuropsychological Impairment Scale, a broad-based self-report measure, the HI
group endorsed significantly more symptoms of somatic and cognitive dysfunction than
the Control group. Taken together, these results are consistent with the Early
Vulnerability Hypothesis and suggest that childhood MTBI may be associated with subtle
objective deficits in executive function, along with elevated somatic and cognitive
symptomology in adulthood.
Description
A Thesis Submitted to the Faculty of Graduate Studies and Research In Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Clinical Psychology,
University of Regina. xv, 136 p.