Friendship, loneliness and psychosocial functioning in children with traumatic brain injury.

OBJECTIVE: This study compares friendship quality, rates of loneliness and general psychosocial functioning in children who have sustained a traumatic brain injury (TBI) with non-injured controls. METHODS: A between-subjects design with 14 participants in the TBI group and 14 in the non-injured control group, aged between 7-13 years and matched for age, gender, receptive vocabulary and socio-economic status. Children completed measures of receptive vocabulary (BPVS II), friendship quality (FQQ-R) and loneliness (LSDS). The main caregiver was asked to assess social skills and social withdrawal (PIC-2) and general psychosocial and behavioural functioning (SDQ). RESULTS: Significant differences were not found on measures completed by children or on the PIC-2. On the SDQ, total difficulties were rated as much greater by caregivers in the TBI group (z = -2.6, p = 0.009) and these were mainly associated with sub-scales relating to emotional problems and hyperactivity. CONCLUSIONS: Whilst evidence for friendship problems was not found in children with TBI, evidence for emotional and behavioural difficulties that may lead to social vulnerabilities later in life were found. This indicates a need for prospective longitudinal research to explore the complex relationship between TBI and poorer social outcomes that may not become evident until adolescence.

A systematic review of psychological interventions to alleviate cognitive and psychosocial problems in children with acquired brain injury.

AIM: It is now generally accepted that paediatric acquired brain injury (ABI) can have an impact on a child's cognitive, social, and behavioural functioning. However, the lack of guidelines on effective interventions for the affected children and their families, particularly beyond the acute recovery phase, can limit access to effective support. We provide a systematic review of the literature on the effectiveness of psychological interventions aimed at alleviating cognitive and psychosocial outcomes after paediatric ABI. METHOD: The search used the Ovid MEDLINE, Embase, Web of Knowledge, and EBSCO databases and hand searches of key journals. Nine studies met inclusion criteria: five intervention studies of cognitive outcome and four of psychosocial outcome. Effect sizes and methodological quality ratings were calculated using specific criteria. RESULTS: Only two of the nine studies were rated as high quality. There was limited evidence for effective interventions for cognitive outcomes (attention, memory, and learning difficulties). For psychosocial outcomes, there was evidence that interventions can alleviate internalizing symptoms. INTERPRETATION: Although there are some encouraging findings, there is a need for further, more rigorously designed, and better controlled research in this important area. We discuss how future research may consider issues such as age-appropriate interventions, the delivery format, and optimum post-injury timing of interventions, as well as multicentre collaborations.