Study Shows Parent's Brain Injury Can Lead to Behavior Problems In Children, Breakdown In Parent-Child Relationship

BUFFALO, N.Y. -- When a parent sustains a brain injury, it can affect a child's behavior, as well as cause problems in the relationship between a child and the brain-injured parent, a University at Buffalo study has shown.

UB researchers investigating how 52 children in 24 families responded to a brain-injured parent found that most of the children experienced some negative behavior changes after the parent's injury, and that a significant breakdown in the relationship between the children and the injured parent occurred in 40 percent of the families.

Results showed that parenting performance changed for the worse in most families, and that these changes were correlated with increased acting out, and relationship and emotional problems in the children.

A critical factor in the children's response to the situation appeared to be depression in the uninjured parent. Two-thirds of the noninjured parents experienced depression.

There was very little apparent correlation between the children's problems and the severity of injury and subsequent disabilities of the injured parent.

Linda F. Pessar, M.D., UB clinical associate professor of psychiatry and lead researcher on the study, said that while previous studies have concluded that psychological, cognitive and behavioral changes in an individual with brain injury may produce enduring stress for the family as a whole, the question of how children in particular respond has received little research attention.

Her study investigated the nature and frequency of the children's psychological and behavioral problems and both parents' behavior and attitudes associated with those problems.

Pessar and colleagues looked only at families who had at least one child who was born before the injury occurred and was still living at home. There was an equal number of boys and girls in the study, ranging in age from 2 to 23 years.

Fathers were the injured parents in 16 of the 24 families, mothers in 8. The age of the injured parent ranged from 25 to 53 years, and time since injury was 16 to 84 months. Twenty of the 24 subjects were considered to have severe brain injury.

The uninjured parents answered questionnaires concerning their children's behavioral changes, as well as parenting changes in themselves and in their brain-injured spouses. Injured spouses answered questions concerning changes in their own parenting behavior.

Seventeen of the 24 uninjured parents scored above the norm for depression, a finding that was significantly related to reduced parenting performance of both parents, which in turn was highly correlated with the three categories studied -- acting-out behavior, relationship problems and emotional problems.

Five families reported a substantial increase in children acting out. This behavior included poor grades and problems at school, absenteeism, temper outbursts and disobeying the injured parent.

Ten families reporting a substantial increase in children's relationship problems, which included being less loving toward the injured parent, not wanting to spend time with the injured parent and not bringing friends home. The injured parent was the father in all but one instance of substantial relationship problems. Older children had more relationship problems than younger children.

Children in four families had substantial emotional problems, such as headaches, bad dreams and refusing to go out with friends.

Pessar said the results suggest that rehabilitation efforts for traumatic brain injury should include a family assessment, and should pay particular attention to the presence of depression in parents, the parenting behavior of both parents and their effects on children.

"Depression is eminently treatable," Pessar said. "That intervention may make a difference in the entire family."

The study was funded by a grant from the National Institute on Disability and Rehabilitation Research, and was published in Brain Injury.

Also participating in the study were Mary Lou Coad, Richard T. Linn, Ph.D., and Barry S. Willer, Ph.D., from the UB Department of Psychiatry.