Journal of the International Neuropsychological Society

Research Articles

Coping Strategies as a Predictor of Post-concussive Symptoms in Children with Mild Traumatic Brain Injury versus Mild Orthopedic Injury

Stacey E. Woodromea1, Keith Owen Yeatesa2a3 c1, H. Gerry Taylora4a5, Jerome Rusina6, Barbara Bangerta7, Ann Dietricha2a8, Kathryn Nussa2a8 and Martha Wrighta4a5

a1 Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, Georgia

a2 Department of Pediatrics, The Ohio State University, Columbus, Ohio

a3 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio

a4 Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio

a5 Rainbow Babies & Children's Hospital, Cleveland, Ohio

a6 Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio

a7 Departments of Radiology and Neurosurgery, University Hospitals Health System, Cleveland, Ohio

a8 Department of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio


This study examined whether children's coping strategies are related to post-concussive symptoms following mild traumatic brain injury (TBI) versus orthopedic injury (OI). Participants were 8- to 15-year-old children with mild TBI (n = 167) or OI (n = 84). They rated their current preferred coping strategies and post-injury symptoms at 2 weeks (baseline) and 1, 3, and 12 months post-injury. Children's reported use of coping strategies did not vary significantly over time, so their baseline coping ratings were examined as predictors of post-concussive symptoms across time. Self-ratings of symptoms were positively related to emotion-focused strategies and negatively related to problem-focused engagement after both mild TBI and OI. Higher problem-focused disengagement predicted larger group differences in children's ratings of symptoms, suggesting that problem-focused disengagement moderates the effects of mild TBI. Coping strategies collectively accounted for approximately 10–15% of the variance in children's post-concussive symptoms over time. The findings suggest that coping may play an important role in accounting for children's perceptions of post-concussive symptoms after mild TBI. (JINS, 2011, 17, 317–326)

(Received June 09 2010)

(Revised December 10 2010)

(Accepted December 13 2010)

(Online publication January 18 2011)


c1 Correspondence and reprint requests to: Keith Owen Yeates, Ph.D., Department of Psychology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205. E-mail: