Neurobehavioral outcome of children's mild traumatic brain injury.

Brain damage is underestimated as a public health and personal problem. The common belief in a good prognosis for childhood brain damage is unsubstantiated. It is based on lack of rigorous study and examiner satisfaction with a low response level. Occult brain trauma plagues victims into maturity. Above a rather low threshold of injury (even without focal neurologic findings), cognitive, personality, and adaptive dysfunctions are common and impairing. Child abuse signals were described. Brain lesions impair both matured functions and those expressed later. Dysfunctions were discussed for these neurobehavioral systems: consciousness, attention and tonic motor level; sensorimotor and body schema; neurophysiologic; cerebral personality; intelligence; memory; language; information processing; posttraumatic stress and mood; identity and insight; adaptivity in the community. Outcome evolves from complex pathologic, neurologic, anatomic, and personality parameters, the postinjury interval and child's age, the maturity and developmental trajectory of the function, social support, and emotional reaction to impairment. Assessment should study the entire range of functions, utilizing records, collaterals, observation, and qualitative and psychometric measurement. Complex, challenging, and ecologically relevant tasks are appropriate. There are several patterns of outcome: immediate permanent deficits; improvement through compensatory mechanisms, but with subclinical deficits; and initial progress with delayed expression (premature plateau of cognitive and personality maturity; physiologic developmental deficits). Confirmation of mild TBI may require several years of observation to determine late dysfunctions and deviation from preinjury or postinjury performance or expected level of development.