CHILDRENS ADAPTIVE BEHAVIORAL COMPETENCE AFTER HEAD-INJURY

Eighty-six children were evaluated in a cross-sectional study 1 to 3 years after hospitalization for closed head injury in order to ascertain the effects of head injury severity, age, and chronicity of injury on the development of adaptive behavioural competence as measured by the Vineland Adaptive Behavior Scales. Twenty-three subjects had sustained moderate to severe injuries and 63 had sustained mild injuries, based on neurosurgical criteria including the Glasgow Coma Score, CT scans, and other medical variables. It was hypothesised that severity of head injury would adversely affect overall adaptive competence. It was also predicted that social competence would be less well developed in children with moderate to severe injury than in those with mild injury. Study findings provided partial support for these hypotheses. An unavoidable confounding of age and gender resulted in the decision to examine the data by gender to determine whether the data could be analysed without regard for this factor. An unexpected gender effect was observed. Severity of injury did adversely influence the adaptive competence of boys, especially in the area of social competency, but hypotheses were not upheld for girls. Discussion focuses on issues related to gender and adaptive outcome, parent report of adaptive functioning in light of gender and cultural factors, the relationship of neuropsychological functioning and adaptive competence, and the nature of social deficits following pediatric traumatic brain injury.