Psychosocial subtypes on the Behavior Assessment System for Children, Second Edition following pediatric traumatic brain injury
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Increasing numbers of children are surviving traumatic brain injuries (Thurman, Alverson, Dunn, Guerrero, it Sniezek, 1999), and in many cases, the public school system is the primary, if not only, provider of services to these survivors. School psychologists will typically be among the professionals responsible for completing evaluations for children with TBI within the school system; therefore, information regarding the existence and delineation of the characteristics of psychosocial problems in children suffering from TBI would be helpful to these and other clinicians. In the current literature, two studies have described specific psychosocial sequelae of pediatric traumatic brain injury (TBI) by identifying profiles of psychosocial functioning based on scores earned on a general behavior rating scale, specifically the Personality Inventory for Children – Revised (PIC-R; Butler, Rourke, Fuerst, & Fisk, 1997) and Child Behavior Checklist (CBCL; Hayman-Abello, Rourke, & Fuerst, 2003). School psychologists, however, may be more familiar with and more accustomed to using the Behavior Assessment System for Children, Second Edition (BASC-2) in their assessment protocols. Therefore, the purpose of this study was to develop a profile of psychosocial functioning following pediatric TBI by subjecting BASC-2 clinical scale profiles to cluster analysis. Data was archival and gathered from neuropsychological evaluations completed at an urban pediatric hospital. Those children aged 6 through 21 with BASC-2 PRS scores were considered for inclusion. Using a variety of hierarchical agglomerative clustering techniques, a typology was derived and compared to existing PIC-R, CBCL, and BASC-2 clinical profiles. The most reliable typology that emerged included two subtypes, which were labeled Normal and Pervasive Emotional Difficulties based on scale elevations of the mean BASC-2 profiles. Using further exploratory analyses, other less statistically reliable subtypes were also observed that were thought to have clinical significance. These were labeled Mild Externalizing/Depression, Mild Externalizing/Attention Problems, Mild Depression, and Mild Anxiety. While some similarities between these subtypes and the PIC-R and CBCL subtypes were noted, the subtypes were found to be quite different from the BASC-2 clinical profiles for the Bipolar Disorder, Depression Disorders, and Emotional/Behavioral Disturbance clinical subgroups. In addition, relationships between psychosocial subtype membership and gender, time elapsed since injury, age at injury, and age at testing were investigated. These analyses revealed time elapsed since injury to be the only variable resulting in a significant difference between subtypes. Limitations of the current investigation as well as suggestions for future studies are also discussed.