Association of parent ratings of executive function with global- and setting-specific behavioral impairment after adolescent traumatic brain injury

Objective: To determine the association of primary caregiver-rated behavioral and metacognitive aspects of executive function (EF) with impaired functioning after adolescent traumatic brain injury (TBI). Design: Multicenter cross-sectional study. Setting: Outpatient. Participants: Primary caregivers and children (N=132) aged 12 to 17 years who sustained a moderate or severe TBI within the past 1 to 6 months. Interventions: Not applicable. Main Outcome Measures: Primary caregiver ratings of EF, tests of memory and processing speed (PS), and a structured parent interview to assess clinical impairments in behavioral functioning were used. Logistic regression was used to examine the relation of ratings of EF with clinical ratings of impairment in global adolescent functioning and in functioning in the home, school, and community settings after controlling for sex, race, socioeconomic status, injury severity, and performance on the tests of memory and PS. Results: Caregiver ratings of poor EF were associated with impairment in both global behavioral functioning (odds ratio [OR]=4.73; 95% confidence interval [CI], 1.54-14.52; P<.01) and community functioning (OR=13.28; 95% CI, 1.94-90.87; P<.01). Conclusions: Caregiver ratings of deficits in EF were associated with impaired behavioral functioning after adolescent TBI and were independent of performance on tests of memory and processing speed. Understanding the relation of EF with clinical impairments as manifested in different settings will help hone assessment batteries and focus treatments where they are needed most.