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Predictors of Personality Change Due to Traumatic Brain Injury in Children and Adolescents Six to Twenty-Four Months After Injury

Received September 13, 2004; revised September 9, 2005; accepted March 11, 2005. From the Department of Psychiatry at the University of California, San Diego, California, and Children’s Hospital and Health Center, San Diego, California; the Department of Physical Medicine and Rehabilitation, Department of Neurosurgery, and Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; the Department of Educational Psychology, University of Houston, Texas; the Department of Psychiatry, Brain and Behavior Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; the Department of Psychiatry, University of Texas Health Science Center, Houston, Texas; the Department of Pediatrics, University of Texas Health Science Center, Houston, Texas; the Department of Behavioral and Brain Sciences, Center for Brain Health, The University of Texas at Dallas, Texas; the Department of Psychology, Brain and Behavior Program, Research Institute, The Hospital for Sick Children. Address correspondence to Jeffrey E. Max, M.B.B.Ch, Children’s Hospital and Health Center, 3020 Children’s Way, MC 5018, San Diego, CA, 92123; jmax{at}ucsd.edu (E-mail).

Phenomenology and predictive factors of personality change due to traumatic brain injury (TBI) 6 to 24 months after injury was investigated in children, ages 5 to 14 years, enrolled from consecutive admissions and followed prospectively for 2 years. Injury and preinjury psychosocial variables were assessed. Personality change occurred in 13% of participants between 6 and 12 months after injury and 12% in the second year after injury. Severity of injury consistently predicted personality change, and preinjury adaptive function predicted personality change only in the second year postinjury. Lesions of the superior frontal gyrus were associated with personality change between 6 and 12 months following injury, after controlling for severity of injury and the presence of other brain lesions. Only lesions in the frontal lobe white matter were significantly related to personality change in the second year after injury. After childhood TBI, neural correlates of personality change evolve between 6 and 12 months and 12 to 24 months after injury. The data implicate the dorsal prefrontal cortex and frontal lobe white matter in the emergence of personality change involving the effortful or conscious regulation of affective states.

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