Introduction: Executive functions are frequently impaired following childhood traumatic brain injury (TBI), and they are difficult to assess. The aims of this study were to perform a comprehensive assessment of executive functioning following moderate-to-severe childhood TBI, and to study demographic and severity factors influencing outcome, using a newly developed test battery (Childhood Executive Functions - FEE Battery).
Patients and Methods: A convenience sample of 43 patients aged 7 to 16 years and 86 matched population norm controls underwent assessment using the FEE battery (12 subtests, designed to assess flexibility, inhibition, working memory, and planning). The parent- and teacher-ratings of the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire were collected.
Results: In the TBI group (65% males; 93% severe TBI; mean age at injury 9.12y [SD=4.1], Glasgow coma scale 5.85 [SD=2.06]; length of coma 6 days [SD=11.21]; time since injury 1.02 [SD=2.67] years), relatively to the control group, performance was significantly impaired in most of the FEE subtests (all time measures and most error measures) and in the BRIEF parent- and in teacher-reports, with moderate to large effect sizes. Univariate correlations in the TBI group did not yield significant correlations between the FEE subtests or the BRIEF questionnaires on one hand, and socio-economic status, TBI severity, or age at injury on the other hand.
Conclusion: Executive functioning is severely impaired following severe childhood TBI, and is best assessed using a combination of neuropsychological tests and behavioural ratings.