Impact of Early Intervention on Outcome After Mild Traumatic Brain Injury in Children Jennie Ponsford, PhD*‡; Catherine Willmott, MSc*‡; Andrew Rothwell, MSc§; Peter Cameron, FACEM; Gary Ayton, FACEM¶; Robyn Nelms, Grad Dip App Psych‡; Carolyn Curran, MPsych‡; and Kim Ng, PhD* ABSTRACT. Objectives. The impact of mild head in- jury or mild traumatic brain injury (TBI) in children is variable, and determinants of outcome remain poorly understood. There have been no previous attempts to evaluate the impact of interventions to improve outcome. Results of previous intervention studies in adults have been mixed. This study aimed to evaluate the impact of providing information on outcome measured in terms of reported symptoms, cognitive performance, and psycho- logical adjustment in children 3 months after injury. Methods. A total of 61 children with mild TBI were assessed 1 week and 3 months after injury, and 58 chil- dren with mild TBI were assessed 3 months after injury only. They were compared with 2 control groups (N  45 and 47) of children with minor injuries not involving the head. Participants completed measures of preinjury be- havior and psychological adjustment, postconcussion symptoms, and tests of attention, speed of information processing, and memory. Children with mild TBI seen at 1 week were also given an information booklet outlining symptoms associated with mild TBI and suggested cop- ing strategies. Those seen 3 months after injury only did not receive this booklet. Results. Children with mild TBI reported more symptoms than controls at 1 week but demonstrated no impairment on neuropsychological measures. Initial symptoms had resolved for most children by 3 months after injury, but a small group of children who had previous head injury or a history of learning or behav- ioral difficulties reported ongoing problems. The group not seen at 1 week and not given the information booklet reported more symptoms overall and was more stressed 3 months after injury. Conclusions. Providing an information booklet re- duces anxiety and thereby lowers the incidence of ongo- ing problems. Pediatrics 2001;108:1297–1303; mild head injury, mild traumatic brain injury, intervention, outcome. ABBREVIATIONS. TBI, traumatic brain injury; PTA, posttrau- matic amnesia; GCS, Glasgow Coma Scale; CBCL, Child Behavior Checklist; BRI, Behavioural Rating Inventory; PCSC, Post Concus- sion Syndrome Checklist; WRAML, Wide Range Assessment of Memory and Learning; CHIPASAT, Children’s Paced Auditory Serial Addition Task; CNT, Contingency Naming Task. I n recent years there has been growing interest in the impact of mild head injury, or mild traumatic brain injury (TBI), in children. It is estimated that approximately 180 children per 100 000 population sustain closed head injury each year. Eighty percent of these injuries are classified as mild. 1 Most of these children are not admitted to a hospital and therefore receive variable medical attention. Studies of chil- dren with mild head injury suggest that headaches and some cognitive and behavioral symptoms are common in the early days after injury 2 but that the majority of children make a good recovery. 3–7 How- ever, some children appear to experience ongoing cognitive and behavioral difficulties, demonstrating cognitive impairments in attention, speed of infor- mation processing, memory, fatigue, and sensorimo- tor function. 8 –10 Some research groups attribute these impairments to preexisting problems. 11–13 Moreover, premorbid concentration difficulties and impulsivity have been identified as risk factors for traumatic head injury in children. 14 In view of the significant demands placed on chil- dren to pay attention and learn, particularly in school, optimal management of any sequelae of mild head injury is essential. Children who sustain mild TBI usually do not show visible signs of being unwell or incapacitated, resulting in the expectation that they will perform at school as usual. Distractibility or restlessness may be interpreted as laziness or delib- erate misbehavior, resulting in punishment and iso- lation rather than support and assistance. Protocols designed to minimize ongoing problems after mild head injury in adults have been described by several authors. 15–22 These generally involve pro- viding information about expected symptoms and suggested coping strategies, in some cases a brief screening assessment, and follow-up telephone con- tact. However, there have been few investigations of the impact of such strategies. Relander et al, 19 Miinderhoud et al, 20 and Wade et al 21 found a posi- tive impact of specific instructions and supportive follow-up contact on outcome. On the other hand, Gronwall 15 and Alves et al 22 found no significant impact of an information booklet alone or with sup- portive follow-up contact in reducing reported postconcussion symptoms. To our knowledge, no such evaluative studies have been conducted in children with mild TBI. Pro- viding information about expected sequelae and sug- From the *Monash University, Melbourne, Australia; ‡Bethesda Rehabilita- tion Unit, Epworth Hospital, Melbourne, Australia; §Julia Farr Services, Adelaide, Australia; Royal Melbourne Hospital, Melbourne, Australia; and ¶Western Hospital, Melbourne, Australia. Received for publication Aug 3, 2000; accepted Jun 25, 2001. Reprint requests to (J.P.) Department of Psychology, Bethesda Rehabilita- tion Unit, Epworth Hospital, 30 Erin St, Richmond, Victoria, 3121, Australia. E-mail: jennie.ponsford@sci.monash.edu.au PEDIATRICS (ISSN 0031 4005). Copyright © 2001 by the American Acad- emy of Pediatrics. PEDIATRICS Vol. 108 No. 6 December 2001 1297