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Family Coping Strategies in Traumatic Brain Injury

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                   Family Coping Strategies in Traumatic Brain Injury

                                         By H. Gerry Taylor, PhD. and Terry Stancin, PhD.



It is well-established that moderate to severe pediatric traumatic brain injury (TBI) can result in longer-term

problems with thinking, memory, behavior and emotional functioning, even long after medical issues have been

resolved and the child has been discharged from medical care.


The risk for developing such problems is greater if the child sustains other significant injuries in addition to the

brain injury, such as severe fracture. The risk of these problems also increases if the child has a history of pre-

injury problems with learning or behavior. Poor performance on neuropsychological testing is not always the best

predictor of behavior challenges. Economic and social disadvantages may also raise the risk for poor outcomes

after injury. Children whose families have fewer social supports and financial resources, and therefore less

accessibility to specialized treatment programs seem to exhibit more problems after TBI. Likewise, the impact of

TBI on the family, and the way the family mobilizes its resources to support the child’s progress are as important

factors in recovery as the severity of injury itself.


An important research finding has been the discovery of a bi-directional relationship between children with TBI

and their families in the recovery process. The quality of life of the child affects the family’s quality of life and the

reverse is true as well. That TBI impacts the entire family is reflected in research findings showing 67% of families

with children with severe brain injury had at least one family member who sought mental health treatment after

the injury.


One important way this bi-directional relationship can be expressed is in comparison of parent and child ratings of

health-related quality of life after TBI. Parents tend to notice more problems with peer relations and other areas,

resulting in lower quality-of-life ratings compared to the child’s own ratings. Therefore, parents are the first line of

defense in recognizing problems as they arise, and initiating treatment.


Research has pinpointed some strategies family members have used successfully in dealing with TBI as a family:


Educated understanding requires learning about the challenges children typically face after TBI. For example,

new behavior problems are common, and sometimes the usual methods of learning and discipline are less

effective. Parents who are knowledgeable about these problems can develop tools for interacting most

successfully with the child (these tools can be used by teachers and peers as well) to help minimize disruptive

behavioral patterns.
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Active coping is described as active attempts by parents to find solutions or alternatives to challenging

problems. While persistence is important, it is equally important to recognize what things can be changed (and

those that cannot), and know when to redirect one’s energy towards a potentially more helpful goal. This can help

prevent the frustration of endless attempts to locate a program that does not exist, or trying to change an

unwanted behavior when changing one’s response to the behavior might be more effective. The latter might be

thought of as coming to terms with the child’s injury and how best to deal with its effects on the child and family.

This can greatly lower a caregiver’s perceived burden and reduce stress for both parent and child.


The key to active coping and acceptance of reality is to focus on changing what can be changed and

accommodating to what cannot be changed.


Family intervention requires making a commitment to the overall health of the family, not just the injured child,

because a healthy family is the best resource in maximizing the child’s achievement and adjustment. Parents,

siblings, and extended family all experience feelings of loss and distress when a loved one is injured. The social,

psychological and economic stressors families can experience after TBI certainly impact the child’s long-term

recovery, so intervention for the family as a whole is highly recommended.


Facilitating recovery refers to consideration of the child’s individual needs and strengths in determining

educational and social interventions. For example, a child who was actively involved in sports can participate in

recreational programs modified for children with exceptional needs, or perhaps a more highly functioning child

might be directed towards a different role in the existing sport (i.e., helping ‘manage’ the team). Another

alternative would be directing the child towards art or music programs, depending upon his or her strengths and

interests. The goal of facilitating recovery is to minimize the disruptive impact of TBI on later development, and

maximize socialization, school performance and the child’s strengths.


Dr. Taylor is Professor of Pediatrics and Psychology at Case Western Reserve University, Cleveland, Ohio. He is also Director

of Pediatric Neuropsychology Service, Division of Behavioral Pediatrics and Psychology, Rainbow Babies and Children's

Hospital, University Hospitals of Cleveland. He has published extensively in the area of outcomes after pediatric TBI and low

birth weight. Dr. Taylor is Board Certified in Clinical Neuropsychology by the American Board of Professional Psychology. He

has been on the editorial boards of a number of child psychology and neuropsychology journals and is on the Maternal and

Child Health Review Committee, National Institute of Child Health and Human Development.



Dr. Stancin is Head of the Division of Child Psychology in the Department of Pediatrics at MetroHealth Medical Center in

Cleveland, Ohio. She is also an Associate Professor of Pediatrics, Psychiatry and Psychology at Case Western Reserve

University. In 2001, Dr. Stancin received the Chairman's Award for Research Excellence in the Department of Pediatrics at
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MetroHealth Medical Center. She serves as an editor and editorial board member for numerous journals. She has published

extensively in the area of pediatric brain injury.


References:


Wade, S., Drotar, D., Taylor, H.G., & Stancin, T. (1995). Assessing the effects of traumatic brain injury on family functioning:

Conceptual and methodological issues. Journal of Pediatric Psychology, 20, 737-752.



Wade, S., Taylor, H.G., Drotar,D., & Stancin, T., & Yeates, K.O. (1996). The pediatric effects of traumatic brain injury (TBI) on

families. Journal of Learning Disabilities, 29, 652-661.



Yeates, K.O., Taylor, H.G., Drotar, D., Wade, S.L., Klein, S., Stancin, T., & Schatschneider, C. (1997). Pre-injury family

environment as a determinant of recovery from traumatic brain injuries in school-age children. Journal of the International

Neuropsychological Society, 3, 617-630.



Wade, S., Taylor, H.G., Drotar, D., Stancin, T., & Yeates, K.O. (1998). Family burden and adaptation during the initial year

following traumatic brain injury (TBI). Pediatrics, 102,

110-116.



Taylor, H.G., Yeates, K.O., Wade, S.L., Drotar, D., Stancin, T., & Klein, S.K. (1999). Influences on first-year recovery from

traumatic brain injury in children. Neuropsychology,

13, 76-89.



Taylor, H.G., Yeates, K.O., Wade, S.L., Drotar, D., Stancin, T., & Burant, C. (2001). Bidirectional child-family influences on

outcomes of traumatic brain injury in children. Journal of the International Neuropsychological Society, 7, 755-767.



Wade, S.L., Borawski, E.A., Taylor, H.G., Drotar, D., Yeates, K.O., & Stancin, T. (2001). The relationship of caregiver coping to

family outcomes during the initial year following pediatric traumatic brain injury. Journal of Consulting and Clinical Psychology,

69, 406-415.



Taylor, H.G., Yeates, K.O., Wade, S.L., Drotar, D., Stancin, T., & Minich, N. (2002). A prospective study of short- and long-term

outcomes after traumatic brain injury in children: Behavior and achievement. Neuropsychology, 16, 15-27.



Stancin, T., Drotar, D., Taylor, H.G., Yeates, K.O., Wade, S.L., & Minich, N.M. (2002). Health related quality of life of children

and adolescents following traumatic brain injury. Pediatrics, 109 (electronic article), e34.



Wade, S.L., Taylor, H.G., Drotar, D., Stancin, T., Yeates, K.O., & Minich, N.M. (2002). A prospective study of the long-term

caregiver and family adaptation following brain injury in children. Journal of Head Trauma Rehabilitation, 17, 96-111.
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Schwartz, L.S., Taylor, H.G., Drotar, D., Yeates, K.O., Wade, S.L., & Stancin, T. (in press). Long-term behavior problems

following pediatric traumatic brain injury: Prevalance, predictors, and correlates. Journal of Pediatric Psychology.



Taylor, H.G., Yeates, K.O., Wade, S.L., Drotar, D., Stancin, T., & Montpetite, M. (in press). Long-term educational interventions

after traumatic brain injury in children. Rehabilitation Psychology.



Yeates, K.O. (1999). Closed-head injury. In K.O. Yeates, M.D. Ris, & H.G. Taylor (Eds.), Pediatric neuropsychology: Research,

theory, and practice (pp.92-116). New York: Guilford.

				
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