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Strong Relationships May Help Adolescents Adjusting to a Traumatic Brain Injury

study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

A traumatic brain injury (TBI) is lasting brain damage from an external force, such as a fall or a car accident. TBI can be mild, moderate, or severe. TBI is especially common during adolescence, with about 300,000 youth hospitalized each year in the US for a TBI, according to the National Electronic Injury Surveillance System. Adolescents adjusting to a TBI may be at risk for emotional and behavioral challenges such as anxiety, depression, or conduct problems. Having strong, supportive relationships with parents, siblings, friends, and teachers can help adolescents adjust to life changes after a TBI. However, if these relationships become strained, adolescents could struggle with adjusting to those life changes. In a recent NIDILRR-funded study, researchers looked at the connections between relationship supportiveness, relationship stresses such as conflict, and adjustment among adolescents with recent TBI. They wanted to find out if adolescents who had more supportive relationships with their parents, siblings, friends, and teachers experienced better adjustment than those with less supportive relationships, and whether the adolescents with more stressful relationships experienced worse adjustment. They also wanted to find out if supportive relationships could buffer the impact of stress on adjustment for adolescents with TBI. Finally, the researchers wanted to find out if the connections between relationship supports, stresses, and adjustment were different between adolescents with more and less severe TBI.

Researchers at the Rehabilitation Research and Training Center on Interventions for Children and Youth with TBI analyzed completed surveys from 152 adolescents with TBI who were enrolled in a larger study. The participants were 11-18 years old and had experienced their TBI less than 18 months before joining the study. Each participant completed the survey 3 times over a 1-year period. On each survey, the participants answered questions about their relationships with parents, siblings, friends, and teachers. For each relationship, the participants rated how understanding, respectful, reliable, and encouraging the relationship felt. These ratings were averaged into an overall level of support for each type of relationship, with higher scores indicating higher levels of support. The participants also rated how much stress they encountered in each relationship, defined as criticism, conflict, irritation, anger, and high expectations. These ratings were also averaged into an overall level of stress for each type of relationship, with higher score indicating higher level of stress.  To measure adjustment, the participants indicated whether or not they had recently experienced a variety of symptoms including internalizing symptoms such as anxiety, depression, or physical symptoms, as well as externalizing symptoms such as disruptive behavior. In addition to the surveys, the researchers reviewed participants’ medical records to determine the severity of the TBI.

The researchers looked at connections between level of relationship support, level of relationship stress, and number of symptoms that the participants reported across the three time points. They found that:

  • For all four types of relationships (with parents, siblings, friends, and teachers), the participants with higher levels of support reported fewer internalizing symptoms than the participants with lower level of support.
  • For family relationships (with parents and siblings), the participants with higher levels of support reported fewer internalizing and externalizing symptoms.  However, this association was stronger for the participants with mild or moderate TBI than for the participants with severe TBI.
  • For all four types of relationships, the participants with higher levels of stress reported more of both internalizing and externalizing symptoms
  • For relationships with teachers, the participants with higher levels of stress but with higher level of support from teachers had fewer externalizing symptoms than those who with higher levels of stress and lower levels of support from teachers.
  • For relationships with friends, the participants with higher levels of support reported fewer internalizing and externalizing symptoms, but only when the stress levels were low. However, when the friend stress levels were high, the levels of support were not related to the symptom levels.

The authors noted that relationships with family members, friends, and teachers can all have a meaningful impact on adolescents’ adjustment after a TBI. Both supports and stresses in these relationships may be linked with adjustment outcomes. Adolescents with stressful friendships, without supportive relationships with teachers, and those with severe TBI may face the highest risk of adjustment difficulties. According to the authors, adolescents with chronic conditions like TBI often turn to their peers for support and could learn more effective coping strategies from their peers if their relationships are supportive. Clinicians serving adolescents with TBI may wish to focus on relationship building and conflict management, in order to support these adolescents to thrive after a TBI.

To Learn More

The Model Systems Knowledge Translation Center (MSKTC) offers a collection of evidence-based information resources on TBI including the TBI InfoComics series and Returning to School after TBI factsheet.

The Center on Brain Injury Research and Training offers resources for teachers and other education professionals who work with students with TBI in their Back to School website. also offers a collection of information resources on TBI in children, including more than 20 articles on adolescents and TBI.

To Learn More About this Study

Lantagne, A, et al. (2018) Interpersonal stressors and resources as predictors of adolescent adjustment following traumatic brain injury. Journal of Pediatric Psychology, 43(7), 703-712. This article is available free in full text from the publisher and from the NARIC collection under Accession Number J78922.

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