Our Research

Caregiver and Environmental Influences on Outcome from Traumatic Brain Injury in Infants and Preschoolers

Principal Investigators

All investigators are faculty members in the Children’s Learning Institute.

Principal Investigator:
Mary R. Prasad, Ph.D., University of Texas Health Science Center Houston

Co-Principal Investigators:
Linda Ewing-Cobbs, Ph.D., University of Texas Health Science Center Houston
Paul Swank, Ph.D., University of Texas Health Science Center Houston

Funding Agency

Department of Education, National Institute on Disability and Rehabilitation Research

Description of the Project

Traumatic brain injury (TBI) is a leading cause of disability in children (Langlois, 2000).  Recent longitudinal studies of infants and preschoolers with TBI have indicated that younger age at injury is not a protective factor from the effects of TBI.  Studies of intellectual development in infants and preschoolers with TBI indicate lower scores than was obtained for school-aged children and adolescents (Anderson & Moore, 1995; Anderson et al., 1997; Ewing-Cobbs et al., 1997).  In a long-term follow-up study of children injured between the ages of 1 and 7 years, the worst outcome was found in the younger group; no individual injured before the age of 4 years was able to work full time as an adult.  These outcomes were worse than expected given the children’s initial recovery and early school achievement (Koskinicmi et al., 1995).

There are no known studies on interventions for infants and preschoolers with TBI that can enhance recovery.  Much of the emphasis in the study of TBI in early childhood has been on medical factors with little or no attention given to family or environmental factors that can influence outcome.  Research conducted with very young children with medical or developmental disabilities has highlighted the importance of family and environmental factors in outcomes.   Drawing on literature from interventions in infants and preschoolers with developmental disabilities, we find two major influences on outcome for young children; the quality of the caregiver-child interaction and the home environment.  Quality of the caregiver interaction has been found to be an important mediating variable between biological risk factors and developmental outcome (Bakeman & Brown, 1980; Singer et al., 2003).  Aspects of the caregiver interaction such as cognitive stimulation, directiveness, and responsivity have been shown to be predictive of developmental outcome for children with risk factors such as poverty or prematurity.  Specific aspects of the home environment, such as the quality of the learning materials in the home, have been shown to be highly related to developmental outcome for children and may function as a protective factor for children with social risk factors, buffering the effects of poverty.  Environmental factors have been found to be more predictive of long-term outcome than medical issues in children with medical complications resulting from prematurity (Weisglas-Kuperus et al., 1993; Molfese et al., 1997).  In school-aged children and adolescents with TBI, the pre-injury family environment has been shown to be highly related to outcome and maybe more influential in outcome than injury severity (Yeates et al., 1997).  Understanding family and environmental influences in outcome from early TBI is the critical first step in developing intervention programs for infants and preschoolers.  Appropriate interventions in early childhood may prevent or decrease the likelihood of greater difficulties later in life.  Home-based intervention studies with infants and preschoolers targeting aspects of the parent-child interaction have found gains in developmental outcome, parental feelings of competency, and the quality of the parent-child interaction.  Focusing on family interactions in addition to the child’s skills may have a greater impact on the child’s development than targeting only the child’s abilities (Kelly & Barnard, 2000).

This study is composed of two projects.  In Project 1, we are determining how the presence of TBI affects caregiver and family functioning as well as and child characteristics by longitudinal between groups design to compare infants and preschoolers with moderate or severe TBI, ages 6 months to 47 months to sociodemographically matched comparison children.  We then assess how child, caregiver, and family characteristics affect the caregiver-child interactions.  Lastly, we are examining how caregiver-child interactions mediate the influence of child, caregiver, and family factors on outcome from early acquired brain injury.  In Project 2, we are using findings from Project 1 to pilot a home-based caregiver focused intervention for infants and preschoolers with TBI.

Project 1
This project will employ a longitudinal prediction model to assess the influence of the caregiver, child, and home environment on outcome.  Caregiver stress, family functioning, child behavior, caregiver-child interactions, and home environment are assessed at least 6 months post-injury to allow for the temporary increase in caregiver stress and family dysfunction that occurs acutely following TBI to abate (Wade et al., 1999; Wade et al., 1996; Wade et al., 2002).   Developmental and adaptive outcomes are  assessed six months later. 

Project 2
In Project 2, we are piloting a short-term home-based intervention program, integrating findings from studies of interventions with children with biological risks, as well as results from Project 1.  The intervention is short-term, empirically based, and focused. Although the length and intensity of the intervention are brief, studies have demonstrated that such interventions can be beneficial.  The purpose of this project is to gather data on the appropriateness of this type of intervention for young children with TBI in a pilot format that is cost-effective; such an approach may open avenues for larger, more intense studies of interventions for this population.

Presentations

  • Prasad, M.R., Joy, J., Alloway, J., and Ewing-Cobbs, L.  Caregiver and child interactions in infants and toddlers with traumatic brain injury.  Paper presented at the meeting of the International Neuropsychological Society.  Portland, OR, 2007.
  • Prasad, M.  Role of family in outcome from traumatic brain injury in children.  Presentation at the 23rd Annual Brain Injury Association of Texas meeting, San Antonio, TX, 2005.
  • Prasad, M. Pediatric Traumatic Brain Injury: A Neuropsychological Perspective. Presentation at the 1st Annual Amarillo Area Brain Injury Conference, Amarillo, Texas 2007
  • Prasad, M.R., Cirino, P.T., Sobhan, S., Alloway, J.A., Ewing-Cobbs, L. Impact of caregiver-child interactions on outcome from traumatic brain injury in infants and toddlers. Paper presented at the meeting of International Neuropsychological Society. Waikola, Hawaii, 2008.

For More Information

Mary R. Prasad, Ph.D.
Principal Investigator
Mary.R.Prasad@uth.tmc.edu
713-500-3888

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