Modeling of Longitudinal Academic Achievement Scores After Pediatric Traumatic Brain Injury

In a prospective longitudinal study, academic achievement scores were obtained from youth 5 to 15 years of age who sustained mild-moderate (n = 34) or severe (n = 43) traumatic brain injuries (TBI). Achievement scores were collected from baseline to 5 years following TBI and were subjected to individual growth curve analysis. The models fitted age at injury, years since injury, duration of impaired consciousness, and interaction effects to Reading Decoding, Reading Comprehension, Spelling, and Arithmetic standard scores. Although scores improved significantly over the follow-up relative to normative data from the standardization sample of the tests, children with severe TBI showed persistent deficits on all achievement scores in comparison to children with mild-moderate TBI. Interactions of the slope and age parameters for the Arithmetic and Reading Decoding scores indicated greater increases over time in achievement scores of the children injured at an older age, but deceleration in growth curves for the younger children with both mild-moderate and severe TBI. These results are compatible with the hypothesis that early brain injuries disrupt the acquisition of some academic skills. Hierarchical regression models revealed that indexes of academic achievement obtained 2 years following TBI had weak relations with the duration of impaired consciousness and socioeconomic status. In contrast, concurrent cognitive variables such as phonological processing and verbal memory accounted for more variability in academic scores. Given the significant and persistent decrement in basic academic skills in youth with severe TBI, it is clear that head-injured youth require intensive, long-term remediation and intervention not only of the academic skills themselves, but also of those cognitive abilities that support the development and maintenance of reading and math.     

Modeling of Longitudinal Academic Achievement Scores After Pediatric Traumatic Brain Injury

In a prospective longitudinal study, academic achievement scores were obtained from youth 5 to 15 years of age who sustained mild-moderate (n = 34) or severe (n = 43) traumatic brain injuries (TBI). Achievement scores were collected from baseline to 5 years following TBI and were subjected to individual growth curve analysis. The models fitted age at injury, years since injury, duration of impaired consciousness, and interaction effects to Reading Decoding, Reading Comprehension, Spelling, and Arithmetic standard scores. Although scores improved significantly over the follow-up relative to normative data from the standardization sample of the tests, children with severe TBI showed persistent deficits on all achievement scores in comparison to children with mild-moderate TBI. Interactions of the slope and age parameters for the Arithmetic and Reading Decoding scores indicated greater increases over time in achievement scores of the children injured at an older age, but deceleration in growth curves for the younger children with both mild-moderate and severe TBI. These results are compatible with the hypothesis that early brain injuries disrupt the acquisition of some academic skills. Hierarchical regression models revealed that indexes of academic achievement obtained 2 years following TBI had weak relations with the duration of impaired consciousness and socioeconomic status. In contrast, concurrent cognitive variables such as phonological processing and verbal memory accounted for more variability in academic scores. Given the significant and persistent decrement in basic academic skills in youth with severe TBI, it is clear that head-injured youth require intensive, long-term remediation and intervention not only of the academic skills themselves, but also of those cognitive abilities that support the development and maintenance of reading and math.     

A prospective study of short- and long-term outcomes after traumatic brain injury in children: behavior and achievement

Longitudinal behavior and achievement outcomes of traumatic brain injury (TBI) were investigated in 53 children with severe TBI, 56 children with moderate TBI, and 80 children with orthopedic injuries not involving brain insult. Measures of preinjury child and family status and of postinjury achievement skills were administered shortly after injury. Assessments were repeated 3 times across a mean follow-up interval of 4 years. Results from mixed model analysis revealed persisting sequelae of TBI. Recovery of math skills was observed in the severe TBI group but only for children from less stressed families. Social disadvantage in children with TBI predicted more adverse behavioral sequelae and less favorable changes in some outcome measures. The findings suggest that pediatric TBI has long-term effects on behavior and achievement but that postinjury progress is influenced by the family environment.     

A prospective study of short- and long-term neuropsychological outcomes after traumatic brain injury in children

Longitudinal neuropsychological outcomes of traumatic brain injury (TBI) were investigated in 53 children with severe TBI, 56 children with moderate TBI, and 80 children with orthopedic injuries only. Neuropsychological functioning was assessed at baseline, at 6- and 12-month follow-ups, and at an extended follow-up (a mean of 4 years postinjury). Mixed model analyses revealed persistent neuropsychological sequelae of TBI that generally did not vary as a function of time postinjury. Some recovery occurred during the first year postinjury, but recovery reached a plateau after that time, and deficits were still apparent at the extended follow-up. Further recovery was uncommon after the first year postinjury. Family factors did not moderate neuropsychological outcomes, despite their demonstrated influence on behavior and academic achievement after childhood TBI.     

Influences on first-year recovery from traumatic brain injury in children

This study examined recovery over the first year following traumatic brain injury (TBI) in children 6-12 years of age. Forty-two children with severe TBI and 52 with moderate TBI were compared to 58 children with orthopedic injuries. The children and their families were evaluated at a baseline assessment and at 6- and 12-month follow-ups. Findings documented cognitive, achievement, and behavioral sequelae of TBI, with only limited evidence for recovery over the first year postinjury. Outcomes were predicted by preinjury factors, TBI severity, and measures of the postinjury family environment. Some of the sequelae of severe TBI were more marked in the context of higher compared with lower levels of family burden or dysfunction. The findings confirm the need to consider environmental contributions to outcomes of TBI in children.     

Long-term behavior problems following pediatric traumatic brain injury: prevalence,predictors, and correlates

OBJECTIVE: To study identified rates of long-term behavior problems in children with traumatic brain injury (TBI) compared to children with only orthopedic injuries and risk factors and correlates for new behavior problems following TBI. METHODS: Sample included children with severe TBI (n = 42), moderate TBI (n = 41), and orthopedic injuries only (ORTHO;n = 50). The baseline assessment measured child behavior, adaptation, and neuropsychological, academic, and family functioning. Follow-ups were conducted at 6 and 12 months and at an extended follow-up a mean of 4 years after injury. RESULTS: The prevalence of caseness, defined as elevated behavior problem ratings, was higher in one or both TBI groups than in the ORTHO group at each follow-up (e.g., 36% of severe TBI group, 22% of moderate TBI group, and 10% of ORTHO group at extended follow-up). Most instances of postinjury-onset caseness at the extended follow-up were evident within the first year after TBI. Predictors were severe TBI, socioeconomic disadvantage, and preinjury behavioral concerns. Concurrent correlates included weakness in working memory and adaptive behavior skills, poorer behavior and school competence, and adverse family outcomes. CONCLUSIONS: Postinjury-onset caseness is persistent, risks are multifactorial, and correlates include child dysfunction and family sequelae.     

Discourse Macrolevel Processing After Severe Pediatric Traumatic Brain Injury

The purpose of this study was to determine if discourse macrolevel processing abilities differed between children with severe traumatic brain injury (TBI) at least 2 years postinjury and typically developing children. Twenty-three children had sustained a severe TBI either before the age of 8 (n = 10) or after the age of 8 (n = 13). The remaining 32 children composed a control group of typically developing peers. The groups' summaries and interpretive lesson statements were analyzed according to reduction and transformation of narrative text information. Compared to the control group, the TBI group condensed the original text information to a similar extent. However, the TBI group produced significantly less transformed information during their summaries, especially those children who sustained early injuries. The TBI and control groups did not significantly differ in their production of interpretive lesson statements. In terms of related skills, discourse macrolevel summarization ability was significantly related to problem solving but not to lexical or sentence level language skills or memory. Children who sustain a severe TBI early in childhood are at an increased risk for persisting deficits in higher level discourse abilities, results that have implications for academic success and therapeutic practices.     

Discourse Macrolevel Processing After Severe Pediatric Traumatic Brain Injury

The purpose of this study was to determine if discourse macrolevel processing abilities differed between children with severe traumatic brain injury (TBI) at least 2 years postinjury and typically developing children. Twenty-three children had sustained a severe TBI either before the age of 8 (n = 10) or after the age of 8 (n = 13). The remaining 32 children composed a control group of typically developing peers. The groups' summaries and interpretive lesson statements were analyzed according to reduction and transformation of narrative text information. Compared to the control group, the TBI group condensed the original text information to a similar extent. However, the TBI group produced significantly less transformed information during their summaries, especially those children who sustained early injuries. The TBI and control groups did not significantly differ in their production of interpretive lesson statements. In terms of related skills, discourse macrolevel summarization ability was significantly related to problem solving but not to lexical or sentence level language skills or memory. Children who sustain a severe TBI early in childhood are at an increased risk for persisting deficits in higher level discourse abilities, results that have implications for academic success and therapeutic practices.     

Discourse macrolevel processing after severe pediatric traumatic brain injury

The purpose of this study was to determine if discourse macrolevel processing abilities differed between children with severe traumatic brain injury (TBI) at least 2 years postinjury and typically developing children. Twenty-three children had sustained a severe TBI either before the age of 8 (n = 10) or after the age of 8 (n = 13). The remaining 32 children composed a control group of typically developing peers. The groups' summaries and interpretive lesson statements were analyzed according to reduction and transformation of narrative text information. Compared to the control group, the TBI group condensed the original text information to a similar extent. However, the TBI group produced significantly less transformed information during their summaries, especially those children who sustained early injuries. The TBI and control groups did not significantly differ in their production of interpretive lesson statements. In terms of related skills, discourse macrolevel summarization ability was significantly related to problem solving but not to lexical or sentence level language skills or memory. Children who sustain a severe TBI early in childhood are at an increased risk for persisting deficits in higher level discourse abilities, results that have implications for academic success and therapeutic practices.     

Cognitive and Academic Functioning in Children With Sickle-Cell Disease

Comparing cognitive processing and academic functioning among children with sickle-cell syndrome and nondiseased siblings who were comparable in age, socioeconomic status, and sex, this study found that children with sickle-cell syndrome scored significantly lower than nondiseased siblings on a reading decoding achievement test and a sustained attention task associated with frontal-lobe functioning. No support was found for either the hypothesis of an age-related decrement of cognitive functioning or the hypothesis that youth with the homozygous condition (HbSS) would perform more poorly on cognitive and academic tasks than would children with heterozygous forms of sickle-cell syndrome (HbSC and HbS-beta thalassemia). The majority of measures were, however, related to social class, suggesting that there is variability in the cognitive functioning of youth in whom sickle-cell disease had been diagnosed which may, in part, be attributed to social class. The finding that hemoglobin is a predictor of intellectual functioning, fine-motor skills, and overall academic achievement was interpreted as suggesting that chronic reduced oxygen delivery may be etiologic and that therapeutic trials aimed at increasing hemoglobin levels should be undertaken.     

Characteristics of Young Learning-Disabled Children Classified According to Patterns of Academic Achievement: Auditory-Perceptual and Visual-Perceptual Abilities

In this study, three 15-member groups of 7- to 8-year-old learning,disabled (LD) children, were composed as follows: Group 1 children exhibited evenly deficient performances on the Reading, Spelling, and Arithmetic subtests of the Wide Range Achievement Test (WRAT); Group 2 children presented a pattern of deficient Reading and Spelling scores in conjunction with significantly higher, although impaired, Arithmetic scores on the WRAT; and Group 3 children exhibited average.or above-average performances on the Reading and Spelling subtests but performed in a significantly deficient manner on the Arithmetic subtest of the WRAT. The performances of these groups of children were compared on 10 auditory-perceptual/linguistic measures and on 6 visual-perceptual measures. Groups 1 and 2 consistently performed in an inferior manner on auditory-perceptual/linguistic measures in comparison to Group 3; Group 3 performed in a manner inferior to that of Group 1 and Group 2 on certain visual-perceptual measures. The relationship of the present findings to previous research designed to determine the neuropsychological abilities of these three subtypes of LD children is discussed.     

Prenatal alcohol exposure and ability, academic achievement, and school functioning in adolescence: a longitudinal follow-up

BACKGROUND: Prenatal alcohol exposure is associated with learning, behavioral, and academic problems even in children without the fetal alcohol syndrome (FAS). OBJECTIVE: To examine the prenatal alcohol exposure and ability, academic achievement, and school functioning in adolescence. METHODS: In a longitudinal cohort, intelligence, academic performance, and school functioning were evaluated in 265 low socioeconomic status (SES) adolescents (M age = 15.1 years), 128 prenatally exposed to alcohol, 53 controls, and 84 special education students by using the Wechsler Intelligence Scale for Children, 3rd edition (WISC-III) and the Wechsler Individual Achievement Test (WIAT). School records were abstracted for grade point averages (GPA), standardized achievement test scores, conduct, attendance, and special education placement. RESULTS: Alcohol-affected youth had significantly lower IQs than those in the other three groups. CONCLUSION: Although academic achievement (WIAT scores) was most impaired in the special education group who showed lower performance over all as well as in reading and spelling, alcohol-affected youth showed significant deficits on mathematics subtests. There was no increased incidence of conduct problems in school records related to alcohol exposure.     

Selective Changes in Executive Functioning Ten Years After Severe Childhood Traumatic Brain Injury

Pediatric traumatic brain injury (TBI) impacts on children's executive functions, but little is known of how such deficits evolve in the long term. Forty adolescents with TBI were assessed ten years post-injury and compared to 19 typically developing participants on a range of executive measures (attentional control, cognitive flexibility, goal setting, information processing). Children with mild or moderate TBI performed within age expectations on all tests; however, those with severe injuries had poorer performance on goal setting and processing speed tasks. Childhood TBI may result in subtle lasting changes in complex executive skills, which could require ongoing support into adulthood.     

Selective changes in executive functioning ten years after severe childhood traumatic brain injury

Pediatric traumatic brain injury (TBI) impacts on children's executive functions, but little is known of how such deficits evolve in the long term. Forty adolescents with TBI were assessed ten years post-injury and compared to 19 typically developing participants on a range of executive measures (attentional control, cognitive flexibility, goal setting, information processing). Children with mild or moderate TBI performed within age expectations on all tests; however, those with severe injuries had poorer performance on goal setting and processing speed tasks. Childhood TBI may result in subtle lasting changes in complex executive skills, which could require ongoing support into adulthood.     

First-Order Theory of Mind Skills Shortly After Traumatic Brain Injury in 3- to 5-Year-Old Children

Post-acute effects of early childhood traumatic brain injury (TBI) on first-order theory of mind (ToM) skills were examined in 86 children with orthopedic injury (OI), 42 children with moderate TBI, and 17 children with severe TBI aged 3 to 5 years at the time of injury. Three-year-olds with TBI performed more poorly than 3-year-olds with OI on an appearance–reality task. The severe TBI group was impaired on false-contents tasks compared to the moderate TBI and OI groups. Age and IQ were strong predictors of ToM performance; however, the relationship between ToM and IQ was not as strong for children with TBI.     

Intellectual, Motor, and Language Sequelae Following Closed Head Injury in Infants and Preschoolers

Examined cognitive and motor performance during the subacutestage of recovery and 8 months postinjury in 21 infants andpreschoolers who sustained a closed head injury (CHI). Childrensustaining severe CHI, who exhibited impaired consciousnessfor at least 1 day, were impaired on measures of intelligence,motor, expressive language, and receptive language functionson the baseline and follow-up evaluations relative to childrenwith mild-moderate injuries. Irrespective of injury severity,motor and expressive language functions were the most vulnerableto the effects of CHI. Results are discussed in terms of therate of development of cognitive functions.     

Executive function outcomes following traumatic brain injury in young children: a five year follow-up

Little is known about the long-term effects of traumatic brain injury (TBI) in very young children. This study used a prospective, cross-sectional design to investigate the impact of TBI on executive function (EF) outcomes in children who sustained a TBI before the age of seven. The study aimed to identify specific or global EF deficits five years post-TBI, and to explore factors that predicted outcomes. Fifty-four children with a TBI and 17 uninjured comparison children participated. Their performance on several cognitive and behavioral EF measures was examined. Results suggested that executive difficulties were present following severe TBI, however children with mild and moderate injuries were relatively unaffected. Skills that develop early appeared to be relatively robust. Injury severity was found to be most predictive of long-term EF, however other injury, child and family-related variables also contributed to outcomes.     

Executive Function Outcomes Following Traumatic Brain Injury in Young Children: A Five Year Follow-Up

Little is known about the long-term effects of traumatic brain injury (TBI) in very young children. This study used a prospective, cross-sectional design to investigate the impact of TBI on executive function (EF) outcomes in children who sustained a TBI before the age of seven. The study aimed to identify specific or global EF deficits five years post-TBI, and to explore factors that predicted outcomes. Fifty-four children with a TBI and 17 uninjured comparison children participated. Their performance on several cognitive and behavioral EF measures was examined. Results suggested that executive difficulties were present following severe TBI, however children with mild and moderate injuries were relatively unaffected. Skills that develop early appeared to be relatively robust. Injury severity was found to be most predictive of long-term EF, however other injury, child and family-related variables also contributed to outcomes.     

Specialized cognitive function and school achievement

Individual differences in performance on academic achievement tests were studied in relation to tasks of specialized cognitive function associated with processing in the right and left cerebral hemispheres. In 1,042 elementary‐school (fourth‐ and fifth‐grade) children, it was found that those who performed better on visuospatial skills than on “verbosequential” skills performed more poorly on reading and language achievement but not on arithmetic—in comparison with children who had the reverse profile (performing better on verbosequential skills than on visuospatial skills). These results held true after measures of overall performance were partialed out, suggesting that the cognitive profile accounted for some of the group differences. It was also demonstrated that the reading scores for the visuospatial profile group tended to be distributed bimodally, whereas the scores for the verbosequential profile group were not. These data suggest that individual differences in achievement are related, in part, to individual differences in development of cerebral processes.     

Short-term memory, working memory, and executive functioning in preschoolers: longitudinal predictors of mathematical achievement at age 7 years

This study examined whether measures of short-term memory, working memory, and executive functioning in preschool children predict later proficiency in academic achievement at 7 years of age (third year of primary school). Children were tested in preschool (M age = 4 years, 6 months) on a battery of cognitive measures, and mathematics and reading outcomes (from standardized, norm-referenced school-based assessments) were taken on entry to primary school, and at the end of the first and third year of primary school. Growth curve analyses examined predictors of math and reading achievement across the duration of the study and revealed that better digit span and executive function skills provided children with an immediate head start in math and reading that they maintained throughout the first three years of primary school. Visual-spatial short-term memory span was found to be a predictor specifically of math ability. Correlational and regression analyses revealed that visual short-term and working memory were found to specifically predict math achievement at each time point, while executive function skills predicted learning in general rather than learning in one specific domain. The implications of the findings are discussed in relation to further understanding the role of cognitive skills in different mathematical tasks, and in relation to the impact of limited cognitive skills in the classroom environment.