What are the current incidence and prevalence rates for pediatric brain injury in the United States?
According to the Centers for Disease Control and Prevention (CDC), if we look at traumatic brain injury for people who are presenting at least to an emergency department we see that the three groups most at risk for TBI involve the pediatric population. There are about 700,000 children ages 0-14 who are sustaining traumatic brain injuries every year. That is likely a low estimate of the number of actual injuries because again, we are only including children that report to an emergency department.
What happens to these children? We know that less than four percent of these children are actually admitted to an inpatient rehabilitation unit. There are some estimates that say about two and a half million students in our country’s educational system every year have sustained a traumatic brain injury at some point. Again, this particular statistic excludes all of those other types of brain injuries that have non-traumatic mechanisms.
These statistics are important because research shows that children who are not admitted to an inpatient rehabilitation unit are less likely than those who do go to inpatient rehab to receive ancillary services such as speech therapy after they leave the hospital. This may be because children who are admitted to an inpatient rehab unit have more severe injuries, or perhaps because inpatient rehab allows more time to educate families about the importance of follow-up. Service providers need to realize there is a huge majority of children who do not get admitted to an inpatient rehab unit and thus are at risk for cognitive-communication challenges and are also less likely to receive services in the schools or in outpatient clinics. If there are two and a half million students every year in our schools that have sustained a traumatic brain injury, we are likely under-serving or under-identifying them 98-99% of the time. Very few of them are showing up as having a traumatic brain injury in our special education counts. By no means am I saying that every student who sustains a traumatic brain injury will require services, but certainly, it is likely more than one to two percent.
Why is there such a huge discrepancy? It is in part related to the fact that standardized testing often does not identify deficits in these children. Another part of the reason is that these children go back to school and they look okay; they are walking and they are talking and these later deficits become “invisible,” in a sense. Additionally, there is the challenge that deficits grow in later years in children who sustain a brain injury. Sandra Chapman (2006) coined the term “neurocognitive stall” to help describe this phenomenon. It refers to the fact that children who sustain a brain injury often regain the skills that they had prior to their injury, but later on, they have trouble keeping up with developmental milestones due to the injuries to the brain that impacted their memory centers and later-emerging cognitive skills, such as attention, memory, self-awareness, organization, and problem-solving.
Please refer to the SpeechPathology.com course, Using Nonstandardized Assessment to Evaluate Cognitive-Communication Abilities in Students with Traumatic Brain Injury, for more information on the challenges and opportunities to evaluating cognitive-communication disorders in children and adolescents with TBI.