Executive functioning in children and adolescents with traumatic brain injuries: Utilization of the Comprehensive Trail Making Test
Traumatic brain injuries have frequently been referred to as the "silent epidemic." The term "silent" is used to describe the often invisible, yet detrimental effects a traumatic brain injury (TBI) may cause. Increasing prevalence rates have led to 1.4 million TBIs occurring each year in the United States, with an estimated 90,000 individuals enduring a permanent disability due to the TBI. Within children and adolescents, TBIs are the leading cause of death and disability.
A childhood TBI often results in life-long cognitive impairments frequently seen in basic psychological processes such as attention, perception, language, memory, and executive functioning skills. Of these vital skills, executive dysfunction has been described as the most debilitating, long-term deficit resulting from a TBI. Despite the epidemic proportions and the long-term effects, few studies have utilized a developmentally appropriate, standardized measure to assess executive functioning within a pediatric TBI population. The purpose of this study was to compare executive functioning, as measured by the Comprehensive Trail Making Test (CTMT), of children and adolescents who have sustained a TBI to a non-injured control group to determine the nature and extent of differences between groups.
The participants included 160 children and adolescents between the ages of 11- and 19-years-old. Eighty of the participants had sustained a head injury and 80 were randomly matched on age and gender from the standardization sample of the CTMT. Initial data analysis utilized a univariate ANOVA which demonstrated significant differences between groups on the CTMT Composite Index. Secondly, repeated measures MANOVAs indicated differences between the clinical and control groups on each CTMT trail and on combination of trails, but no within group differences. Finally, the results of the TBI sample were examined to confirm the findings of a two factor model evident in the CTMT standardization sample. Results revealed that a single factor model was a better fit for the present sample of TBI participants. The findings of this study enhance the understanding of the substantial impact a pediatric TBI has on executive functioning. The implications of these results provide additional interventions for practitioners and educators as they work with this population.