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EXECUTIVE FUNCTIONS IN CHILDREN WITH SEVERE, MODERATE AND MILD TRAUMATIC BRAIN INJURY IN COMPARISON WITH NON-INJURED CONTROLS AND THEIR RELATIONSHIP TO BEHAVIOUR
R. Ramalakshmi, H. E. Miller, R. J. McCarter, B. J. Hameed, P. M. Sharples. Frenchay Hospital, Bristol, UK
Introduction: Traumatic brain injury (TBI) selectively damages neural systems responsible for executive function (EF), a collection of inter-related functions responsible for purposeful, goal directed, problem-solving behaviour. TBI is a common problem in childhood, yet surprising few paediatric data exist concerning the impact of TBI on EF and its relationship with behaviour.
Aims: To compare EF in children with severe, moderate and mild TBI and non-injured controls, and to relate EF to other measures of cognition and behaviour.
Methods: Prospective cohort study. TBI was classified by admission Glasgow Coma Score (GCS) as severe (GCS 3–8), moderate (GCS 9–12) and mild (GCS 13–15). EF was assessed using the Behaviour Rating Inventory of Executive Function (BRIEF); intellect by WISC-III; attention by Test of Everyday Attention in Children (TEA-Ch), memory by Children’s Memory Scales (CMS); behaviour by Child Behaviour Checklist (CBCL). Cognitive and behavioural assessments were performed 12–24 months after injury.
Results: 57 subjects were studied (20 severe TBI, 18 moderate/mild TBI, 19 controls). Mean age was 12.8 years (TBI) and 12.2 years (controls). There were significant differences in the three groups with respect to the BRIEF summary scales Behaviour Regulation Index (BRI) (p = 0.001), Metacognition (MI) (p = 0.007) and Global Executive Composite (GEC) (p = 0.006). Significant group differences were seen in the domains relating to inhibitory control (p = 0.003), shifting (p = 0.006), emotional control (p = 0.003), initiation (p<0.001), working memory (p = 0.002), planning (p = 0.025), self-monitoring (p = 0.028) but not organisation of materials (p = 0.072). Significant correlations were seen in TBI children between the BRIEF GEC and performance IQ (p = 0.001); attention (p = 0.04); and CBCL externalising (p<0.001), internalising (p = 0.005), total competence (p = 0.012) and total problem scales (p<0.001) but not between GEC and verbal IQ (p = 0.365) or memory (p = 0.147). In control children, GEC correlated with the CBCL …