Academic Skills After Brain Injury: A Lifespan Perspective

• Published in: Neuropsychology Vol. 36; no. 5; pp. 419 - 432
• Main Authors: Sullivan, Alyssa W., Bowren, Mark D., Bruss, Joel, Tranel, Daniel, Demir-Lira, Ö. Ece
• Format: Journal Article
• Language: English
• Published: United States American Psychological Association 01-07-2022
• Subjects: Academic Achievement; Adolescent; Adult; Age Differences; Aged; Aged, 80 and over; Brain Injuries; Brain Lesions (Disorders); Child; Child, Preschool; Female; Functional Laterality; Human; Humans; Infant; Infant, Newborn; Life Span; Longevity; Male; Mathematics; Middle Aged; Seizures; Spelling; Young Adult; academic skills; early vulnerability hypothesis; brain lesion
• ISSN: 0894-4105; 1931-1559
• DOI: 10.1037/neu0000806

Objectives: This study investigated academic skills outcomes after brain injury and identified the influence of age and injury factors across the lifespan. Method: Our sample included 651 participants with focal brain lesions. Math, reading, and spelling data from the Wide Range Achievement Test (WRAT) were used as the academic skills outcomes. Age of lesion onset ranged from 0 to 85 years old. Linear regressions were conducted to identify the relation between age and injury factors and academic skills outcomes. Lesion-symptom mapping was conducted to identify the brain areas that, when lesioned, were associated with deficits in academic skills. Results: A quadratic model of age of lesion onset significantly predicted math (R2 = .28, p < .001), reading (R2 = .29, p < .001), and spelling outcomes (R2 = .32, p < .001), while accounting for various covariates. Education, sex, lesion size and laterality, etiology, and seizure history were additional reliable predictors of academic skills outcomes across the lifespan. Academic skill deficits were associated with damage to various brain areas across the left-hemisphere frontal, temporal, and parietal lobes, the insular area, and left- and right-hemisphere white matter. Conclusions: This study supports age of lesion onset as a relevant predictor of academic skills after brain injury in a lifespan sample. Several other variables (e.g., education, sex, lesion characteristics, and seizure history) are notable in the prediction of outcomes across the lifespan. Future work could investigate more diverse samples and emphasize recruitment of early onset injuries to examine generalizability and potential critical periods for academic skills.
Key Points
Question: This article examines academic skills outcomes after brain injury by identifying how age and injury factors influence outcomes, with a special focus on the age at which a brain injury occurs, in a lifespan sample. Findings: A distributed brain network is relevant for academic skills and age of lesion onset, education, sex, lesion size and side, etiology, and seizure history are significant predictors of academic skills in a lifespan sample. Importance: The age at which a brain injury occurs, and the location of the injury could be utilized to inform potential risk for academic skills deficits after brain injury. Next Steps: Future work could benefit from more precisely defining periods of increased risk for deficits in academic skills after brain injury and utilize methods commonly used in those with adult-onset injuries (i.e., lesion-symptom mapping) in those with developmental-onset lesions to further inform lesion-deficit relations for those with early onset brain injury.