Vulnerability or Sparing? The Impact of Developmental Stage at TBI on Longitudinal Cognitive, Psychosocial, and Neuroimaging Outcomes


Linda Ewing-Cobbs


Heather T. Keenan
Elisabeth Wilde
Christopher Giza


Estimating the long-term impact of pediatric TBI is difficult since the injury interacts with the moving target of ongoing brain and behavioral development. Developmental variables, including age at injury and time since injury, are critically important to inform our understanding of the impact of TBI on both initial recovery and on the subsequent development. TBI sustained at different stages during childhood may uniquely affect the trajectory of brain development and connectivity, leading to a downstream impact on neuropsychological functioning. Longitudinal follow-up of children's brain and behavioral development is essential as prior studies have shown that children may initially appear to be on track with their peers after TBI, but fall behind in some areas as demands for new skills increase. To date, longitudinal studies of neuropsychological outcomes after pediatric TBI indicate that younger age at injury or injury during specific age ranges may be associated with greater vulnerability to adverse effects in a variety of cognitive and psychosocial domains. Identification of these periods of vulnerability is crucial to develop awareness of the need for heightened surveillance and increasing referral for rehabilitation and school services. For example, children injured during the preschool years showed increasing ADHD and affective problems during the first year after injury, which is particularly relevant given their importance for later self-regulation of behavior and academic success. Executive function and psychosocial difficulties likely contribute to the lower functional academic skills in younger children and emergence of increased academic difficulty that has been reported years after complicated-mild/moderate TBI.

To address gaps in our understanding of the impact of developmental stage at injury on brain, behavioral, and physiologic responses to injury, we propose to examine several strands of evidence. First, we will present data from a large cohort study including children with mild to severe TBI injured from preschool through adolescent stages of development. Longitudinal changes in executive functions, psychosocial outcomes, and post-concussive symptoms during the first year after TBI will be examined. We will also examine longitudinal structural neuroimaging studies that highlight how injury at different developmental stages impacts ongoing brain development and neuropsychological outcomes. Translational studies will be reviewed to update what is known about basic mechanisms of recovery and neurometabolic cascades following acquired brain injury during developmental stages corresponding to childhood and adolescence. In both translational and child studies, we will highlight the influence of environmental variables on the quality of neurobehavioral outcomes. Finally, we will integrate information about vulnerability or sparing of function at different stages across brain, behavioral, and translational models.


Learning Objectives:

  1. Identify age ranges that appear to be particularly vulnerable to specific long-term adverse neuropsychological outcomes or sparing after mild to severe pediatric TBI and how family and environmental factors affect recovery.
  2. Examine variables influencing long-term outcomes in translational developmental models of pediatric TBI and factors enhancing or hindering outcomes.
  3. Differentiate whether TBI sustained at different developmental stages is associated with unique longitudinal neuroimaging findings.