Articles
Lifetime and Novel Psychiatric Disorders After Pediatric Traumatic Brain Injury

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ABSTRACT

Objective

To assess lifetime and current psychiatric disorders at least 1 year after traumatic brain injury (TBI) in children and adolescents.

Method

Forty-six youths who sustained a TBI between the ages of 6 through 15 years were evaluated at least 1 year post-TBI to identify the presence of lifetime and/or novel psychiatric disorders. Semistructured interviews of the parent and child and standardized parent self-report rating instruments were used.

Results

Attention-deficit/hyperactivity disorder and depressive disorders were the most common lifetime and novel diagnoses. A wide variety and high rate of novel psychiatric disorders were identified; 74% of these disorders persisted in 48% of the injured children. Internalizing disorders were more likely to resolve than externalizing disorders. Both interviews and parent ratings were sensitive to current externalizing behaviors; interviews more often detected internalizing disorders, whereas parent ratings also identified cognitive difficulties.

Conclusions

Findings were generally consistent with previous research demonstrating the high rate of novel psychiatric disorders following pediatric TBI. Psychiatric interviews were sensitive in identifying both lifetime and novel disorders.

Section snippets

Subjects

Forty-six children and adolescents (29 males and 17 females) were seen in conjunction with their participation in a larger prospective study of the neurobehavioral outcome of TBI encompassing a number of cognitive functions including executive functions, attention, discourse, and memory (e.g., Brookshire et al., 2000, Levin et al., 1996). This article reports on preliminary long-term psychiatric outcome in a representative subsample from this ongoing study. Children were eligible for inclusion

Lifetime and Current Psychiatric Disorders

Despite attempts to exclude children with preinjury neuropsychiatric disorders, the DICA-R identified 16 children with 20 previously undiagnosed DSM-IV disorders. Thirteen of these children had internalizing disorders that were associated with minimal if any impairment. ADHD was the most common disorder present prior to injury (i.e., 10 total including 6 predominantly inattentive type) followed by 6 anxiety disorders including 4 specific phobias. Demographic variables were similar among

Psychiatric Interview Findings

The current study was generally consistent with previous retrospective (Lehmkuhl and Thoma, 1990, Max et al., 1998b, Shaffer et al., 1975) and prospective (Brown et al., 1981, Max et al., 1997a, Max et al., 1997b, Max et al., 1997c) research using psychiatric interviewing in revealing a high rate of psychiatric disorder at least 1 year after significant TBI in children and adolescents. In the present sample, 76% of the children had lifetime psychiatric disorders, which is quite similar to rates

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    This research was supported by NIH grant NS-21889, Neurobehavioral Outcome of Head Injury in Children, from the National Institute of Neurological Disorders and Stroke.

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