Behavioral and cognitive predictors of educational outcomes in pediatric traumatic brain injury

Abstract

Research reveals mixed results regarding the utility of standardized cognitive and academic tests to predict educational outcomes in youth following a traumatic brain injury (TBI). Yet, deficits in everyday school-based outcomes are prevalent after pediatric TBI. The current study used path modeling to test the hypothesis that parent ratings of adolescents’ daily behaviors associated with executive functioning (EF) would predict long-term functional educational outcomes following pediatric TBI, even when injury severity and patient demographics were included in the model. Furthermore, we contrasted the predictive strength of the EF behavioral ratings with that of a common measure of verbal memory. A total of 132 adolescents who were hospitalized for moderate to severe TBI were recruited to participate in a randomized clinical intervention trial. EF ratings and verbal memory were measured within 6 months of the injury; functional educational outcomes were measured 12 months later. EF ratings and verbal memory added to injury severity in predicting educational competence post injury but did not predict post-injury initiation of special education. The results demonstrated that measurement of EF behaviors is an important research and clinical tool for prediction of functional outcomes in pediatric TBI.

Trial registration: ClinicalTrials.gov NCT00409448.

Figures

Fig. 1

Path model with BRIEF Parent-Report GEC predicting CBCL School Competence. Note. All paths were included in the model. χ2(2) = 1.086, p > .05, CFI = 1.00, RMSEA = 0.00. Dashed lines indicate non-significant paths. Path weights are standardized. ***p < .001, **p < .01, *p < .05.

Fig. 2

Path model with BRIEF Self-Report GEC predicting CBCL School Competence. Note. χ2(2) = .747, p > .05, CFI = 1.00, RMSEA = .0.00. Dashed lines indicate non-significant paths. Path weights are standardized. ***p < .001, **p < .01, *p < .05.

Fig. 3

Path model with BRIEF Parent-Report GEC predicting Special Education. Note. Special Education is a dichotomous outcome variable, thus the pictured model is a logistic regression, which means that the degrees of freedom were calculated differently than in an OLS regression, and the magnitude of standardized coefficients to the Special Ed outcome variable should be interpreted with caution (see Methuen & Methuen, 1998–2004). 95% CI for odds ratios are presented in parentheses. χ2(4) = 2.488, p > .05, CFI = 1.00, RMSEA = 0.00. Dashed lines indicate non-significant paths. Path weights are standardized. ***p < .001, **p < .01, *p < .05.

Fig. 4

Path model with BRIEF Self-Report GEC predicting Special Education. Note. Special Education is a dichotomous outcome variable, thus the pictured model is a logistic regression, which means that the degrees of freedom were calculated differently than in an OLS regression, and the magnitude of standardized coefficients to the Special Ed outcome variable should be interpreted with caution (see Methuen & Methuen, 1998–2004). 95% CI for odds ratios are presented in parentheses. χ2(4) = 2.314, p > .05, CFI5 1.00, RMSEA = 0.00. Dashed lines indicate non-significant paths. Path weights are standardized. ***p < .001, **p < .01, *p < .05.