Relation of family characteristics and survivor characteristics to outcome after acquired brain injury in adolescents

The following study investigated the role of factors such as individual injury-related impairment, family characteristics and amount of time elapsed since injury in predicting outcome in a sample of 38 moderately to severely brain injured adolescents. Of particular interest was the potential mediating effect family style may play in optimizing individual adolescent and family outcome when degree of impairment is considered. Outcome was determined in two ways: individual outcome (as measured on the Community Integration Questionnaire and the Portland Adaptability Inventory) and family outcome (as measured on the FAM III). Various symptom checklists were administered to adolescents, parents and rehabilitation professionals to capture the severity and types of residual impairments. A Principle Components Analysis was conducted to reduce the number of such variables, yielding three factors: (i) the adolescent's perspective on cognitive/emotional functioning, (ii) the parent's perspective on cognitive/emotional motional functioning and finally, (iii) physical functioning and dependency. Family characteristics were determined from parent responses on the FACES III, a measure which captures levels of Cohesion and Adaptability.

A series of hierarchical regressions were conducted, separately for individual and family outcome with the following significant findings. Individual outcome was found to be optimized to some extent by higher levels of adaptability within the family, even in cases of more severely cognitively and behaviourally impaired adolescents. Time since injury contributed significantly to the prediction of individual outcome with the PAI, with worse outcome noted as greater time elapsed since injury. In terms of overall family outcome, the results suggest that a more disengaged family style may benefit families of more impaired adolescents while greater levels of cohesion was related to improved family functioning with lesser degrees of impairment. The implications of these findings were reviewed and included the need to consider physical functioning/dependancy and its impact on outcome, and not only cognitive/emotional functioning, as has been emphasized in the literature. Further, research in future needs to consider the importance of “goodness of fit” among families of the brain injured, in an effort to identify those families which may benefit from professional intervention to optimize outcome.