La qualité de la relation parent-enfant suite à un traumatisme crânio-cérébral léger à l’âge préscolaire

Traumatic brain injury (TBI) represents one of the leading causes of death and disability in children worldwide. The young brain is particularly vulnerable to injury due to inherent physiological and developmental factors. Mild traumatic brain injuries (mTBI) represent the vast majority of insults (about 90%). Despite their high prevalence in early childhood and the growing literature identifying social sequelae following mTBI in older children, little is yet known of their impact on a young child’s social development. Parent-child relationships represent the center of young children’s social environment and are therefore ideal contexts for studying the potential effects of mTBI on young children’s (18 to 60 months) social functioning. The overall objective of this thesis was to assess the quality of parent-child interactions six months after mTBI, and identify its underlying contributing factors. The thesis includes two empirical articles. The first investigates the impact of mTBI on the quality of parent-child interactions using an observational tool and parental report. The sample included 130 children divided into three groups: children with mTBI (n = 47), children with orthopedic injury (n = 27), and typically developing children (n = 56). The results suggest that mTBI dyads present lower interaction quality when compared to typically developing children and their parents when an observational measure is used. No significant differences were identified between the orthopedic injury group and the two other groups. Qualitative visual inspection of the data suggests, however, that dyads in the orthopedic injury group and their parents tend to have slightly higher interaction quality than the dyads composed of children with mTBI, and lower interaction quality than dyads with typically developing children. In contrast, quality of parent-child interactions assessed by parental report did not differ across groups. The aim of the second article was to investigate the factors that contribute to the quality of parent-child interactions six months after mTBI in the preschool years (n = 68). Potential contributing factors were assessed among parental factors (e.g., age, socioeconomic status, family burden, parental stress, marital satisfaction) and child-related factors (e.g., age, sex, post- concussive symptoms, fatigue, adaptive/behavioral skills). Socioeconomic status, child post- concussive symptoms, and child sleep problems were all found to be significant independent factors that contribute to parent-child interactions six months post-injury. The thesis provides evidence that early mTBI can alter parent-child interaction quality and that observational measures may be more sensitive to changes in parent-child interactions after mTBI than parental report. These findings are of importance when considering empirical evidence that young children exposed to positive interactions with their parents tend to exhibit better social abilities later in life. This thesis also demonstrates that both parental and child- related factors contribute to parent-child interaction quality following mTBI.

Keyphrases: Pédiatrie, Commotion cérébrale, Pediatric, Preschoolers, Traumatic brain injury, Concussion, Social skills, Parent-child interaction