The Relationship Between Childhood Trauma History and Neurobehavioral Symptoms Following Traumatic Brain Injury

Research Objectives: To determine the association between childhood adversity (abuse, household dysfunction, neglect, and/or traumatic brain injury [TBI] before the age of 18) and neurobehavioral symptoms in adulthood, after controlling for the presence and severity of adult TBI.

Design: Cohort study.

Setting: Community.

Participants: English-speaking adults with and without a self-reported history of mild to severe TBI (N=64; n=52 with a history of TBI; n=12 with no history of TBI).

Interventions: N/A

Main Outcome Measures: Behavioral Assessment Screening Tool (BAST) Negative Affect, Substance Abuse, Executive Dysfunction, Fatigue, and Impulsivity subscales for adults. Adverse Childhood Experiences (ACEs) Questionnaire used to calculate scores for four distinct constructs of childhood adversity: 1) emotional/physical abuse, 2) household dysfunction, 3) sexual abuse, and 4) neglect. Ohio State University Traumatic Brain Injury (OSU-TBI) Identification Method used to determine TBI severity and history of TBI before the age of 18.

Results: Five domains of childhood adversity (emotional/physical abuse, household dysfunction, sexual abuse, neglect, and severity of TBI before the age of 18) accounted for 28.1% of the variability in negative affect (R2ADJΔ = .281, p < .001) and 12.0% of the variability in fatigue (R2ADJΔ = .120, p = .025), after adjusting for age, gender, and adult TBI severity. Childhood adversity also accounted for 10.9% of the variability in executive dysfunction (R2ADJΔ = .109, p = .047) , but was not associated with impulsivity symptoms (R2ADJΔ = .012, p = .348). Experiences of neglect during childhood had the strongest effect on negative affect (BStand=.506), fatigue (BStand=.426), and executive dysfunction (BStand=.485).

Conclusions: Our results suggest that, following TBI in adulthood, chronic neurobehavioral symptom patterns are related to experiences of trauma during the first 18 years of one’s life. In particular, neglect during childhood appears to be strongly related to negative affect, fatigue, and executive dysfunction symptoms, even years after brain injury in adulthood. Future studies should further investigate the unique impact of these childhood adversity domains on neurobehavioral symptoms post-TBI.

Author(s) Disclosures: NIH/NICHD R03HD094445