Research Reports - Observed parent behaviors as time-varying moderators of problem behaviors following traumatic brain injury in young children

Dev Psychol. 2016 Nov;52(11):1777-1792.

Treble-Barna A(1), Zang H(2), Zhang N(2), Taylor HG(3), Stancin T(4), Yeates
KO(5), Wade SL(1).

Parent behaviors moderate the adverse consequences of pediatric traumatic brain
injury (TBI); however, it is unknown how these moderating effects change over
time. This study examined the moderating effect of observed parent behaviors over
time since injury on the relation between TBI and behavioral outcomes.
Participants included children, ages 3-7 years, hospitalized for moderate (n =
52) or severe (n = 20) TBI or orthopedic injury (OI; n = 95). Parent-child dyads
were videotaped during structured task and free play conditions, and parents
completed child behavior ratings. Linear mixed models using a lagged,
time-varying moderator analysis examined the relationship of observed parent
behaviors at the baseline, 6-month, and 12-month assessments to child behavior
problems at 6 months, 12 months, and 18 months postinjury, after controlling for
preinjury levels of child behavior problems. The effect of TBI on behavior was
exacerbated by less favorable parent behaviors, and buffered by more favorable
parent behaviors, in children with severe TBI over the first 12 months
postinjury. By 18 months postinjury, however, the moderating effect of parent
behaviors diminished, such that children with severe TBI showed more behavior
problems relative to children with moderate TBI or OI regardless of parent
behaviors or in response to parent behaviors that were initially protective. The
results suggest that the moderating effects of the family environment are complex
and likely vary in relation to both recovery and developmental factors, with
potentially important implications for targets and timing of intervention. 

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