Important Outcomes for Children and Adolescents With Cognitive-Communication Disorders After Traumatic Brain Injury: An International Multiperspective Consensus Study.

PURPOSE: The aim of this study was to reach consensus among researchers, clinicians, and service managers on the most important outcomes of cognitive-communication treatments for children and adolescents (ages 5-18 years) with traumatic brain injury, in the postacute stage of rehabilitation and beyond.

METHOD: This is an international three-round e-Delphi study. In Round 1, participants answered three open-ended questions, generating important treatment outcomes at three stages of development (5-11, 12-15, and > 15-18 years). Results were analyzed using qualitative content analysis and combined with outcomes from a previous scoping review. In Rounds 2-3, outcome importance was ranked on a 9-point scale. Consensus was defined a priori with outcomes rated as being "essential" (7-9) by at least 70% of respondents and rated 1-3 by less than 15% of respondents. Consensus outcomes were linked to the International Classification of Functioning, Disability and Health (ICF).

RESULTS: A total of 360 outcomes met consensus for all age groups. For 5- to 11-year-old children, important outcomes linked almost equally to the Body Functions (n = 52, 13.1%) and Activity/Participation (n = 50, 12.6%) components of the ICF. Outcomes of "successful start to school," "return to school," and "school functioning" were uniquely important. For older children and adolescents, outcomes linked to the Activity/Participation component of the ICF most frequently (12-15 years: n = 62, 15.6%; > 15-18 years: n = 73, 18.4%). For older cohorts, unique outcomes of "emotional safety," "employment," and "life skill development" met consensus.

CONCLUSIONS: Participants consider many outcomes, spanning most of the ICF, to be important for children and adolescents with cognitive-communication disorders (CCDs). As children and adolescents age, the importance of ICF components shifts, and distinct outcomes emerge, highlighting the necessity of developmentally relevant rehabilitation. The broad range of outcomes reaching consensus reflects pediatric CCD complexity and the need for holistic, person-centered care. Future research should explore the priorities of children and adolescents with CCDs and their families.