Predictors of cognitive function and recovery 10 years after traumatic brain injury in young children
Abstract
BACKGROUND AND OBJECTIVES: Childhood traumatic brain injury (TBI) has implications for functional outcomes, but few studies have documented long-term outcomes. The purpose of this study was to plot recovery of cognitive and functional skills after early childhood TBI to 10 years postinjury and to identify the contribution of injury, environment, preinjury characteristics, and acute functional recovery. METHODS: Subjects were recruited consecutively to this prospective, longitudinal study, which used a between-factor design, with injury severity as the independent variable. Forty children with TBI aged 2 and 7 years were recruited on admission to a tertiary pediatric hospital, divided according to injury severity, and compared with 16 healthy controls acutely and 12 and 30 months and 10 years postinjury. Cognition, adaptive ability, executive function, and social/behavioral skills were examined. RESULTS: Children with severe TBI had poorest outcomes, with deficits greatest for cognition. Recovery trajectories were similar across severity groups but with significant gains in verbal skills from 12 and 30 months to 12 months and 10 years. Predictors of outcome included preinjury ability (for adaptive function) and family function (social/behavioral skills). CONCLUSIONS: Results confirm a high risk of persisting deficits after severe TBI in early childhood. Children with less severe TBI appear to recover to function normally. Contrary to speculation about "growing into deficits," after protracted recovery to 30 months, young children make age-appropriate progress at least to 10 years postinsult. Environmental factors were found to contribute to adaptive and social/behavioral recovery.
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The neuroplasticity literature is currently mixed and inconclusive, largely due to methodological limitations.
“The neuroplasticity literature is currently mixed and inconclusive, largely due to similar methodological limitations as those outlined above [41–43].”
The low-average mean performance on Fluid Cognition in the severe TBI group is typical of previous findings reporting neuropsychological outcomes in pediatric TBI.
“The low-average mean performance on Fluid Cognition in the sTBI group is typical of previous findings reporting neuropsychological outcomes in pediatric TBI (Anderson et al., 2012; Beauchamp et al., 2011; Catroppa & Anderson, 2003; Treble-Barna et al., 2017b).”
From Evaluating cognitive performance using the National Institutes of Health Toolbox Cognitive Battery in children with traumatic brain injury (2025) · cites this paper as Anderson et al., 2012
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Ilie, G., Trenholm, M., Boak, A., Mann, R. E., Adlaf, E. M., Asbridge, M., Hamilton, H. A., Rehm, J. T., Rutledge, R. D. H., & Cusiman, M. D. (2020) · PLoS ONE · doi:10.1371/journal.pone.0229489 · Cited by 29 · see citing works
Nacoti, M., Fazzi, F., Biroli, F., Zangari, R., Barbui, T., Kochanek, P. M., & The Collaborative Pediatric TBI Working Group (2021) · Frontiers in Pediatrics · doi:10.3389/fped.2020.594425 · Cited by 28 · see citing works
“These observations highlight the clinical relevance of prolonging neuropsychological and motor rehabilitation for years after TBI and monitoring long-term results, especially in those children at higher risk of neuropsychological disabilities (100, 101).”
BackgroundDahl, H. M., Anđelić, N., Løvstad, M., Holthe, I. L., Hestnes, M., Diseth, T. H., & Myhre, M. C. (2021) · European Journal of Paediatric Neurology · doi:10.1016/j.ejpn.2021.02.002 · Cited by 28 · see citing works
Language impairments in traumatic brain injury: a window into complex cognitive performance.
Vas, A. K., Chapman, S., & Cook, L. G. (2015) · Handbook of Clinical Neurology · doi:10.1016/b978-0-444-63521-1.00031-5 · Cited by 24 · see citing works
“, rote memory skills) (Dennis, 2000; Gamino et al., 2009; Anderson et al., 2012) (Chs 40 and 41).”
Crowe, L. M., Catroppa, C., & Anderson, V. A. (2015) · Handbook of clinical neurology · doi:10.1016/b978-0-444-63521-1.00041-8 · Cited by 28 · see citing works
Self-citationChevignard, M., Kerrouche, B., Krasny‐Pacini, A., Mariller, A., Pineau-Chardon, E., Notteghem, P., Prodhomme, J., Gall, D. L., Roulin, J., Fournet, N., et al. (2017) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000295 · Cited by 28 · see citing works
Does processing speed mediate the effect of pediatric traumatic brain injury on working memory?
Gorman, S. A., Barnes, M. A., Swank, P. R., Prasad, M. R., Cox, C. S., & Ewing‐Cobbs, L. (2015) · Neuropsychology · doi:10.1037/neu0000214 · Cited by 27 · see citing works
Improved Behavior, Motor, and Cognition Assessments in Neonatal Piglets
Sullivan, S., Friess, S., Ralston, J., Smith, C. M., Propert, K., Rapp, P., & Margulies, S. (2013) · Journal of Neurotrauma · doi:10.1089/neu.2013.2913 · Cited by 29 · see citing works
Dennis, E., Caeyenberghs, K., Asarnow, R., Babikian, T., Bartnik-Olson, B. L., Bigler, E., Figaji, A., Giza, C., Goodrich-Hunsaker, N. J., Hodges, C., et al. (2020) · Brain Imaging and Behavior · doi:10.1007/s11682-020-00363-x · Cited by 19 · see citing works
“Limited or insensitive measurement tools, misconception of the benefits of neuroplasticity in children, and the complex interplay of factors that can influence recovery in the developing brain contribute to this (for a review, see [Anderson et al. 2012]).”
BackgroundResidual Cognitive Disability after Completion of Inpatient Rehabilitation among Injured Children
Zonfrillo, M. R., Durbin, D. R., Winston, F. K., Zhang, X., & Stineman, M. G. (2013) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2013.09.022 · Cited by 27 · see citing works
Pathophysiology and Management of Moderate and Severe Traumatic Brain Injury in Children
Guilliams, K. P., & Wainwright, M. S. (2014) · Journal of Child Neurology · doi:10.1177/0883073814562626 · Cited by 26 · see citing works
Bridging the gap: Mechanisms of plasticity and repair after pediatric TBI
Maria, N. S. S., Sargolzaei, S., Prins, M. L., Dennis, E. L., Asarnow, R. F., Hovda, D. A., Harris, N. G., & Giza, C. C. (2019) · Experimental Neurology · doi:10.1016/j.expneurol.2019.04.016 · Cited by 27 · see citing works
“Anderson and colleagues showed that children with severe TBI (Glascow Coma Score 3-8) recorded persistent depressed intellectual abilities up to 10 years postinjury (Anderson et al., 2012).”
BackgroundCardiac arrest in infants, children, and adolescents: long-term emotional and behavioral functioning
van Zellem, L., Utens, E. M. W. J., Madderom, M. J., Legerstee, J. S., Aarsen, F. K., Tibboel, D., & Buysse, C. M. P. (2016) · European Journal of Pediatrics · doi:10.1007/s00431-016-2728-4 · Cited by 25 · see citing works
Interleukin-8 Predicts Fatigue at 12 Months Post-Injury in Children with Traumatic Brain Injury
Crichton, A. J., Ignjatović, V., Babl, F. E., Oakley, E. A., Greenham, M., Hearps, S. J. C., Delzoppo, C., Beauchamp, M. H., Guerguerian, A., Boutis, K., et al. (2019) · Journal of Neurotrauma · doi:10.1089/neu.2018.6083 · Cited by 25 · see citing works
“Further, in an earlier work from our group, more broadly, 37,38 child functional and quality of life outcomes have been predicted by injury severity was classified based on the child’s lowest GCS within 24h.”
Self-citationBoerwinkle, V. L., Schor, N. F., Slomine, B. S., Molteni, E., Ramirez, J., Rasmussen, L., Wyckoff, S. N., Gonzalez, M. J., Gillette, K. D., Schober, M. E., et al. (2023) · Neurocritical Care · doi:10.1007/s12028-023-01673-w · Cited by 25 · see citing works
Patterns of traumatic brain injury and six-month neuropsychological outcomes in Uganda
Bangirana, P., Giordani, B., Kobusingye, O. C., Murungyi, L., Mock, C., John, C. C., & Idro, R. (2019) · BMC Neurology · doi:10.1186/s12883-019-1246-1 · Cited by 26 · see citing works
Trajectory of Long-Term Outcome in Severe Pediatric Diffuse Axonal Injury: An Exploratory Study
Lang, S., Kilbaugh, T. J., Friess, S. H., Sotardi, S. T., Kim, C. T., Mazandi, V. M., Zhang, B., Storm, P. B., Heuer, G. G., Tucker, A. M., et al. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.704576 · Cited by 24 · see citing works
Rehabilitation in Pediatric Stroke: Cognition and Behavior
Mrakotsky, C., Williams, T. S., Shapiro, K. A., & Westmacott, R. (2022) · Seminars in Pediatric Neurology · doi:10.1016/j.spen.2022.100998 · Cited by 24 · see citing works
TraumaRegister, D. G. U., Lichte, P., Andruszkow, H., Kappe, M., Horst, K., Pishnamaz, M., Hildebrand, F., Lefering, R. L., Pape, H., & Kobbe, P. (2015) · European journal of medical research · doi:10.1186/s40001-015-0159-8 · Cited by 24 · see citing works
“In this context, it was concluded that young children might be more vulnerable to disruptions caused by TBI compared to older children, as their brain is more rapidly developing with considerable cognitive skill maturation [7, 31, 32, 35].”
BackgroundFaber, J., Wilde, E. A., Hanten, G. R., Ewing‐Cobbs, L., Aitken, M. E., Yallampalli, R., MacLeod, M. C., Mullins, S. H., Chu, Z. D., Li, X., et al. (2016) · Brain Injury · doi:10.1080/02699052.2016.1199910 · Cited by 23 · see citing works
“Furthermore, in the same study [20], severity of head injury significantly influenced long-term post-injury outcome.”
BackgroundBaque, E., Barber, L. A., Sakzewski, L., & Boyd, R. N. (2016) · Brain Injury · doi:10.3109/02699052.2016.1165869 · Cited by 21 · see citing works
Cognitive Communication Impairments in Children With Traumatic Brain Injury: A Scoping Review
Cermak, C. A., Scratch, S. E., Reed, N. P., Bradley, K., de Launay, K. Q., & Beal, D. S. (2018) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000419 · Cited by 22 · see citing works
Lee, J. B., Affeldt, B. M., Gamboa, Y., Hamer, M., Dunn, J. F., Pardo, A. C., & Obenaus, A. (2018) · Developmental Neuroscience · doi:10.1159/000494134 · Cited by 21 · see citing works
Traumatic Injury to the Developing Brain: Emerging Relationship to Early Life Stress
Parker, K. N., Donovan, M. H., Smith, K., & Noble‐Haeusslein, L. J. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.708800 · Cited by 21 · see citing works
“The earlier the age of a TBI, the higher the risk for delayed or arrested development of cognitive and higher-level executive functioning (18, 59, 61).”
BackgroundPediatric Traumatic Brain Injury: Impact on the Developing Brain
Blackwell, L. S., & Grell, R. M. (2023) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2023.06.019 · Cited by 22 · see citing works
Paediatric traumatic brain injury: prognostic insights and outlooks
Au, A. K., & Clark, R. S. B. (2017) · Current Opinion in Neurology · doi:10.1097/wco.0000000000000504 · Cited by 21 · see citing works
Molteni, E., Colombo, K., Pastore, V., Galbiati, S., Recla, M., Locatelli, F., Galbiati, S., Fedeli, C., & Strazzer, S. (2020) · Brain Sciences · doi:10.3390/brainsci10030162 · Cited by 21 · see citing works
Verlinden, I., Güiza, F., Dulfer, K., Cleemput, H. V., Wouters, P. J., Guerra, G. G., Joosten, K., Verbruggen, S. C. A. T., Vanhorebeek, I., & den Berghe, G. V. (2022) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000002971 · Cited by 20 · see citing works
Roscigno, C. I., Savage, T. A., Grant, G. A., & Philipsen, G. F. (2013) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.04.017 · Cited by 20 · see citing works
Sharma, R., Casillas-Espinosa, P. M., Dill, L. K., Rewell, S. S. J., Hudson, M. R., O'Brien, T. J., Shultz, S. R., & Semple, B. D. (2021) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2021.11.013 · Cited by 19 · see citing works
Ryder, C., Mackean, T., Hunter, K., Williams, H., Clapham, K. F., Holland, A. J. A., & Ivers, R. (2019) · Critical Public Health · doi:10.1080/09581596.2019.1581918 · Cited by 19 · see citing works
“SES/position was reported on 46% (n = 11) of studies, generally USA based (n = 7, 64%), using a variety of tools: Duncan socioeconomic index, Daniel’s Scale of Occupational Prestige or Hollingshead Four Factor Index (Anderson et al., 2006, 2001, 2004; Ding et al., 2006; McCarthy et al., 2006; Moran et al., 2011; Polin…”
BackgroundMethodInfluentialSluys, K. P., Lannge, M., Iselius, L., & Eriksson, L. E. (2015) · Quality of Life Research · doi:10.1007/s11136-015-1002-y · Cited by 19 · see citing works
Golos, A., & Bedell, G. M. (2017) · Developmental Neurorehabilitation · doi:10.1080/17518423.2017.1342711 · Cited by 19 · see citing works
“Furthermore, children with severe TBI have been found to have persistent functional deficits in areas such as adaptive functioning and academic performance compared to children with moderate TBI and children with orthopedic injuries,(16) as well as the poorest outcomes, mainly cognitive deficits, compared to children…”
ResultCooper, J. M., Catroppa, C., Beauchamp, M. H., Eren, S., Godfrey, C., Ditchfield, M. R., & Anderson, V. A. (2013) · Journal of Neurotrauma · doi:10.1089/neu.2013.3101 · Cited by 18 · see citing works
“11,36,53 These studies, however, investigated EF post-brain injury by comparing adolescents living with TBI with controls.”
Self-citationConsensus-Based Evaluation of Outcome Measures in Pediatric Stroke Care: A Toolkit
Feldman, S. J., Beslow, L. A., Felling, R. J., Malone, L. A., Waak, M., Fraser, S. M., Bakeer, N., Lee, J. E. M., Sherman, V., Howard, M. M., et al. (2023) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2023.01.009 · Cited by 18 · see citing works
Sørensen, K., Liverød, J. R., Lerdal, B., Vestrheim, I. E., & Skranes, J. S. (2014) · Developmental Neurorehabilitation · doi:10.3109/17518423.2014.916761 · Cited by 19 · see citing works
Blaha, R. Z., Arnett, A. B., Kirkwood, M. W., Taylor, H. G., Stancin, T., Brown, T. M., & Wade, S. L. (2014) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000059 · Cited by 18 · see citing works
Hughes, N. (2015) · Criminal Justice Studies · doi:10.1080/1478601x.2014.1000004 · Cited by 17 · see citing works
“…outcomes were predicted by ‘family function’ and ‘family intimacy’ (Anderson et al., 2012, p. 259); a result ‘in keeping with previous reports from school-age samples and evaluation more proximal to time of injury’ (Anderson et al., 2012, p. 259; citing Catroppa et al., 2008; Yeates et al., 2010).”
ResultThe long-term effects of childhood traumatic brain injury on adulthood relationship quality
Rogers, A., & McKinlay, A. (2019) · Brain Injury · doi:10.1080/02699052.2019.1567936 · Cited by 17 · see citing works
Selection of children with ultra-severe traumatic brain injury for neurosurgical intervention
Greenan, K., Taylor, S. L., Fulkerson, D. H., Shahlaie, K., Gerndt, C. H., Krueger, E. M., & Zwienenberg, M. (2019) · Journal of Neurosurgery Pediatrics · doi:10.3171/2019.1.peds18293 · Cited by 17 · see citing works
Botchway-Commey, E. N., Godfrey, C., Anderson, V. A., Nicholas, C. L., & Catroppa, C. (2018) · Journal of Neurotrauma · doi:10.1089/neu.2018.5743 · Cited by 17 · see citing works
“T raumatic brain injury (TBI) is a major cause of death and acquired disability in children and adolescents, 1 with well-documented accounts of unfavorable outcomes in cognitive, 2,3 behavioral, 4,5 and neuropsychological 6,7 domains.”
InfluentialSelf-citationLindsey, H. M., Lalani, S. J., Mietchen, J. J., Gale, S. D., Wilde, E. A., Faber, J., MacLeod, M. C., Hunter, J. V., Chu, Z. D., Aitken, M. E., et al. (2019) · Brain Imaging and Behavior · doi:10.1007/s11682-019-00093-9 · Cited by 16 · see citing works
Vassel-Hitier, J., Verdier, V., Rasquier, S., Chalard, A., Laurent‐Vannier, A., & Chevignard, M. (2019) · Brain Injury · doi:10.1080/02699052.2019.1623420 · Cited by 15 · see citing works
“Unlike other studies (2,6,7), we found no correlation between age at injury and language, intellectual, or rehabilitation outcomes.”
BackgroundResultInfluentialPaget, S., Beath, A. W. J., Barnes, E. H., & Waugh, M.-C. A. (2012) · Developmental Neurorehabilitation · doi:10.3109/17518423.2012.671381 · Cited by 15 · see citing works
“children who sustain a severe TBI early in life and typically developing peers stabilise between five and ten years following the injury [24].”
BackgroundLong-Term Intellectual Function After Traumatic Brain Injury in Very Young Children
Crowe, L. M., Catroppa, C., Babl, F. E., Godfrey, C., & Anderson, V. A. (2020) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000626 · Cited by 14 · see citing works
Self-citationMaternal warm responsiveness and negativity following traumatic brain injury in young children.
Fairbanks, J. M., Brown, T. M., Cassedy, A. E., Taylor, H. G., Yeates, K. O., & Wade, S. L. (2013) · Rehabilitation Psychology · doi:10.1037/a0033119 · Cited by 14 · see citing works
Therapeutic strategies to target acute and long-term sequelae of pediatric traumatic brain injury
Huh, J. W., & Raghupathi, R. (2018) · Neuropharmacology · doi:10.1016/j.neuropharm.2018.06.025 · Cited by 14 · see citing works
Fuentes, M., Jimenezb, N., Apkona, S. D., & Rivarab, F. P. (2016) · Journal of Pediatric Rehabilitation Medicine · doi:10.3233/prm-160376 · Cited by 10 · see citing works
Wilde, E. A., Merkley, T. L., Lindsey, H. M., Bigler, E. D., Hunter, J. V., Ewing‐Cobbs, L., Aitken, M. E., MacLeod, M. C., Hanten, G. R., Chu, Z. D., et al. (2020) · Journal of Neurotrauma · doi:10.1089/neu.2019.6698 · Cited by 13 · see citing works
“whether cognitive deficits emerge or worsen when the brain injured child reaches the age when the cognitive ability in question is typically established.(60)”
BackgroundVolpe, D. S. J., Oliveira, N. C. A. C., dos Santos, A. C., Linhares, M. B. M., & Carlotti, A. P. D. C. P. (2017) · Brain Injury · doi:10.1080/02699052.2017.1358398 · Cited by 13 · see citing works
“In addition, FSIQ may also be influenced by the pre-injury function, family status and environmental factors (22).”
BackgroundPaediatric traumatic brain injury: unique population and unique challenges
Agrawal, S., Mannix, R., Anderson, V. A., Beauchamp, M. H., Ferguson, A. R., Braga, L. W., Chong, S., Figaji, A. A., Giza, C. C., Menon, D. K., et al. (2025) · Brain · doi:10.1093/brain/awaf459 · Cited by 12 · see citing works
“38,45 46-48 These conditions may emerge or persist across the lifespan, further amplifying the long-term burden of pTBI.”
Self-citation
- Authors
- Anderson, V., Godfrey, C., Rosenfeld, J. V., & Catroppa, C.
- Affiliations
- Royal Children's Hospital (AU)
- Murdoch Children's Research Institute (AU)
- The Alfred Hospital (AU)
- Venue
- PEDIATRICS
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2012-02-01
- Volume
- 129
- Issue
- 2
- Pages
- e254-e261
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2162200017
- Cited by
- 224
- References
- 35
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 9 · 2023: 11 · 2022: 20 · 2021: 17 · 2020: 20 · 2019: 24 · 2018: 15 · 2017: 10 · 2016: 19 · 2015: 22 · 2014: 12 · 2013: 14 · 2012: 11
- FWCI
- 14.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Keywords
- traumatic brain injury, pediatric brain injury, long-term outcomes, cognitive recovery, injury severity, adaptive function, executive function, family functions, verbal ability, recovery trajectories
- MeSH terms
- Adaptation, Psychological, Child, Child Behavior Disorders, Child, Preschool, Cognition Disorders, Disability Evaluation, Family Relations, Female, Humans, Infant, Infant, Newborn, Intelligence, Language Development Disorders, Longitudinal Studies, Male, Prognosis, Prospective Studies, Social Environment, Glasgow Coma Scale, Parenting, Brain Injury, Chronic, Family Conflict, Executive Function
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