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Background and Aims: Post-concussive symptoms (PCS) are central to the assessment and management of mild traumatic brain injury (mTBI); however, this remains poorly understood in children aged ≤5 years. The study aimed to explore individual PCS, pattern of parents' PCS report over time, proportion of symptomatic children, and variables associated with parents' report of PCS in their preschool child after a mTBI., Methods: Children aged 2-5 years with either a mTBI (n=13) or limb injury (n=6) were recruited from the emergency department (ED). Parent ratings of child PCS were assessed at ED presentation, at one month, and at three months post-injury. Injury (e.g. injury group, pain), child (e.g. pre-existing behavior, symptoms), and parent (e.g. parental stress, education) characteristics were considered when investigating variables that may be relevant to parent report of PCS., Results: The number of total, physical, and sleep PCS were significantly higher after mTBI, with a significant decrease in physical and sleep PCS over time. The proportion of symptomatic children was comparable between injury groups at each time point. Acute pain and pre-injury symptoms were significantly associated with parents' acute PCS report in the mTBI group. Further research is needed on variables that may be relevant to parents' PCS report at follow-up., Conclusion: Preliminary findings suggest a general trauma response after a mTBI or limb injury, but acute physical and sleep PCS may help differentiate the injury groups. Injury and premorbid child variables may be relevant to parents' report of acute PCS in their child. Additional research is needed to investigate PCS in preschoolers and variables that may predict parents' PCS report.

Objective: This study assessed the consequences of childhood traumatic brain injury (TBI) on sleep, fatigue, depression, and quality of life (QoL) outcomes and explored the relationships between these variables at 20 years following childhood TBI., Participants: We followed up 54 young adults with mild, moderate, and severe TBI, and 13 typically developing control (TDC) participants, recruited at the time of TBI., Methods: Sleep was assessed with the Pittsburgh Sleep Quality Index and actigraphy., Results: At 20 years postinjury, results showed no significant difference between whole TBI group and TDC participants on subjective sleep quality; however, the moderate TBI group reported significantly poorer subjective sleep quality compared to those with severe TBI. Poorer subjective sleep was associated with increased symptoms of fatigue, depression, and poorer perceptions of General Health in the TBI group. Actigraphic sleep efficiency, fatigue, depression, and QoL outcomes were not significantly different between TBI and TDC or among TBI severity groups., Conclusions: These preliminary findings underscore associations between subjective sleep disturbance, fatigue, depression, and QoL in this TBI sample, and mostly comparable outcomes in sleep, fatigue, depression, and QoL between the TBI and TDC groups. Further research is required to clarify these findings.

Children with acquired brain injury (ABI) are at risk of impairments in self-regulation and disruptive behavior. We aimed to investigate the effectiveness of the Signposts program to reduce disruptive behavior and improve self-regulation in Hispanic children with ABI, and reduce parental stress and improve parenting practices. Using a randomized controlled trial design, we assigned children (n = 71) and their parents to Signposts or generic telephone support. Blinded assessors conducted assessments at pre-intervention, immediately post-intervention, and at 3 months post-intervention. Signposts was effective in reducing dysfunctional parenting practices. Further, when analyzing participants at risk of behavioral disturbance (n = 46), Signposts was effective in reducing child disruptive behavior in the home environment and emotional self-regulation. No differences were found for parental stress, parent sense of competence, child disruptive behaviors at school, and child cognitive and behavioral self-regulation. The reduction in disruptive behavior was associated with the implementation of authoritative parenting practices (external regulation), and not associated with child self-regulation.

Background: Acquired brain injury (ABI) during childhood typically causes behaviour problems in the child and high levels of stress in the family., Objectives: (1) To investigate the feasibility and effectiveness of a parenting programme to: improve behaviour and self-regulation (SR) in Mexican children with ABI, enhance parenting skills, and decrease parental stress in parents of children with ABI; (2) to explore the impact of parent SR on child., Methods: Case study design with four participants post-ABI, aged 7-12 years, recruited in Mexico City. A parenting programme (Signposts for Building Better Behaviour) was delivered and provided parents with strategies to manage child behaviour. Child behaviour, child self-regulation, parental stress and parenting practices were measured before, immediately post-intervention, and three months post-intervention., Results: At immediate and three months post-intervention improvements in parenting skills, reduction in parental stress, and improvement in child behaviour were identified., Conclusions: The programme is feasible in a Mexican population and was effective in improving parenting skills and reducing stress in parents of children with ABI, as well as improving child behaviour and behavioural SR. These domains continue improving three months after the intervention. The improvements in challenging behaviour at home did not transfer to the school environment.

Objective: The Sydney Psychosocial Reintegration Scale for Children (SPRS-C) assesses psychosocial functioning in children with acquired brain injury (ABI). This article aims to: (1) describe normative data for the parent-rated SPRS-C and, (2) evaluate the discriminant validity of the SPRS-C., Methods: For Aim 1, participants were parents of typically developing children (TDC) aged 5-14 years (N = 200). For Aim 2, participants with ABI were aged 5-14 years (n = 26). A matched group of TDC was sampled from the larger normative sample to serve as a control group (n = 26)., Results: For Aim 1, SPRS-C scores across the 10 age-bands were in the higher ranges. Correlation coefficients of SPRS-C total score with child's age and parent occupational skill level were not statistically significant. For Aim 2, SPRS-C scores for the ABI group were significantly lower than the control group., Conclusions: These data provide a guide for clinical interpretation of the SPRS-C for measuring psychosocial functioning in children with ABI.

Objective: Research into olfactory dysfunction (OD) following paediatric traumatic brain injury (TBI) is limited. The current study investigated the frequency of OD following paediatric TBI and the relationship between OD and injury characteristics including severity, site of impact and cause of injury. It was hypothesized that children with moderate/severe TBI would demonstrate greater OD than those with mild TBI., Design/method: Thirty-seven children aged 8-16 with TBI were recruited to a prospective longitudinal study at a metropolitan children's hospital. Olfactory assessment, using the University of Pennsylvania Smell Identification Test, was completed at 0-3 months post-injury., Results: Nineteen per cent of participants demonstrated impaired olfaction, while a small number (5%) were anosmic. A significant relationship between OD and severity of injury was found. No other injury variables demonstrated a significant relationship with olfactory outcomes., Conclusions: OD was relatively common in this paediatric TBI cohort and the hypothesized relationship with severity of injury was supported. It is recommended that information about OD after TBI be routinely provided to children and families. Further research is needed in larger cohorts to support the implementation of routine clinical assessment, understand the relationship between OD and other injury characteristics, determine the functional implications of OD and document recovery trajectories.

Objective: Impairments in attention and memory are common sequelae following paediatric acquired brain injury (ABI). While it has been established that such impairments are long-term and, therefore, affect quality-of-life, there is a scarcity of evidence-based interventions to treat these difficulties. The current study aimed to pilot the efficacy of the Amsterdam Memory and Attention Training for Children (Amat-c: English version) using both neuropsychological and ecologically sensitive measures. It was expected that children with attention and memory difficulties post-ABI would show improved performance post-intervention on cognitive and ecological measures, with maintenance at 6 months post-intervention., Methods and Procedures: Ten children with an ABI, between the ages of 8-13 years at the time of recruitment were identified through audits of presentations to a metropolitan paediatric hospital. Each child underwent screening, the 18 week intervention programme, pre-intervention, immediate and 6 month post-intervention assessments., Outcomes/results: Findings supported the hypothesis that children would show post-intervention (immediate and 6 month) improvement in areas of attention and memory, with generalization to everyday life., Conclusions/implications: Preliminary results provide support for the efficacy of the Amat-c post-childhood ABI. A larger study is needed to confirm these findings, as a reduction in attention and memory difficulties will enhance everyday functioning.

Objectives: To determine if domains included in popular measurement systems (e.g. the Peds QL™) reflect the adolescent survivor of a brain injury's sense of QoL and explore this relationship in reference to an emerging model of wellbeing in the adolescent with TBI., Methods: Mixed methods; adolescent QoL assessed using the PedsQL™ self-report and a semi-structured interview created by the lead author. Adolescent self-report was compared to adolescent narratives., Results: Ten adolescents participated. Adolescent PedsQL™ total was within normal limits. Adolescents reported that changes identified by the PedsQL were not important and did not impact on their sense of QoL. The importance on social components of QoL-as opposed to cognitive-provide additional support of the emerging model of wellbeing in adolescents with TBI., Conclusions: The PedsQL can identify changes post-TBI, but fails to consider whether these changes are relevant to the adolescent. Alternate methods of exploring QoL-which emphasize the interaction of social networks and friendships, should be considered to avoid an oblique view of QoL outcomes after TBI.

Objective: The primary aim of this case study was to explore the behavioural changes of a paediatric patient in post-traumatic amnesia (PTA) during a music therapy session. A secondary objective was to measure the effect of the music therapy intervention on agitation., Method: Video data from pre, during and post-music therapy sessions were collected and analysed using video micro-analysis and the Agitated Behaviour Scale., Results: The participant displayed four discrete categories of behaviours: Neutral, Acceptance, Recruitment and Rejection. Further analysis revealed brief but consistent and repeated periods of awareness and responsiveness to the live singing of familiar songs, which were classified as Islands of Awareness. Song offered an Environment of Potential to maximise these periods of emerging consciousness. The quantitative data analysis yielded inconclusive results in determining if music therapy was effective in reducing agitation during and immediately post the music therapy sessions., Conclusion: The process of micro-analysis illuminated four discrete participant behaviours not apparent in the immediate clinical setting. The results of this case suggest that the use of familiar song as a music therapy intervention may harness early patient responsiveness to foster cognitive rehabilitation in the early acute phase post-TBI.

Objective: Impairments in attention and memory are common consequences following paediatric acquired brain injury (ABI). Despite this, there is a scarcity of evidence-based interventions for these difficulties. The current study aimed to pilot the feasibility and efficacy of the English version of the Amsterdam Memory and Attention Test for Children (Amat-c) and to identify ecologically valid measures sensitive to post-evaluation improvements. It was expected that children with attention and memory difficulties post-TBI would show improved performance post-intervention on traditional cognitive measures and on measures of everyday performance., Methods and Procedures: Three children (case study design) with an acquired brain injury (near drowning, birth delivery complications, fall from a horse) and currently between the ages of 8-13 were identified through audits of presentations to a metropolitan paediatric hospital. Each child underwent screening, pre-intervention and post-intervention assessments (immediate and 6 months)., Outcomes/results: Results indicated improved performance in the areas of attention and memory from pre- to post-intervention, with gains maintained at 6 months post-intervention., Conclusions and Implications: Findings demonstrate initial support for efficacy of the Amat-c and its use with survivors of child ABI to alleviate common cognitive and functional consequences. A larger study is needed to further confirm these findings.

Background: Outcome after childhood traumatic brain injury (CTBI) is heterogeneous, with several predictors influencing long-term outcome., Method: This exploratory study used person-oriented cluster analysis to investigate individual profiles of medical, psychological and social predictors and their relation to longitudinal development in a sample of 127 participants with mild, moderate and severe CTBI. Outcome of cognitive, adaptive and academic function was measured at 30 months and 10 years post-injury., Results: A nine-cluster solution, explaining 67% of the variance in the sample, resulted in two clusters with individuals with mostly mild injuries, five with mostly moderate injured individuals and two clusters with severely injured individuals. Best outcome at 10 years post-injury had a cluster with individuals with moderate injuries, young age at injury, average socioeconomic status (SES) and high pre-injury adaptive function. Worst outcome had a small cluster with severely injured individuals, young age at injury, average SES and average pre-injury adaptive function., Conclusions: The findings suggest that pre-injury adaptive function is an influential predictor of outcome following moderate CTBI. Age at injury in the severe group appears to have increased influence over time, with younger age at injury associated with reduced outcome at 10 years after severe CTBI.

Objective: This study investigated the long-term psychosocial outcome and quality-of-life (QoL) of 15-18 year olds, sustaining childhood traumatic brain injury (TBI) between birth and 5 years., Method: Thirty-three participants (17 TBI parent-proxies, 16 control parent-proxies) were involved in the present study which compared parent-ratings for the TBI group and healthy controls on the Sydney Psychosocial Reintegration Scale-Child form (SPRS-C) and the Paediatric Quality of Life Inventory (PedsQL)., Results: Despite comparable overall psychosocial reintegration scores, parents reported that their teens with TBI were more likely to experience poor QoL compared to controls. On further analysis, some aspects of psychosocial outcome appear to be compromised following childhood TBI., Conclusions: Interventions targeting childhood TBI must consider QoL in addition to symptom reduction and be extended throughout adolescence. The limitations of the sample size are cause for concern; however, preliminary results do validate the need for future research efforts.

Background: Childhood acquired brain injury (ABI) often leads to impairment in cognitive functioning, resulting in disabilities in both the home and school environment. Assessing the impact of these cognitive deficits in everyday life using traditional neuropsychological tests has been challenging. This study systematically reviewed ecological measures of cognitive abilities available for children with ABI., Method: Eight databases were searched (until October 2011) for scales: (1) focused on ecological assessment of cognitive functioning; (2) with published data in an ABI population; (3) applicable to children up to 17;11 years of age; and (4) in English. The title and abstract of all papers were reviewed independently by two reviewers., Results: Database searches yielded a total of 12 504 references, of which 17 scales met the inclusion criteria for the review, focusing on executive functions (n = 9), memory (n = 3), general cognitive abilities (n = 2), visuo-spatial skills (n = 2) and attention (n = 1). Four tasks used observation of actual performance in a natural environment, five were proxy-reports and six were functional paper and pencil type tasks, performed in an office., Conclusion: Overall, few measures were found; eight were still experimental tasks which did not provide norms. Executive functions were better represented in ecological assessment, with relatively more standardized scales available.

Objective: This study investigated parent-adolescent agreement in long-term psychosocial and quality-of-life (QoL) outcomes. The sample comprised adolescents aged 15-18 years, who sustained childhood traumatic brain injury (TBI) between birth and 5 years of age., Methods: Thirty-three participants (17 adolescents with TBI and 16 TBI parent-proxies) were involved in the study which compared parent and adolescent ratings on the Sydney Psychosocial Reintegration Scale-Child form (SPRS-C) and the Pediatric Quality-of-Life Inventory (PedsQL). The questionnaires were administered through phone interviews., Results: As hypothesized, parent-adolescent agreement was acceptable for psychosocial outcome (intra-class coefficient [ICC] of 0.844, p < 0.001), whereas discrepancies were found for ratings of QoL (ICC of 0.506, p = 0.092)., Conclusion: The finding that parents and adolescents agree on psychosocial outcome is promising for those instances when the patient is unable to report; however, discrepancies regarding QoL suggest caution needs to be taken when interpreting parent-rated QoL data.

Aim: The corpus callosum (CC) can be affected by childhood traumatic brain injury (TBI), through focal lesions, reductions in size and arrested development. Little is known, however, about what constitutes normal CC shape and appearance and how it may be affected in the long-term after early TBI., Methods: In this study, the appearance of the CC was investigated in individuals with TBI assessed 10 years post-injury (n = 52, mean age = 16.82 years, SD = 3.55 years, 24 male) and compared to age-matched healthy controls (n = 44, mean age = 15.77 years, SD = 1.21 years, 18 male). A simple visual analysis technique was used to code the appearance of the CC according to location of focal thinning and severity of thinning and results between groups were compared using Chi-square analysis., Results: A significantly higher proportion of patients with childhood TBI had focal posterior thinning of the CC than age-matched controls (p = 0.001)., Conclusions: The findings call into question previous conclusions that focal posterior thinning is a normal variant of development. Instead, attenuations of the posterior portion of the CC in the long-term may reflect altered cortical and callosal development as a result of early brain injury, although the functional significance of this remains to be determined.

Purpose: This study describes the disciplinary practices of parents following acquired brain injury (ABI) of their child and examines the relationship between disciplinary use, family-parental adversities and children's behavioural sequelae., Method: Participants were 48 parent respondents of children between 3-12 years with mild, moderate and severe ABI. Parents provided demographic information and completed questionnaires investigating disciplinary strategy use, parental-family functioning and child behaviour., Results: Over-reactive and lax disciplinary strategies were endorsed most by parents. Dysfunctional levels of disciplinary use were associated with children who displayed more behaviour problems, parents with elevated distress and families experiencing more dysfunction and social adversity., Conclusion: Dysfunctional parenting practices, if not ameliorated, could exacerbate problematic child behaviour following ABI, as well as parent and family difficulties. Parental assessment may be useful as a method of screening for parental factors that put children at risk for ongoing behaviour problems and families for ongoing stress.

Objective: To date no study has reported findings regarding attentional deficits following pre-school paediatric traumatic brain injury (TBI), as long as 10 years post-injury. It was predicted that more severe TBI would be associated with generalized deficits at 10 years post-TBI, particularly for skills not mastered at time of injury., Research Design: The sample comprised 40 prospectively-recruited children (42% of the original sample) who had sustained a mild, moderate or severe traumatic brain injury (TBI) between the ages of 1-7 years and 19 non-injured control participants. Children were assessed 10 years post-TBI, with a focus on measures of attentional ability., Outcomes/results: While attentional deficits were not evident across all components of attentional ability, both early- and later-established attention skills were compromised, particularly following severe TBI. Environmental predictors were generally not successful predictors of attentional outcome at 10 years post-TBI. Age at injury and acute IQ were identified as contributing to attention at 10 years., Conclusions/implications: The present study shows that attentional deficits do occur and persist to 10 years following serious TBI. Clinicians may be able to screen for such deficits and so intervene in order to prevent or lessen the consequences of such difficulties.

Background: Virtual reality (VR) is an emerging area of paediatric clinical and research practice, however the majority of research to date has focused on outcomes for adults following stroke. This paper appraises and describes current evidence for use of virtual reality interventions to improve upper limb function of children with neurological impairment., Methods: A comprehensive database search was undertaken to explore literature on the use of VR systems for rehabilitation of upper limb skills of children with neurological impairment. Studies investigating the use of robotics or other mechanical devices were excluded. Five studies were found and were critiqued using the Downs and Black scale for measuring study quality., Results: One randomized control trial and four case studies were found. No study scored over 50% on the Downs and Black scale, indicating methodological limitations that limit generalizability., Conclusions: Current evidence for the use of VR to improve hand and arm skills is at an emerging stage. Small sample sizes and inconsistencies in outcome measurement limit the ability to generalize findings. Further studies are required to investigate the ability to maintain gains made in VR over time and to determine whether gains transfer from the VR to real life tasks and activities.

Objective: The aims of this review were to: (i) briefly outline common sequelae following childhood traumatic brain injury (TBI); (ii) provide a summary of models and research in the area of intervention; (iii) discuss issues and obstacles in the evaluation of research in the area of intervention; (vi) discuss integrative and translational aspects of research in this area; (v) provide an example of intervention studies being conducted in the laboratory; and (vii) highlight the need for continued and collaborative work in the paediatric intervention field., Conclusions: When reviewing the literature, it is clear that while challenging, the development and evaluation of intervention programs for children post traumatic brain injury, must be encourage and pursued. This in turn will lead to improved quality of life for these children and their families.

Background: Following TBI in childhood it is common for deficits to be seen in higher order skills, such as executive functions, both in the acute and longer-term post-injury. Despite this, very little evaluative research has been conducted with children post-TBI, particularly in the area of EF., Methods: The current study aimed to develop and implement a pilot intervention programme for adolescent/young adults (n = 3), in the chronic phase of recovery, when EF skills are no longer in a rapid state of development., Results and Conclusions: Study results highlight the importance and need for accurate and relevant outcome measures that capture subtle as well as more obvious changes following intervention.

Primary Objective: This study seeks to extend previous findings by documenting memory performance in a sample of 70 children at 5 years post-injury. It was anticipated that increasing injury severity would be associated with decreased performance on working and complex memory tasks. It was also expected that injury severity would significantly predict memory, but that the time from insult to subsequent testing would be associated with an increased relationship to non-injury factors., Research Design: Participants were assessed at 5 years post-injury, aged between 6-14 years, using measures of immediate, working and complex memory., Methods and Procedures: The sample comprised 18 children who had sustained a severe TBI, 24 with a moderate TBI, 11 with a mild TBI and 17 healthy controls, matched for age, gender and socio-economic-status., Results: Results indicated that severe TBI was associated with decreased complex auditory-verbal memory performance, although children with TBI did not display impairment on immediate, working or complex visual-spatial memory. While injury severity significantly predicted complex memory outcome, non-injury factors failed to significantly predict either working or complex memory performance., Conclusions: Future research should be engineered towards further clarifying what influences recovery from childhood TBI in the elongated post-injury period.

Primary Objective: To determine the predictive value of structural neuroimaging in the clinical setting following TBI., Research Design: Prospective between-group design, comparing groups with regard to: (i) the presence or absence of cerebral pathology and (ii) the location of cerebral pathology. The predictive value of injury variables was investigated using hierarchical regressions., Methods and Procedures: Thirty-six children, between 6 and 14 years, who sustained a moderate to severe TBI 5 years previously participated in this study. Children's performances on five measures of attentional control were examined in relation to the presence, location and severity of their lesions, as coded by the Coffey classification system 1., Main Outcomes and Results: Frontal lesion severity was not predictive of performance on any of the measures. However, generalized (frontal and extrafrontal) and extrafrontal lesion severity was predictive of poor performance., Conclusions: These findings support the argument that functional organization in children may differ from that in adults, suggesting that multiple cerebral regions, or a diffuse cerebral network, may mediate children's executive functions (EF). Results are also consistent with the hypothesis that the amount of damaged brain tissue, rather than its location, may be more predictive of neurobehavioural outcome following early TBI.

Primary Objective: Attentional deficits are common following TBI in adults. This study examined whether these skills are also vulnerable following early childhood injury, when such skills are rapidly developing., Research Design: This study investigated attention 30 months post-TBI in pre-schoolers (n=56) and age-matched controls (n=26). TBI children were divided into mild, moderate and severe injury groups., Methods and Procedure: Pre-injury data were collected at time of injury. Assessment of attention included the Continuous Performance Test, Wechsler Intelligence Scale and Personality Inventory for Children., Main Outcomes and Results: Severe TBI was associated with reduced accuracy and slowed processing, particularly on complex motor responses. Sustained attention was more intact. Parental reports indicate internalized behavioural problems and somatic complaints., Conclusions: Young children with severe TBI are at risk for severe, persisting attentional impairments. Children with mild and moderate TBI show better outcome, with pre-injury behaviour and age also predictive of attentional skills at 30 months post-injury.

Primary Objective: Disruptions to executive function (EF) may occur as a result of traumatic brain injury (TBI), in the context of direct damage to frontal regions or in association with disruption of connections between these areas and other brain regions. Little investigation of EF has occurred following TBI during childhood and there is little evidence of possible recovery trajectories in the years post-injury. The present study aimed to (i) examine whether a dose-response relationship exists between injury severity and EF; (ii) document recovery of EF in the 2 years post-injury and (iii) determine any additional predictors of outcome in the domain of EF., Research Design: The study employed a prospective, longitudinal design, with participants recruited at time of injury and followed over a 2-year period., Methods and Procedures: The study examined EF in a group of 69 children who had sustained a mild, moderate or severe TBI. Four components of EF were assessed: (i) attentional control; (ii) planning, goal setting and problem solving; (iii) cognitive flexibility; and (iv) abstract reasoning., Outcomes and Results: Results showed that, while children with severe TBI performed most poorly during the acute stage post-injury, they exhibited greatest recovery of EF over a 24-month period. Regardless, functional deficits remained most severe for this group 2 years post-injury. Results demonstrated the multi-dimensional nature of EF and the differential recovery of skills, following childhood TBI. Pre-injury ability and age at injury were identified as significant predictors of EF and functional skills., Conclusions: Children sustaining severe TBI at a young age are particularly vulnerable to impairments in EF. While these difficulties do show some recovery with time since injury, long-term deficits remain and may impact on ongoing development.

Primary Objective: To examine memory skills, at acute, 6- and 12-monthly stages, following childhood traumatic brain injury (TBI)., Research Design: Prospective, longitudinal, between-group design, comparing pre-injury and postinjury intellectual and memory measures, across three levels of injury severity., Methods and Procedures: Investigation of memory skills in a group of 76 children who had sustained a mild, moderate or severe TBI. Specific tests were used to measure immediate and short-term memory, and more complex multi-trial learning., Main Outcomes and Results: The severe TBI group exhibited greater deficits on memory tasks, irrespective of modality, in the acute, 6- and 12-month post-injury stages, in comparison to mild and moderate TBI groups. Performance was dependent on both injury severity and task demands., Conclusions: Memory difficulties are present during the acute, 6- and 12-months following childhood TBI. With a clearer understanding of the memory deficits following TBI, appropriate strategies can be taught and interventions implemented for these children.

Traumatic brain injury (TBI) may have a profound impact on a child's ongoing development. Various risk factors have been found to predict outcome, but considerable variability remains unexplained. This study used a prospective, longitudinal design to examine recovery of memory function following TBI within the pre school period. Ninety-six children with TBI were divided according to injury severity (mild, moderate, severe), and compared to age and SES matched healthy controls (n = 35). Children were evaluated acutely and at 6,12 and 18 months post-injury using intellectual and memory measures. Results showed a relationship between greater injury severity and poorer intellectual ability. This dose-response relationship was not clearly evident for memory function within the acute phase of recovery, but developed over time, with greater memory impairments evident for children with more severe TBI by 12 months post-injury. Children with mild TBI exhibited few memory problems. Findings are discussed in the context of theories of plasticity and recovery of function.