The Role of Executive Functioning, Anxiety, and Family Burden on Mathematical Performance in Children with Traumatic Brain Injury



Journal Title

Journal ISSN

Volume Title



Mathematical performance is closely linked with anxiety and executive processes, which are both adversely impacted by traumatic brain injury (TBI) in children. The present study examined the impact of executive functioning, anxiety, and family burden of injury on mathematical performance in children with TBI or orthopedic injuries (OI) at 2 months and 2 years post-injury. Participants (ages 6 to 15 years) had been hospitalized for complicated-mild/moderate and severe TBI (n = 51) or OI (n = 47) and were enrolled in a prospective longitudinal study. Children completed two measures of mathematics (calculation and problem solving), and parents completed measures of family burden, anxiety, and executive function. Mediation and path analyses were used to evaluate contributions of the above variables to mathematical outcomes. Compared to children with OI, children with TBI had lower calculation and problem solving scores, higher family burden, and executive functioning impairment persisting 2 years post-injury (p < 0.05). Mediation analyses revealed that executive functioning at 2 months partially mediated the role of group on calculation at 2 months (b = -0.71; 95% bootstrap confidence interval CI of -1.93 to -0.06). Problem solving at 2 months and calculation at 2 months mediated the relation of group to problem solving and calculation scores at 2 years post-injury, respectively. Neither anxiety nor family burden significantly impacted mathematical performance (p < 0.05). Executive functioning difficulties at 2 months post-injury in children with complicated-mild/moderate to severe TBI predicts long-term functioning and may serve as a red flag regarding the need for interventions to improve educational and psychological health outcomes.



Pediatric traumatic brain injury, Mathematical performance, Executive functions, Anxiety, Family burden