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Determinants of Effective Caregiver Communication After Adolescent Traumatic Brain Injury.

ABSTRACT: OBJECTIVE:To characterize the effects of caregiver mental health and coping strategies on interactions with an injured adolescent acutely after traumatic brain injury (TBI). DESIGN:Multi-site, cross-sectional study. SETTING:Outpatient setting of 3 tertiary pediatric hospitals and 2 tertiary general medical centers. PARTICIPANTS:Adolescents (N = 125) aged 12-17 years, 1-6 months after being hospitalized with complicated mild to severe TBI. METHODS:Data were collected as part of a multi-site clinical trial of family problem-solving therapy after TBI. Multiple regression analyses were used to examine the relationship of caregiver and environmental characteristics to the dimensions of effective communication, warmth, and negativity during caregiver-adolescent problem-solving discussions. MAIN OUTCOMES MEASURES:Adolescent and caregiver interactions, as measured by the Iowa Family Interaction Rating Scales. RESULTS:Caregivers who utilized problem-focused coping strategies were rated as having higher levels of effective communication (P < .01), as were those with higher socioeconomic status (P < .01). Problem-focused coping style and higher socioeconomic status were also associated lower levels of negative interactions (P < .01 and P < .05, respectively). Female gender of the adolescent and fewer children in the home were associated with increased parental warmth during the interaction (P < .01 and P < .05, respectively). Neither adolescent TBI severity nor caregiver depression significantly influenced caregiver-teen interactions. CONCLUSIONS:Problem-focused coping strategies are associated with higher levels of effective communication and lower levels of caregiver negativity during the initial months after adolescent TBI, suggesting that effective caregiver coping may facilitate better caregiver-adolescent interactions after TBI.

SUBMITTER: Hobart-Porter L

PROVIDER: S-EPMC5437845 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

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Determinants of Effective Caregiver Communication After Adolescent Traumatic Brain Injury.

Hobart-Porter Laura L Wade Shari S Minich Nori N Kirkwood Michael M Stancin Terry T Taylor Hudson Gerry HG

PM & R : the journal of injury, function, and rehabilitation 20150214 8

<h4>Objective</h4>To characterize the effects of caregiver mental health and coping strategies on interactions with an injured adolescent acutely after traumatic brain injury (TBI).<h4>Design</h4>Multi-site, cross-sectional study.<h4>Setting</h4>Outpatient setting of 3 tertiary pediatric hospitals and 2 tertiary general medical centers.<h4>Participants</h4>Adolescents (N = 125) aged 12-17 years, 1-6 months after being hospitalized with complicated mild to severe TBI.<h4>Methods</h4>Data were col ...[more]

PMID: 25687111

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Project description:Despite the life-long implications of social and communication dysfunction after pediatric traumatic brain injury, there is a poor understanding of these deficits in terms of their developmental trajectory and underlying mechanisms. In a well-characterized murine model of pediatric brain injury, we recently demonstrated that pronounced deficits in social interactions emerge across maturation to adulthood after injury at postnatal day (p) 21, approximating a toddler-aged child. Extending these findings, we here hypothesized that these social deficits are dependent upon brain maturation at the time of injury, and coincide with abnormal sociosexual behaviors and communication. Age-dependent vulnerability of the developing brain to social deficits was addressed by comparing behavioral and neuroanatomical outcomes in mice injured at either a pediatric age (p21) or during adolescence (p35). Sociosexual behaviors including social investigation and mounting were evaluated in a resident-intruder paradigm at adulthood. These outcomes were complemented by assays of urine scent marking and ultrasonic vocalizations as indices of social communication. We provide evidence of sociosexual deficits after brain injury at p21, which manifest as reduced mounting behavior and scent marking towards an unfamiliar female at adulthood. In contrast, with the exception of the loss of social recognition in a three-chamber social approach task, mice that received TBI at adolescence were remarkably resilient to social deficits at adulthood. Increased emission of ultrasonic vocalizations (USVs) as well as preferential emission of high frequency USVs after injury was dependent upon both the stimulus and prior social experience. Contrary to the hypothesis that changes in white matter volume may underlie social dysfunction, injury at both p21 and p35 resulted in a similar degree of atrophy of the corpus callosum by adulthood. However, loss of hippocampal tissue was greater after p21 compared to p35 injury, suggesting that a longer period of lesion progression or differences in the kinetics of secondary pathogenesis after p21 injury may contribute to observed behavioral differences. Together, these findings indicate vulnerability of the developing brain to social dysfunction, and suggest that a younger age-at-insult results in poorer social and sociosexual outcomes.

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Determinants of Effective Caregiver Communication After Adolescent Traumatic Brain Injury.

Publications

Determinants of Effective Caregiver Communication After Adolescent Traumatic Brain Injury.

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