COGNITIVE IMPAIRMENTS IN CHILDREN FOLLOWING TRAUMATIC BRAIN INJURY: CLINICAL SPECTRUM, NEUROPSYCHOLOGICAL ASSESSMENT, AND REHABILITATION OUTCOMES

Abstract

Traumatic brain injury (TBI) is one of the leading causes of acquired cognitive disability in the pediatric population worldwide. Children who sustain mild, moderate, or severe TBI frequently demonstrate lasting deficits in attention, memory, executive function, processing speed, and academic achievement. The heterogeneity of injury severity and developmental stage at the time of injury complicates both diagnosis and treatment planning. This review aims to systematically characterize the spectrum of cognitive impairments observed after pediatric TBI, discuss validated neuropsychological assessment instruments, and summarize evidence-based rehabilitation strategies reported in recent literature. A narrative review was conducted of peer-reviewed publications indexed in PubMed, Scopus, and Google Scholar from 2005 to 2024. Studies involving children aged 0–17 years with diagnosed TBI and cognitive outcome data were included. Case reports and studies without control groups were excluded. Attention and working memory deficits are the most consistently reported sequelae across all TBI severity levels. Executive dysfunction, particularly in planning, cognitive flexibility, and inhibitory control, is prevalent in moderate-to-severe TBI. Age at injury is a critical moderator: injuries sustained before age five carry higher risk of pervasive cognitive delay due to disruption of ongoing brain maturation. Neuropsychological batteries such as NEPSY-II and the Cogstate Brief Battery demonstrate strong sensitivity for pediatric post-TBI assessment. Cognitive rehabilitation incorporating goal management training and computerized attention training shows moderate-to-large effect sizes.