Traumatic Brain Injury and School Readiness Among Preschool-Aged Children in the United States

Abstract

Background

The aim of this study is to examine the association between traumatic brain injury (TBI) and school readiness using a nationally representative sample of preschool-aged children in the United States.

Methods

Using data on 15,402 preschool-aged children (ages three to five years) from the 2016 to 2018 cohorts of the National Survey of Children’s Health, this study investigates the association between lifetime measure of TBI in children and four domains of school readiness: early learning skills, self-regulation, social-emotional development, and physical health/motor development.

Results

Among this sample of preschool-aged children, 252 (1.64%) had experienced a TBI during their lifetime. Within school readiness domains, TBI was associated with a 62% to 99% increase in the rate of needs support/at-risk items and a 129% to 322% increase in the rate of at-risk items, contingent on the exact domain examined. Additional analyses reveal that, net of covariates, TBI reduced the predicted probability of being on-track across all four domains from approximately 0.424 for children with no history of TBI to 0.224 for children with a history of TBI.

Conclusions

A history of TBI was associated with reductions in school readiness within and across domains. Facilitating better communication between parents, pediatricians, and schools about both TBI and responses to TBI may result in the implementation of services and individualized, tailored instructional approaches that can improve educational outcomes.

Introduction

In recent years, research has drawn attention to traumatic brain injury (TBI) as a serious public health concern in the United States.^1,2 Estimates indicate that approximately 640,000 TBI-related emergency department visits and 18,000 TBI-related hospitalizations occur in the United States per year.¹ TBI also results in approximately $76.5 billion (in 2010 dollars) in direct and indirect costs related to medical care, treatment, and lost productivity.^3,4

TBI is a particularly salient issue for pediatricians, as it is the leading cause of death and disability among children aged zero to four years.^5,6 Beyond death and disability, the experience of a TBI among young children can disrupt various facets of development, including emotional, behavioral, and cognitive development.7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 Even so, scholars have generally overlooked the role of TBI in inhibiting early school readiness, particularly as it pertains to the intersection and simultaneity of multiple domains of school readiness (e.g., early learning skills, self-regulation, social-emotional development). This is a particularly noteworthy oversight in pediatric research, given that the American Academy of Pediatrics has supported a School Readiness Framework for assessing a child’s development and support needs before entering school, as well as to identify at-risk children.¹⁹

Educational trajectories are shaped by a variety of factors.²⁰ However, there is a growing awareness that many of the skills and competencies needed to be successful in school are acquired during the first years of life.²¹ Consequently, it is plausible that adverse events early in life may impede school readiness and contribute to subsequent poor academic outcomes.²² Notably, there is an array of adverse social contexts that may inhibit school readiness in children, including adverse childhood experiences and growing up in poverty.²² However, little research has explored how experiencing sudden life events that can alter brain functions and development (e.g., TBI) can inhibit school readiness. This gap is a particularly notable one in the literature considering that (1) early school readiness is thought to be central to child development^21,22 and (2) TBI carries severe consequences for academic outcomes and cognitive function later in life.^11,13,23 The identification of specific facets of school readiness in relation to TBI sequalae is important for the implementation of well-specified prevention programming.

Drawing from a unique US data source with well-characterized measurement of school readiness, the aim of the present study is to examine the association between TBI and school readiness using a nationally representative sample of preschool-aged children from the National Survey of Children’s Health (NSCH). Doing so promises to provide new insights regarding the challenges pertaining to school readiness that may be incurred by children with a history of TBI. Considering the far-reaching importance of both TBI and early childhood education, a deeper understanding of the characteristics and needs of these children is required to respond with evidence-informed programs and policies.