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Psychiatric Disorders in Children and Adolescents Six-to-Twelve Months After Mild Traumatic Brain Injury
Jeffrey E. Max, M.B.B.Ch; David Pardo, B.S.; Gerri Hanten, Ph.D.; Russell J. Schachar, M.D.; Ann E. Saunders, M.D.; Linda Ewing-Cobbs, Ph.D.; Sandra B. Chapman, Ph.D.; Maureen Dennis, Ph.D.; Elisabeth A. Wilde, Ph.D.; Erin D. Bigler, Ph.D.; Wesley K. Thompson, Ph.D.; Tony T. Yang, M.D., Ph.D.; Harvey S. Levin, Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:272-282. doi:10.1176/appi.neuropsych.12040078
View Author and Article Information

This study was supported by National Institute of Mental Health (NIMH) Grant K-08 MH01800 (Dr. Max) and National Institute of Neurological Disorders and Stroke (NINDS) Grant NS-21889 (Dr. Levin).

Disclosures: Dr. Schachar is a consultant for Eli Lilly Corporation and Purdue Pharma (Canada). None of the other authors has financial disclosures to make relative to for-profit enterprises.

From the Dept. of Psychiatry, University of California, San Diego, and Rady Children’s Hospital, San Diego, CA.

Send correspondence to Dr. Max; e-mail: jmax@ucsd.edu

Copyright © 2013 by the American Psychiatric Association

Received April 02, 2012; Revised May 28, 2012; Accepted July 10, 2012.

Abstract

The objective of this study was to understand how novel psychiatric disorders (NPD) in children with mild traumatic brain injury (MTBI) are related to pre-injury variables, injury-related variables, and concurrent neurocognitive outcome. A group of 79 children, ages 5 to 14 years, who had experienced MTBI, were studied from consecutive hospital admissions with semistructured psychiatric interviews soon after injury (baseline); 60 children were reassessed 12 months post-injury. Standardized instruments were used to assess injury severity; lesion characteristics; pre-injury variables, including psychiatric disorder, family psychiatric history, family functioning, socioeconomic status, psychosocial adversity, adaptive functioning, and post-injury neurocognitive and adaptive functioning. NPD occurred in 17 of 60 participants (28%) in the 6–12-month interval after injury, with disorders that were significantly associated with socioeconomic status, psychosocial adversity, estimated pre-injury academic functioning, and concurrent deficits in adaptive functioning, academic performance, processing speed, memory, and expressive language. NPD was not significantly associated with pre-injury adaptive functioning, injury severity, family psychiatric history, pre-injury psychiatric disorder, lesion location, gender, or age at injury. These findings suggest that the short-term psychiatric morbidity associated with MTBI in children occurs more commonly than previously reported and is related to both pre-injury social factors and concurrent neurocognitive functioning.

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TABLE 1.Demographic, Psychosocial, and Injury Data on the Mild Traumatic Brain Injury Cohort (N=79)
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TABLE 2.Lesion Distribution, Based on Research Magnetic Resonance Imaging: Entire Cohort (N=65) and in Children With and Without Novel Psychiatric Disorder (NPD) in the First 12 Months After Injury
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TABLE 3.Predictors of Novel Psychiatric Disorder (NPD) in the Interval 6–12 Months After Mild Traumatic Brain Injury (MTBI)
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Values are mean (standard deviation) except where indicated. Effect size refers to Cohen’s d.

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ABC: Adaptive Behavior Composite.

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a Pearson χ2=0.54.

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b Pearson χ2=8.25.

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c Fisher’s exact test.

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TABLE 4.Neurocognitive Correlates of Novel Psychiatric Disorders (NPD) in the Interval 6–12 Months After Mild Traumatic Brain Injury (MTBI)
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Values are expressed as mean (standard deviation [SD]).

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ABC: Adaptive Behavior Composite; CELF–3: Clinical Evaluation of Language Fundamentals, 3rd Edition; CVLT–C: California Verbal Learning Test, Children’s Version; NS: not significant; p: significance level; WISC–III: Wechsler Intelligence Scale for Children, 3rd Edition; W-J–R: Woodcock-Johnson–Revised.

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