Pediatric traumatic brain injury (TBI) is one of the leading causes of mortality and disability with mild TBI (mTBI) accounting for 80–90% of all treated cases (Cassidy et al., 2004). Recent epidemiological data reveal that the risk of mTBI is extremely high during early childhood (i.e., before the age of 6 years; Faul et al., 2010). Due to the vulnerability of the developing brain during this period, sustaining TBI could alter the development of executive functions (EF), which are in an intense period of maturation (Anderson et al., 2006). EF refer to higher-order cognitive processes and overarching self-regulatory abilities that underlie flexible goal-directed behavior, such as working memory and planning (Garon et al., 2008). The development of EF can also be influenced by social factors such as the family environment; for example, the quality of parent-child relationships has been identified as a proximal antecedent of child EF (Bernier et al., 2012). This study investigated whether variations in the quality of parent-child dyadic interaction after mTBI sustained during early childhood predict EF performance 18 months post-injury.
Eighty-four children aged 24 to 66 months (M=55.66; SD= 11.04) were recruited into 2 groups: children with accidental mTBI (N=48) and a control group of children with orthopedic injuries (N=34). Three dyadic components (harmonious communication, mutual cooperation, emotional ambiance) of parent-child relationships were assessed during two 10-minute interaction sequences (free play, snack time) using the Mutually Responsive Orientation (MRO) scale 6 months post-injury (Kochanska et al., 2005), and then averaged into a global MRO score. At 18 months post-injury, children were assessed on spatial working memory (Spin the Pots) and planning (Tower of Hanoï). The results were then averaged into a global EF score. Regression analyses in a moderator model (Hayes, 2015) were conducted, controlling for child sex and age.
The results revealed that over and above the covariates, MRO uniquely and positively predicted working memory and planning performance in the TBI group (b=.38, p= .02), respectively evaluated by the Spin the pots (b=.33, p=.0462) and the Hanoï tower (b=.30, p=.0462) tests. In contrast, EF score was not predicted by MRO in the control group (b= .19, p= .24) and showed no significant links with working memory (b=.09, p = .41) and planning performance (b=.09, p= .35).
These results suggest that the quality of parent-child dyadic interactions moderates child EF performance 18 months after early mTBI. Better quality parent-child relationships may improve EF by providing children with opportunities to stimulate EF through enriched interactions (Lewis et al., 2009) and promoting the internalization of regulatory strategies that are core features of EF (Bronfenbrenner et al., 1983; Bernier et al., 2012).

Parents-child relationships as a moderator of executive functioning after early childhood mTBI