Ecological Assessment of Everyday Executive Functioning at Home and at School using the BRIEF Questionnaire following Childhood Traumatic Brain Injury (TBI)
Dr Mathilde CHEVIGNARDa, Mrs Bernadette KERROUCHEb, Dr Agata KRASNY-PACINIc, Mrs Aude MARILLERa, Mrs Emmanuelle PINEAU-CHARDONa, Mrs Pauline NOTTEGHEMa, Mrs Julie PRODHOMMEd, Prof Didier LE GALLe, Dr Jean-Luc ROULINf, Dr Nathalie FOURNETf, Dr Arnaud ROYe
a Service de Rééducation des Pathologies Neurologiques Acquises de l'Enfant - Hôpitaux de Saint Maurice, b Centre de Suivi et d’Insertion pour Enfants et Adolescents avec Lésion Cérébrale Acquise - Hôpitaux de Saint Maurice, c Institut Universitaire de Réadaptation Clemenceau - Strasbourg, d Service de Neurochirurgie, Hôpital Necker Enfants Malades, Paris, e Laboratoire de Psychologie, LUNAM, Université d’Angers, f Laboratoire de Neurocognition et de Psychologie, Université Savoie Mont-Blanc, Chambéry
Introduction: Cognitive and behavioural aspects of executive functioning (EF) are frequently impaired following childhood TBI. The Behavior Rating Inventory of Executive Function (BRIEF) questionnaire provides an ecological assessment of EFs in everyday life in home and school environments. The aims of this study were to describe the dysexecutive disorders in children with TBI using the BRIEF; to compare parent- and teacher-ratings and to analyse the demographic and medical variables influencing outcome.
Methods: Participants: Children/adolescents aged 5 - 17 years 11 months, referred to a paediatric rehabilitation department following TBI. Outcome measures: the parent- and the teacher-report of the BRIEF were collected during neuropsychological assessment (2009-2014), as well as the teacher-report (from 2014). Age at injury and assessment, parental education and TBI severity were collected.
Results: 194 patients (142 boys) participated in the study [mild (n=13), moderate (n=12) or severe (n=169: mean duration of coma 7.2 days; SD=6.5)]. 193 parent-reports and 28 complete teacher reports of the BRIEF were available. Mean age at injury/assessment were 6.9 (SD=4.4), and 11.8 (SD=3.5) years respectively. According to parent-ratings, children had significantly elevated scores in all BRIEF indices [Global Executive Composite (GEC), Behaviour Regulation Index (BRI), Metacognition Index (MI)], and subscales (mean T-scores 61-64; all p< .0001), with 24% to 48.0% scoring in the clinical range. Teachers’ ratings indicated similar deficits in all sub-scales (mean T-scores 63-70; all p< .001), with 39.3-57.2% scoring in the clinical range. For patients with teacher and parent-reports (n=27), no significant difference was found between parent and teacher ratings, which were significantly correlated (r .44 to .72). Regression analyses indicated that GEC was significantly predicted by older age at assessment. The regression model for BRI was not significant. For MI, younger age at injury and older age at assessment were significant predictors.
Discussion and conclusion: This study highlights elevated levels of executive dysfunction in everyday life following childhood TBI, evident in home and school environments. Younger age at injury seems to influence the cognitive rather than the behavioural aspects of EFs, whereas older age at assessment is related to higher levels of complaints, probably due to the increasing levels of expectations.
Keywords : traumatic brain injury, child, adolescent, executive functions, ecological assessment, everyday life, home, school