Personal Injury Law

Objective Documentation of Anxiety Disorders in Children and Adolescents after Traumatic Brain Injury

By Bruce Stern

I have just read an interesting article published in the Journal of Neuropsychiatry and Clinical Neuroscience (2011; 23:29-39), which examines the nature, rate, predictive factors and neuroimaging correlates of new-onset definite anxiety disorders after traumatic brain injury. The study took children with traumatic brain injury from consecutive admissions to five trauma centers and who were studied with psychiatric interviews soon after injury and again six months post injury. The study found that new set (novel definite) anxiety disorders and novel definite/sub clinical anxiety disorders were heterogeneous and occurred in 8.5% and 17% of the participants respectively in the first six months after injury.
 
In doing the research, the authors noted 'the incidents of anxiety problems appears to increase after traumatic brain injury, although findings are mixed, depending on the measure of anxiety, whether disorders or symptom-counts. The literature suggests that when anxiety symptoms or disorders develop after TBI, they are varied and include post-traumatic stress disorder, phobic disorders, obsessive-compulsive disorder, and generalized anxiety disorder. 
 
The researchers hypothesized that novel anxiety in children and adolescents with TBI would be significantly associated with demographic, psychiatric and injury variables as follows:

1. Younger age at injury;
2. Family history of anxiety disorder, pre-injury anxiety, or other manifestations of effective dysregulation, e.g., novel depression and personality change due to TBI; and
3. Greater severity of injury, lesions of the dorsal-pre frontal regional and a lower incidents of orbito frontal gyrus lesions.  

The study included 177 participants, age 5-14 years, who suffered a traumatic brain injury between 1998 and 2003. The children were selected from three academic centers in Texas, Rady Children's Hospital in San Diego, and the Hospital for Sick Children in Toronto, Canada. 
 
The researchers found that novel definite anxiety disorder 'was significantly associated with younger age at injury and tended to be associated with novel depressive disorder, as well as lesions of the superior frontal gyrus. Novel definite/subclinical anxiety disorder was significantly associated with concurrent psychiatric problems of personality change due TBI and novel definite/subclinical depressive disorder as well as with lesions of the super frontal gyrus and a trend-association with frontal lobe white-matter lesions.  The findings suggested that anxiety after childhood TBI may be part of broader problem of effective dysregulation related to damage dorsal frontal lobe and frontal white-matter systems, with younger children being at greater risk for developing novel anxiety disorder after TBI. 

Full post as published by Traumatic Brain Injury Law Blog on March 07, 2011 (boomark / email).