Children With Mild TBI at Risk for Behavioral and Emotional Problems

Jennifer Herrin for Medscape

June 10, 2022

The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Mild traumatic brain injury (mTBI) and possible mTBI are associated with greater risk for poor behavioral and mental health outcomes in adolescents.

  • An unexpected finding was the association of mTBI with decreased cerebrospinal fluid volume, although the authors say caution is warranted in interpreting these results.

Why This Matters

  • In 2014, emergency departments in the United States saw more than 812,000 cases of TBI in children.

  • Symptoms of mTBI, which accounts for 75% of all TBI cases, persist for 1–3 months in most children, but in about 14%, the injury leads to disability requiring specialized medical and educational care.

  • Children who experience mTBI are at risk for neural changes that can lead to impaired mental health.

  • Psychosis-like experiences (PLEs) have been associated with different structural and neural changes in the brain; further understanding is needed regarding how events such as TBIs might be related to PLEs.

Study Design

  • The authors used a mixed-effects model to conduct longitudinal analysis of baseline (n = 11,876), year 1 (n = 11,225), and year 2 (n = 10,414) data from the Adolescent Brain Cognitive Development (ABCD) study.

  • The ABCD study is a prospective longitudinal study of 11,876 children who were enrolled at ages 9–10 and were followed up annually with in-person visits, participant and parent questionnaires, and baseline and year 2 MRI scans.

  • Bayesian methods were used in a multilevel analysis to investigate the possible mediation of structural brain metrics (including total cortical volume, cortical thickness, and sulcal depth) between mTBI and mental health outcomes.

  • The study sample included 199 children with mTBI and 527 other children with possible mTBI across the three time points.

Key Results

  • The study supports previous findings of the association between mTBI and deterioration in mental health: Children with mTBI or possible mTBI had 16% and 7% greater risk, respectively, of experiencing behavioral and emotional problems compared with those without TBI.

  • The associations were significant after adjustment for participant and family characteristics (including age, sex, race/ethnicity, perceptions of neighborhood safety, parental education and marital status, and household income) and multiple imputation for missing data.

  • Individuals with possible mTBI showed a 17% increased risk of experiencing distress after a PLE.

  • Structural brain metrics and MRI intensity measures (gray matter–white matter contrast) failed to show evidence of meaningful mediation between mTBI and mental health outcomes.


  • The sample included a disproportionately low number of Black children with mTBI, perhaps reflecting well-known underreporting of head injuries among minority populations.

  • Because of a gap in data collection and concerns about recall bias, the authors did not evaluate the longitudinal relation of structural brain metrics with mTBI and mental health outcomes, which limited causal inference.

  • The ABCD study is ongoing and will collect more MRI data to examine longitudinal associations.


  • The study received funding from the National Institute on Drug Abuse, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and other sources.

  • The authors have disclosed no relevant financial or commercial relationships.

This is a summary of a preprint research study, "Association Between Mild Traumatic Brain Injury, Brain Structure, and Mental Health Outcomes in the Adolescent Brain Cognitive Development Study," written by Daniel A. Lopez, from the Cognitive Neurophysiology Laboratory at the University of Rochester School of Medicine and Dentistry, Rochester, New York, and colleagues. This study was ublished on and is provided to you by Medscape. This study has not yet been peer reviewed. The full text can be found on

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