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Abstract
Traumatic brain injury in childhood causes increased stress levels in families and impacts
child-parent interactions as well as sibling outcomes. Participants include children who have a
TBI and their families and children who do not have a TBI and their families. The participants
are divided into an experimental group and a control group. Researchers observe family
interactions and score all participants using the Family Assessment Measure Version III. After
scores from each family and each group are obtained they can be compared and analyzed. It is
predicted that there will be a significant difference in FAM-III scores between the experimental
group and the control group. Implications from research include increased medical professional
knowledge of the effects of TBI on family interactions and thus, earlier interventions.
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Introduction to the Problem
Traumatic brain injury poses special challenges for the victim and for the family.
Traumatic brain injuries are often life-long injuries and individual prognosis is difficult to
determine due to the wide range of differences within each individual and the areas of the brain
that are injured. There are increased levels of stress in families who have been impacted by TBI.
When a child experiences a TBI their family goes through a great deal of stress and mental
anguish due to the injury.
According to Rollins, parents and families go through four themes or stages after their
child experiences a TBI (Rollins, 2013). These stages include being grateful that their child is
still alive, grieving for the child they knew, running on nerves, and finally, seeking to get the
child and the family’s needs met (Rollins, 2013). Pediatric traumatic brain injury typically occurs
within two distinct age groups, toddlers and adolescents (Geyer, Meller, Kulpan, Mowery, 2013).
When TBI occurs in infants less than one year of age, child abuse is usually the cause (Geyer et
al., 2013). Falls and motor vehicle crashes are leading causes of TBI in later childhood and
adolescence (Geyer et al., 2013). TBI is categorized into three groups including mild, moderate,
and severe (Geyer et al., 2013). The Glasgow Coma Scale helps determine which category a
patient falls into (Geyer et al., 2013). To be considered in the mild category the Glasgow Coma
Scale score must be thirteen or higher; loss of consciousness and physical and cognitive
impairments along with a Glasgow Coma Scale score of nine to twelve categorizes a moderate
brain injury and a score of less than eight and airway and hemodynamic support categorizes a
severe brain injury (Geyer et al., 2013).
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Research Question, Hypothesis, and Variables
There may be changes to family dynamics after a child has suffered a Traumatic Brain
Injury (TBI), specifically changes in stress levels and interactions between parents and children.
Sibling outcomes are also impacted. It is hypothesized that traumatic brain injuries sustained in
childhood impact child-parent interactions and sibling outcomes. In this study the independent
variable is the TBI. Participants will either have TBI or not, the level of injury does not matter in
this study. The dependent variable is the child-parent interactions and sibling outcomes. Other
considerations include extraneous variables which may include child, parent, and sibling
relationships prior to the TBI. A moderator variable in this study may include economic
conditions in each family unit that participates in the study.
Literature Review
There is not an abundance of data on the effects on families following a TBI. Previous
studies have shown greater levels of injury-related stress among parents whose children have
experienced a severe TBI (Drotar, Stancin, Taylor, Wade, Owen, 1998). The sample size in this
study is relatively small, future research should include a larger and more diverse sample.
TBI causes complex challenges within family functioning. Historically studies have
investigated family functioning by indirect assessment (Fairbanks, Brown, Cassedy, Taylor,
Yeates, 2013). The data collected in this study was only collected during free play activities and
six months post-injury (Fairbanks et al., 2013). Future studies should include data after six
months post injury and during other activities as well.
Unilateral brain injury can impact reading comprehension and school achievement
(Demir, Fisher, Goldin-Meadows, Levine, 2014). There is still little knowledge of memory and
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retelling ability in children with a unilateral brain injury. Narrative skills in kindergarten have
been proven to be a reliable predictor of later school success and reading comprehension (Demir
et al., 2014). There are other factors that need to be taken into consideration when assessing
retelling and reading comprehension such as the severity and placement of the brain injury.
Longitudinal studies need to be conducted to compare results and determine accuracy of this
study.
There may be a significant link between affective state and depression among individuals
with TBI. Previous studies have shown a relationship between this (Juengst, Arenth, Whyte,
Skidmore, 2014). Prior mental illness and full family histories must be taken into consideration
when choosing participants. Further research should include larger sample sizes and longitudinal
studies to compare the effects of TBI on affective state and depression.
Internet based therapy and interventions are gaining popularity. The problem solving
intervention method, Counselor-Assisted Problem-Solving, is examined for efficiency in
improving caregiver adaptation after a TBI (Wade, Karver, Taylor, Cassedy, Stancin, 2014).
These types of internet based therapy methods have been associated with a reduction in caregiver
distress surrounding TBI (Wade et al., 2014). This study only included a small and very specific
sample group. Research in the future should include a larger and more diverse sample to provide
more ability to generalize the results.
Movement exercises have been helpful in the past for treating TBI. One study seeks to
determine which treatment interventions are most successful in improving community
integration for individuals with TBI (Elias, Talbot, Weider, 2012). Bodily-kinesthetic
movements help produce and strengthen neural pathways (Elias, Talbot, Weider, 2012). The data
is difficult to collect, there needs to be a more standardized way to collect the data.
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Ethical Considerations
This study involves an experimental group that includes children who have a TBI and
their families and a control group which includes children who do not have a TBI and their
families. The study will examine the interactions between the parent and the child, and how the
siblings of the TBI are affected. Informed consent is necessary as well as debriefing. If the
families are aware of the intent of the study, to measure interactions, they may act differently
when being observed which would make the data inaccurate. There are also special
considerations since many of the participants will be children. This requires parental consent and
child consent as well as keeping all participants knowledgeable about the study and what to
expect. See informed consent forms in Appendix.
Proposed Method
This study consists of two groups, an experimental group and a control group. The
experimental group consists of children who have TBI and their families. The control group
consists of children who do not have TBI and their families. The inclusion criterion includes a
physician’s explanation of a child’s TBI or an explanation that they are in good health standing,
depending on which group they will be in. The children in the experimental group need to have a
TBI and the children in the control group have to be typically developing children. There will be
a small group of researchers working on the study to collect data and work with participants.
Quota sampling will be used. Participants will be selected that have the desired
characteristics, in this case TBI and typically developing children. This sampling method is
useful and realistic and will allow researchers to collect accurate data that will be helpful for this
study and further research. Stratified sampling will also be used to ensure a diverse sample of
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participants with different backgrounds, including socio-economic class and reason for injury are
chosen.
The Family Assessment Measure Version III will be used in this study. The FAM-III
assesses characteristics and process of families that have a disabled family member (Skinner,
Steinhauer, Santa Barbara, 1993-95). It consists of three scales including general, self-rating, and
dyadic relationship (Skinner, Steinhauer, Santa Barbara, 1993-95). Each question within the
assessment is converted into a numerical value and then calculated into a score, the core is given
a color code and profile (Skinner, Steinhauer, Santa Barbara, 1993-95). Each family member can
be assessed and each score can be compared to one another and charted on a family profile
(Skinner, Steinhauer, Santa Barbara, 1993-95). In this study, all participants will be assessed
using the FAM-III. Scores and family profiles from both the experimental group and the control
group will be compared to determine any differences between the two groups. This would give a
detailed and thorough picture of family interactions and feelings. Although thorough and
comprehensive, family members may not be completely honest when answering the questions
therefore the data collected may not be accurate.
To increase reliability in this study a large number of participants are needed and a large
number of observations will be conducted. The FAM-III will allow for standardized and accurate
measuring of interactions between children and their families. To increase validity, both the
experimental and control groups will be compared to determine if there is a difference in child-
family interaction between the two groups.
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Expected Findings and Discussion
Both descriptive and inferential statistics will be used in this study. Descriptive statistics
will be used to describe the data. Family behavioral scores and profiles will be averaged and
examined. Inferential statistics will be used to take the descriptive statistics and use them to test
the hypothesis. It is hypothesized that there will be a significant difference between the
experimental and control groups on the dependent variable, family interactions, this will be
measured by the FAM-III. A t-test will be used to compare the experimental group FAM-III
mean score and the control group FAM-III mean score.
This study expects to find that there are significant differences in family interactions in
the experimental group and control group. These differences could be attributed to increased
stress in the experimental group. When collecting data and making conclusions based on that
data, it is important to consider that it may not be completely accurate due to the participants
being aware that they are being observed and scored using the FAM-III.
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References
Demir, O.E., Fisher, J.A., Goldin-Meadows, S., Levine, S.C. (2014). Narrative processing in
typically developing children and children with early unilateral brain injury: Seeing
gesture matters. Developmental Psychology, 50.3, 815-828. Retrieved from ProQuest.
Drotar, D., Stancin, T., Taylor, H.G., Wade, S.L., Owen, K. (1998). Family burden and
adaptation during the initial year after traumatic brain injury in children. Pediatrics,
102.1, 110. Retrieved from Academic OneFile.
Elias, E., Talbot, M.B., Weider, K. (2012). Therapeutic dance and movement: A holistic
treatment modality for individuals with traumatic brain injury. The Exceptional Parent,
42.3, 45. Retrieved from INFOTRAC.
Fairbanks, J.M., Brown, T.M., Cassedy, A., Taylor, H.G., Yeates, K.O. (2013). Maternal warm
responsiveness and negativity following traumatic brain injury in young children.
Rehabilitation Psychology, 58.3, 223-232. Retrieved from ProQuest.
Geyer, K., Meller, K., Kulpan, C., Mowery, B.D. (2013). Traumatic brain injury in children:
Acute care management. Pediatric Nursing, 39.6, 283. Retrieved from Academic
OneFile.
Juengst, S.B., Arenth, P.M., Whyte, E.M., Skidmore, E.R. (2014). Brief report of affective state
and depression status after traumatic brain injury. Rehabilitation Psychology. Retrieved
from ProQuest.
Rollins, J.A. (2013). Pediatric traumatic brain injury: A brief look at the parent perspective.
Pediatric Nursing, 39.6, 273. Retrieved from Academic OneFile.
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Skinner, H.A., Steinhauer, P.D., Santa Barbara, J. (1993-95). Family assessment measure version
III. Multi-Health Systems, Inc. Retrieved from Mental Measurements Yearbook.
Wade, S.L., Karver, C.L., Taylor, H.G., Cassedy, A., Stancin, T. (2014). Counselor-assisted
problem solving improves caregiver efficacy following adolescent brain injury.
Rehabilitation Psychology, 59.1, 1-9. Retrieved from ProQuest.
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Appendix
Informed Consent Form
To Whom It May Concern:
Baker College Online is conducting research involving children who have experienced a
traumatic brain injury. The purpose of the study is to examine child and family interactions and
outcomes following a TBI. Your participation is voluntary but would be greatly appreciated and
help the psychology research department gain valuable insight into the topic.
There will be two groups of participants involved in the study. One group will include
children and their families with TBI; one group will include children and their families who do
not have TBI. The groups will be in a room that is equipped with various toys and activities and
your child will never have to be separated from you. If at any time you or your child becomes
uncomfortable, you may leave the study.
If you would like additional information concerning the study, or if you have any other
questions please contact us. Your participation would be appreciated and helpful. Thank you for
your time and consideration, we look forward to hearing from you.
Sincerely,
Baker College Online Psychology and Research Department
(555) 555-5555
I give permission for my child and I to participate in the above addressed research study.
______________________ ______________
Parent/Guardian Signature Date
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Child Informed Consent Form
I, ____________, understand that mom and dad have said that it is okay for me to participate in a
project about families under the direction of the researchers. I am taking part because I want to. I
have been told that I can stop at any time I want to and nothing will happen to me if I want to
stop.
______________________ ________________________ _____________
Signature Witness by Parent/Guardian Date
