Graduation Year

2024

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Psychology

Major Professor

Edelyn Verona, Ph.D.

Committee Member

Margaret Booth-Jones, Ph.D.

Committee Member

Peter Clayson, Ph.D.

Committee Member

Fallon Goodman, Ph.D.

Committee Member

Max Owens, Ph.D.

Keywords

activities of daily living, latent class analysis, post-concussion syndrome, undergraduate students

Abstract

Traumatic brain injury (TBI) involves a head injury that is, for some individuals, associated with long-term behavioral difficulties, including externalizing behaviors. The literature on TBI and its links to externalizing is limited in several important ways. First, there is evidence that current classification system of mild, moderate, or severe is imprecise and contains important variation within TBI categories. Second, TBI and externalizing are understudied among high functioning individuals, such as undergraduate students, despite rates of TBI among this population that are similar to those of the general population. Third, while it is theorized that executive functioning deficits explain the association between TBI and externalizing behaviors, this has yet to be directly tested. The current study (preregistered at https://osf.io/9rbyd/) sought to 1) empirically derive TBI classifications within an undergraduate sample, 2) assess how resultant TBI classes related to scores on behavioral executive functioning tasks, 3) assess how TBI classes related to self-reported externalizing behavior, and 4) investigate the degree to which executive functioning partially explained relationships between TBI classes and externalizing behavior. Results revealed that 49.7% of participants were positive for a TBI, and that most TBIs among this sample (95%) would classically be considered mild. Four classes emerged from latent class analyses and were titled Childhood Falls, Intermediate Impacts, Minor Sports, and Serious and Numerous injuries. All TBI classes, relative to a non-injured control group, showed higher post-concussion syndrome (PCS) scores and externalizing, but the latter difference was only statistically significant for the Serious and Numerous class. The Serious and Numerous class was also associated with the highest lifetime number of injuries, PCS, and traditional measures of severity (e.g., loss of consciousness, posttraumatic amnesia), even though most injuries in this class would traditionally be considered mild TBIs. None of the TBI classes showed relatively lower executive functioning task performance, and there was no evidence of indirect effects of TBI on externalizing through executive functioning. In general, results indicate that that there is substantial heterogeneity in outcomes and indicators of severity among college students with traditional mild TBI. Further, results suggested that TBI is not related to executive functioning deficits, and a history of TBI is only substantially associated with externalizing behaviors among undergraduate students with more serious and numerous injuries.

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