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Clinical Psychology Associates of North Central Florida           Gainesville and Ocala Florida              CPANCF.COM

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neuropsychology testing room florida - all rights reserved Ernest J. Bordini, Ph.D.According to the CDC, traumatic brain injury (TBI) leads to about 640,000 emergency department visits, 18,000 hospitalizations, and 1,500 deaths in children ages 14 and younger each year. Research published in the Journal of Pediatric Health Care in 2015 indicated that more than 37,000 children sustain a severe TBI each year.

According to a report to Congress, close to 200,000 brain injurie a year are the result of motor vehicle or traffic accidents, including those involving bicycles and trains. However, the CDC notes that the most common cause of TBI in children is falls, accounting for nearly half of TBI-related hospitalizations. Sports concussions are also a source of childhood and adolescent brain injuries. Children and adolescents in contact sports may be motivated to minimize impact due to a desire to keep playing. 

Many childhood or adolescent traumatic brain injuries are preventable. See our article on preventing summertime head injuries or considerations in driving for ADHD teens reflect efforts at reducing preventable traumatic brain injury.

Parents often worry about what they should watch for if their child or adolescent has suffered a traumatic brain injury. The Cincinnati Children’s Hospital Medical Center indicates common signs and symptoms of traumatic brain injury in children include:

Physical signs such as headache(s), sensitivity to light, sensitivity to sound, nausea or vomiting, feeling tired or sleepy.

Cognitive signs such as feeling foggy or confused, slow thinking or slow processing, memory issues, unable to concentrate, poor judgement.

Emotional signs such as being irritable or fussy, more emotional than normal, sad or nervous.

Sleeping signs such as those involving a change in sleeping pattern, trouble falling asleep, or trouble staying asleep.

The Centers for Disease Control notes that:

- Children's brains are still developing.
- Children's brains are more vulnerable to damage.
- Children's symptoms may be different from adults.
- Children may have difficulty communicating their symptoms.
- Children may have difficulty with schoolwork and social activities.


Childhood and pediatric concussions can differ from the presentation in adults.  Loss of consciousness may be less frequent, and children may simply manifest with periods on non-responsiveness. At time of injury, the severity of TBI is typically defined by the initial Glasgow Coma Scale (GCS) or Pediatric Glasgow Coma Scale score. The Pediatric Glasgow Coma Scale (PGCS) is used to assess the level of consciousness in children aged 2 years or younger and is based on the Glasgow Coma Scale (GCS) but modified for preverbal children. It consists of three tests: eye opening, motor response, and verbal response. The main differences between the two scales are in the verbal response, with one change in motor response. The PGCS score ranges from 3 (deep coma or death) to 15 (fully awake and aware). Medscape provides a table for the PGCS scoring. 

While the GCS and PGSC provide an estimate of initial severity leading to expectations of recovery or longer-term changes, neuropsychological assessment provides standardized measures of neurocognitive and other functioning follow brain injury.

The study of the cognitive, motor, attentional, memory, and behavior of children related to brain functioning or disease is known as pediatric neuropsychology. Pediatric neuropsychological assessment of children is more complicated than that of adults because the brain goes through several stages of development and maturation including spurts of myelinization and continued myelinization into late teen and even early adult years. Children are also faced with periodic as well as more constant challenges in terms of increased demands on productivity, multi-tasking, abstraction, writing, expression, learning and memory. 

Children and teens with pre-existing learning disability or other neurodevelopmental disorders may be at risk for greater impact from mild concussions. Due to the developing brain and changing demands, repeat neuropsychological testing is very common and necessary. 

Different age-appropriate tests are necessary for the neuropsychological assessment of children. Behavior and observational scales which rely on observations and collateral report are more common in assessments of children.  These often include teacher as well as parent scales.  Experience in working with and assessing children for head injuries as well as for more commonly encountered difficulties such as learning disabilities and ADHD helps the experienced child or pediatric neuropsychologist avoid misdiagnosis.

The Society of Pediatric Psychology indicates evidence-based practice recommendations for a comprehensive neuropsychological assessment that evaluates intellectual functioning, attention, memory, executive functioning, and language abilities to identify potential deficits and facilitate school re-entry. They note that injuries in younger children may have cognitive and/or behavioral changes that might not be apparent until the child is older and more advanced executive and social skills are required. For this reason, long-term follow-up was also recommended.

Our pediatric neuropsychological assessment services for children, adolescents and college students includes assessment of ADHD, Specific Learning Disability, Autism Spectrum Disorders (ASD, formerly classified as Autism, Asperger's, pervasive developmental disorder PDD), neurodevelopmental disorders, cerebral palsy, mental retardation, pediatric brain cancer, sickle cell disease, neurological birth injuries, anoxia and pediatric concussions or childhood traumatic brain injuries

Our office has more than 30 years of experience in pediatric neuropsychological assessment of brain injury in children, adolescents and adults.  Brain injuries in children and adolescents can have long lasting consequences as they children may experience changes in their health, neurocognitive abilities, thinking, and behavior that affect learning, self-regulation, and social participation. The Society of Pediatric Psychology notes that moderate to severe TBI in children and tens has been associated with increased risk for persisting deficits in adaptive functioning, lower rates of participation in activities, poor social engagement, and decreased life satisfaction.  A recent study has raised concerns about increased risk of psychotic disorders for children who have suffered pediatric traumatic brain injury (Yau et, al,, 2023).

Ernest J. Bordini, Ph.D. is a pediatric neuropsychologist with more than 30 years of experience in the neuropsychological assessment of traumatic brain injury in children and adolescents. 


(1) Get the Facts About TBI | Concussion | Traumatic Brain Injury | CDC  

New Edition of Severe Pediatric TBI Guidelines Published 2015  | AAFP.

Report to Congress: Traumatic Brain Injury in the United States. 

Fact Shet:  Traumatic Brain Injury in Children and Adolescents Society of Pediatric Psychology

Yau, C. K., Revill, G., Blackman, G., et al. (2023). Pediatric traumatic brain injury as a risk factor for psychosis and psychotic symptoms: a systematic review and meta-analysis. medRxiv doi:10.1101/2023.02.17.23286118

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