Traumatic brain injury is the single most common cause of death and disability in children and adolescents, according to the national Centers for Disease Control and Prevention. Now, UCLA researchers have found that the effects of a blow to the head, whether it's mild or a concussion, can linger for years.
Talin Babikian, lead study author and a UCLA postdoctoral fellow in psychiatry and biobehavioral sciences, and senior author Robert Asarnow, a UCLA professor of psychiatry, analyzed 28 selected articles about traumatic brain injury, or TBI, published between 1988 and 2007, quantifying for the first time all of the available literature on the effects of TBI on the developing brains of children and adolescents. Their findings appear in the May issue of the journal Neuropsychology.
The key, and most surprising, finding, the authors say, was that over time, children and adolescents with a severe TBI appear to fall even farther behind their peers than was previously thought, making intervention and monitoring especially important in this group.
Various levels of TBI in children were included in the studies that were reviewed. The extent of a brain injury is typically based on the Glasgow Coma Scale, a standard clinical tool used to measure the severity of these injuries. The scale measures a person's eye/pupil response, motor response and verbal communication to determine whether a TBI is mild, moderate or severe.
Children in the studies were sorted by TBI severity and the time since their injury. All three severity levels were examined, and follow-up exams were done, on average, 0–5 months, 6–23 months or 24-plus months after injury for 14 key aspects of neurocognition.
Additional key findings of the study:
- Time didn’t heal all wounds — the worse the injury, the worse the neurocognitive outcome over time, especially on measures of general intellectual functioning and brain processing speed. The moderate and severe TBI groups were similarly impaired after examination at 24-plus months. While there was modest recovery in intellectual functioning and attention, weaknesses in many children with even moderate TBI persisted even two years after the injury, compared with children in control groups.
- For children diagnosed with severe TBI, more help was needed. They showed significant problems within months on IQ, executive functioning (processing speed, attention), and verbal memory (both immediate and delayed) measures. After two or more years, all areas studied were impaired.
"The good news is that the studies showed that children with mild traumatic brain injuries and concussions may show some difficulties in cognition initially, but the effects are subtle and typically diminish over time," Babikian said. "The bad news, though, is the existence of a subgroup of patients who show persistent neurocognitive problems and need to be screened and followed.
"And because younger children have more development ahead of them, the same injury can affect a 4-year-old and a 12-year-old very differently," she said. "Further, children who suffer a severe brain injury may show a slower rate of development as a group, highlighting the importance of targeted treatment developed specifically for children with severe TBI."
Equally important, Babikian said, is the take-home message of prevention.
"Because younger children with a traumatic brain injury seem to generally do worse than their older counterparts," she said, "the public health implication of this research is a reminder of the importance of the use of protective measures to minimize the effects of a brain injury when one does occur, as well as prevention through consistent use of helmets and seat belts."
The research was funded by the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health, and by the Della Martin Foundation. The authors report no conflict of interest.
The UCLA Department of Psychiatry and Biobehavioral Sciences is the home within the David Geffen School of Medicine at UCLA for faculty who are experts in the origins and treatment of disorders of complex human behavior. The department is part of the Semel Institute for Neuroscience and Human Behavior, a world-leading interdisciplinary research and education institute devoted to the understanding of complex human behavior and the causes and consequences of neuropsychiatric disorders.
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