Review Paper

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  • The prevalence of childhood TBI’s, which is defined as those between 0-14 years of age, is staggering. In fact a Centers for Disease Control and Prevention 2000report states:Each year traumatic brain injury results in an estimated3,000 deaths29,000 hospitalizations400,000 emergency department visits (http://www.cdc.gov/traumaticbraininjury/assessing_outcomes_in_children.html#3)
  • When it comes to the recovery process of pediatric patients who have previously suffered from a TBI, Anderson et al. (2006) found that both current family functioning and the status of pre-injury family functioning ultimately influenced the child’s long-term post injury prognosis. Their evidence supported the notion that “children with severe injuries from socially disadvantaged families are at greatest risk of poor outcome” (p. 55). Interestingly, in areas such as educational and memory function, overall adaptive abilities and injury severity had a significant influence, while psychosocial factors were reported as less influential. The strength of this study was its longitudinal design spanning over a 30-month period. The weaknesses of this report were a small sample size used, and the use of parental questionnaires, which may have contained biased viewpoints.
  • On the other hand, authors Catroppa, Anderson, Morse, Haritou, and Rosenfeld (2008) reported findings of SES and family functioning to be less significant, while injury severity and pre-injury cognitive and behavioral status to be the main contributors to overall recovery and functioning post-injury. Surprisingly however, performance recorded on math abilities did appear to be related to SES and family intimacy implying that “parental educational levels or degree of support in the family” (p. 715) influenced this specific area of testing. The strengths of this study were the inclusion of preschool children and its longitudinal design spanning over 5 years post injury. This reports weaknesses were a small sample size limiting the statistical options, and having only one parent and/or caregiver reporting on the child instead of gaining multiple feedbacks to compile together.
  • While conversely, Chapman et al. (2010) found variables such as “SES, family functioning, and permissible parenting style as significant” (p.55) influencers during the recovery process. Likewise, these influences, when less than desirable, can negatively influence the child’s behavior and overall executive functioning. This reciprocal occurrence of parenting style, and the child’s overall behavior patterns, leads one to question where does it originate, with the child’s injury or with the overall family environment? The strengths of this study were that researchers explored the post injury effects on early childhood, an area lacking in reported measures, and examined the children’s executive functioning as well as behavioral patterns. The weaknesses of this report were parental questionnaires and potential bias, and the variations of tests given across age groups as no one test was given as a standard measure.
  • Incidentally, authors Kinsella, Ong, Murtagh, Prior, and Sawyer (1999) discovered a reciprocal relationship between families that reported an increase in negative childhood behavioral problems two years following a TBI, and greater overall family dysfunction. The strength of this study was the use of time increments such as an assessment at 3 months, 1 year, and 2 years post-injury. The weaknesses were potential rater bias because researchers had the foreknowledge of the child’s diagnosis, and the parental bias potential when answering the questionnaires.
  • Furthermore, Potter et al. (2011) reported a direct correlation between parenting styles and behavioral outcomes in children following a TBI. It was discovered that authoritarian and permissive parenting styles negatively influenced the child’s overall executive functioning and behavioral dysfunctions, while on the other hand authoritative parenting styles enhanced and encouraged the development of healthy executive functions. Remarkably, these differences in parenting styles and their influences did not show up during the first 6 months post injury, possibly due to the natural healing process the children underwent. The strengths of this report were focused on the direct result of parenting styles and executive functioning, an area with limited support and awareness. The weakness of this study was in the small sample size that was utilized.
  • Likewise, authors Sesma, Slomine, Ding, and McCarthy (2008) reported finding a direct correlation to lower SES, (i.e. families using Medicaid insurance) and an increased caregiver report of childhood executive dysfunction. Furthermore, the greater the overall family dysfunction reported, the lower the children performed on measures of verbal, memory, and math skills. The strength of this report was the utilization of the Behavior Rating Inventory of Executive Function (BRIEF) measure, which records the events during the child’s daily activities. This measurement has been demonstrated as a reliable and valid measure of both the developing child, and children who have suffered a TBI. The weaknesses of this report were related to parental bias when answering a questionnaire and that the information was collected retrospectively.
  • Continuing on, Taylor et al. (2002) reported on the long-term recovery process following a childhood TBI and found that there was “little evidence of recovery after the 1st post-injury year” (p.22). Interestingly, when looking at family influences, these researchers found evidence of short-term catch-up growth in math when the family environment was ideal, healthy, and supportive. Conversely, it was discovered that a long-term decline in academic performance was noticeable in “children from more disadvantaged backgrounds” (p.22). The strengths of this study included an orthopedic injury group of children for comparison and both short-term and long-term phases of recovery were recorded. The weakness of this study was that the attrition rate was high for lower SES children possibly affecting the overall results.
  • Sadly, Wade et al. (2008) found that the parent-child relationship demonstrated a disruption after the brain injury was sustained and that the relationship perpetually demonstrated distress and impairment as the recovery process moved forward based on injury severity. Surprisingly, the injury severity accounted for more variance in parental warmness than both race and SES combined. The strengths of this study were that researchers used an observational approach when coding parent-child relationships instead of relying on biased questionnaires. The weakness of this report is that the parent-child relationships may have differed before injury making it difficult to gage these results.
  • Additionally, Wade et al. (2011) found statistical evidence on the correlation between lower SES family environments and higher levels of post-injury behavioral problems. Furthermore, parental responsiveness appeared directly related to children exhibiting issues with internalizing and externalizing behaviors, regardless of “race, SES, parental distress, and family functioning” (p.130). Additionally, these researchers discovered that parental negativity also increased externalized behavioral issues as well as increasing ADHD symptoms. The strength of this report was including a comparison group of orthopedic injured children to contrast with children who suffered from a TBI. The weaknesses were potential coder bias during the interview as some were able to determine the child’s diagnosis based on a visible cast.
  • Finally, Yeates, Taylor, Walz, and Stancin (2010) explored the family environment concerning its impact on recovery from childhood TBI. These researchers found “better family functioning predicted better behavioral adjustment at 18 months post-injury” (p.352). Furthermore, they agreed with the previous findings on the impact of parenting style on recovery whereas authoritative parenting was associated with better overall social competence. Remarkably, these findings stood true across both groups of children, those post TBI and those with orthopedic injuries. The strengths of this study were that researchers followed up in three separate time increments, the first at 6 months, the second at 12 months, and the last at 18 months. The weakness of this study was the use of various measurements as the test given varied based on child’s age.
  • Most of the above reports support the notion that the overall family unit and its daily functioning abilities can enhance and/or hinder the recovery outcomes in children who suffer from a TBI. Intriguingly, a new pattern has emerged and that is the discovery of the impact parenting styles can have on recovering children. Of all the above reports, only one failed to find the impact of SES and family functioning as significantly related to the recovery process as all other factors. Instead, Catroppa et al. (2008) found that injury severity was the only statistically significant factor.
  • Review Paper

    1. 1. Renee SanduskyAdvanced General Psychology 492 Instructor Dr. Darcel Harris Argosy University
    2. 2. Thousands of children receive a diagnosis of traumatic brain injury(TBI) every year (Wade, Cassedy, Walz, Taylor, Stancin, & Yeates,2011). Many studies have previously reported on a child’s overallrecovery process and the potential for long-term post injurybehavioral disorders. The purpose of this literature review is toidentify and evaluate psychosocial attributes that can help enhanceand encourage the overall recovery process, as well as ascertain thevariables that help decrease dysfunctional behaviors in a child whohas undergone a TBI. Several previous peer-reviewed researcharticles were obtained that directly reported on the topic ofchildhood TBI, and the recovery outcomes documented duringvarious time increments. The cumulative findings support thenotion that many psychosocial elements such as familyfunctioning, parenting styles, and overall parent-childrelationships can influence a child’s recovery potential.Implications for future research are assessing the value,enhancement, or hindrance of sibling relationships on a childrecovering from a TBI.
    3. 3. One of the highest causes of death anddisability among children today is dueto obtaining a traumatic brain injury(TBI) (Wade et al., 2011). The recoveryprocess and overall prognosis variesfrom child to child and are influencedby many factors. Several independentstudies highlight significant elements,which can either enhance or inhibit thechild’s full recovery potential. Outsideof the medical requirements andrehabilitation, little has been compliedto educate social services, medicalpersonnel, family members, and eventhe public on the psychosocial elementsthat help, hinder, or otherwise impedethe recovery process. I believe gainingthis insight can help empowercaregivers and offer aid during this verydifficult time in their lives.
    4. 4. When it comes to psychosocial elements…..…what helps or hinders the recovery process?
    5. 5.  Anderson et al. (2006) found that both current family functioning and the status of pre-injury family functioning ultimately influenced the child’s long- term post injury prognosis
    6. 6.  Catroppa, Anderson, Morse, Haritou, and Rosenfeld (2008) reported findings of SES and family functioning to be less significant, while injury severity and pre-injury cognitive and behavioral status to be the main contributors to overall recovery and functioning post- injury
    7. 7.  Chapman et al. (2010) found variables such as “SES, family functioning, and permissible parenting style as significant” (p.55) influencers during the recovery process.
    8. 8.  Negative childhood    Negative family behaviors functioning Kinsella, Ong, Murtagh, Prior, and Sawyer (1999) discovered a reciprocal relationship between families that reported an increase in negative childhood behavioral problems two years following a TBI, and greater overall family dysfunction.
    9. 9.  Potter et al. (2011) reported a direct correlation between parenting styles and behavioral outcomes in children following a TBI.
    10. 10.  Sesma, Slomine, Ding, and McCarthy (2008) reported finding a direct correlation to lower SES, (i.e. families using Medicaid insurance) and an increased caregiver report of childhood executive dysfunction.(http://berkeley.edu/news/media/releases/2008/12/02_cortex.shtml)
    11. 11.  Taylor et al. (2002) found that when looking at family influences, there is evidence of short-term catch-up growth in math when the family environment was ideal, healthy, and supportive.
    12. 12.  Wade et al. (2008) found that the parent-child relationship demonstrated a disruption after injury and perpetually demonstrated distress and impairment as the recovery process moved forward.
    13. 13. Dysfunctional behaviors Family increases SES as….. decreases Wade et al. (2011) found statistical evidence on the correlation between lower SES family environments and higher levels of post-injury behavioral problems.
    14. 14.  Yeates, Taylor, Walz, and Stancin (2010) found “better family functioning predicted better behavioral adjustment at 18 months post-injury” (p.352).
    15. 15. Common Themes:Psychosocial factors do in fact influence a child’s recovery potential! Elements such as:  Parental involvement  Parental warmness  Family functioning  Parenting styles  SES level All are variables that can help or hinder a child’s recovery!
    16. 16. Implications and Future Research Looking towards the futuremore information is needed todetermine if early identification andintervention of these potentiallyharmful and/or hindering elementscan, and to what extent, make a long-term difference in a child reachingtheir full recovery potential. Someaspects to further consider are theroles of siblings, and the impact thisrelationship may have on the child’srecovery capacity.
    17. 17. In this circle of parent-child relationships and post-injury behavioral issues, how does the sibling variablefit, if at all?
    18. 18. Thank you!
    19. 19. References Anderson, V. A., Catroppa, C., Dudgeon, P., Morse, S. A., Haritou, F., & Rosenfeld, J. V. (2006). Understanding predictors of functional recovery and outcome 30 months following early childhood head injury. Neuropsychology, 20 (1), 42-57. Catroppa, C., Anderson, V. A., Morse, S. A., Haritou, F., & Rosenfeld, J. V. (2008). Outcome and predictors of functional recovery 5 years following pediatric traumatic brain injury. Journal of Pediatric Psychology, 33 (7), 707-718. Chapman, L. A., Wade, S. L., Walz, N. C., Taylor, H. G., Stancin, T., & Yeates, K. O. (2010). Clinically significant behavior problems during the initial 18 months following early childhood traumatic brain injury. Rehabilitation Psychology, 55 (1), 48-57.
    20. 20.  Kinsella, G., Ong, B., Murtagh, D., Prior, M., & Sawyer, M. (1999). The role of the family for behavioral outcome in children and adolescents following traumatic brain injury. Journal of Consulting and Clinical Psychology, 67 (1), 116-123. Potter, J. L., Wade, S. L., Walz, N. C., Cassedy, A., Stevens, M. H., Yeates, K. O., & Taylor, H. G. (2011). Parenting style is related to executive dysfunction after brain injury in children. Rehabilitation Psychology, 1-8. Sesma, H. W., Slomine, B. S., Ding, R., & McCarthy, M. L. (2008). Executive functioning in the first year after pediatric traumatic brain injury. Pediatrics, 121 (6), 1686-1695. Taylor, H. G., Yeates, K. O., Wade, S. L., Drotar, D., Stancin, T., & Minich, N. (2002). A prospective study of short- and long-term outcomes after traumatic brain injury in children: Behavior and achievement. Neuropsychology, 16 (1), 15- 27.
    21. 21.  Wade, S. L., Cassedy, A., Walz, N. C., Taylor, H. G., Stancin, T., & Yeates, K. O. (2011). The relationship of parental warm responsiveness and negativity to emerging behavior problems following traumatic brain injury in young children. Developmental Psychology, 47 (1), 119-133. Wade, S. L., Taylor, H. G., Walz, N. C., Salisbury, S., Stancin, T., Bernard, L. A., Oberjohn, K., & Yeates, K.O. (2008). Parent-child interactions during the initial weeks following brain injury in young children. Rehabilitation Psychology, 53 (2), 180-190. Yeates, K. O., Taylor, H., Walz, N. C., & Stancin, T. (2010). The family environment as a moderator of psychosocial outcomes following traumatic brain injury in young children. Neuropsychology, 24 (3), 345-356.

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