Twenty five children with inflicted traumatic brain injury (TBI) seen in Scotland between 1980 and 1999 were followed prospectively with neurologic and cognitive examinations performed at the Department of Child Life and Health, University of Edinburgh, Scotland. Sixty eight per cent of survivors showed abnormalities at mean follow-up of 59 months; impairments were severe with complete dependency in 36%, moderate in 16%, and mild in 16%. Outcome correlated with the Pediatric Trauma and Glasgow Coma Scores but not with age at injury or mechanism of injury. Inflicted TBI has a poor prognosis and correlates with severity of injury. Behavior problems in 52% began to manifest at age 2 to 3 years, and learning difficulties and attention and memory deficits were recognized only when the child attended school. [1]

COMMENT. This study confirms the high morbidity in survivors of TBI in infants, and sequelae may be manifested only after long-term follow-up. The authors emphasize the importance of environmental factors in behavior and development of these patients.

Executive functions after traumatic brain injury in children are reviewed at Baylor College of Medicine, Houston, TX [2]. Executive functions include cognitive control (decision making, planning, achieving goals), self-regulation, motivation, and conforming to social behavior. Inhibition is an age-dependent skill linked to cognitive control, and impaired in TBI as well as ADHD. The executive dysfunction following TBI resembles that seen with “developmental” ADHD, and both are related to frontal lobe involvement, which in TBI may be progressive.