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UI researchers study traumatic brain injuries, psychiatric disorders in children

IOWA CITY, Iowa -- University of Iowa researchers who studied children with traumatic brain injury (TBI) found that certain risk factors helped predict whether a child would develop a psychiatric disorder in the second year after the injury occurred.

For 24 months researchers followed 42 children, ages 6 to 14, who had suffered either a mild or severe TBI. The presence of a "novel" psychiatric disorder in the second year after TBI was identified in 15 of those children. The study results are published in the September issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"By 'novel' we mean a psychiatric disorder that developed in a child who didn't have the disorder before the injury," says Dr. Jeffrey Max, UI assistant professor of psychiatry and lead investigator in the study. "So this could be a child who had been free of psychiatric disorders before the injury, or a child who had a psychiatric disorder but then developed another one after the injury."

Max and his colleagues looked at six variables to assess the risk factors related to the presence of psychiatric disorders among children in the second year after TBI. Three of those variables -- the severity of the injury, the child's pre-injury psychiatric history, and the functionality of the child's family -- were significant in predicting the development of a novel psychiatric disorder.

"The severity of the injury itself has long been an obvious variable to consider," Max says. "The more serious the injury, the more likely the child is going to develop problems. We found that to be true."

The researchers also found that children in the study with a psychiatric disorder at any time in their lives were at a higher risk of developing another psychiatric disorder in the second year after a TBI.

Interestingly, family function before the injury played an important role in whether a child developed a psychiatric disorder in the two years following the injury. In the study, children from dysfunctional families were more likely to develop a psychiatric disorder following their injury. Max cites examples of family dysfunction -- parents not consistently applying and enforcing a set of basic rules, not communicating with their children or each other, and not recognizing or solving emotional or practical problems regarding their children or themselves.

Whether the child's family was functional or not was determined by interviews researchers conducted with the child's parents soon after the injury occurred.

"Other studies have looked at family function and have found this variable affects the child's outcome, even children with severe head injury," Max says. "This is promising because it suggests that regardless of the severity of the head injury, a child who has a well-functioning family is going to have a better recovery. You can't do much about the initial impact of a TBI once it's occurred, but strong family support can have a positive influence.

"Alternatively, if family function can be improved through family therapy, we may see improvement in the child's functioning. A study involving family therapy may help clarify this unknown," he says.