Types Of Behavior Problems Research Articles

Temporal Pattern of Co-Development of Internalizing and Externalizing Problem Behaviors: An Application of Bivariate Mixed-Effects Models.

Although previous research has shown that internalizing and externalizing behavior problems often co-occur, the relationship between the developmental trajectories of these two types of behavior problems is understudied. The co-occurring evolutions of developmental trajectories of two behaviors has two components: 1) the correlation between the slopes of two behavior profiles (termed the association of the evolutions); and 2) the marginal correlation of two development trajectory profiles, which is the development of correlation between internalizing and externalizing behavior over time (termed the evolution of the association). The association of the evolutions and the evolution of the association have not been fully explored in the context of the development of internalizing and externalizing behavior problems among kindergarteners in the United States. The random-effects approach for joint modeling of multivariate longitudinal profiles was used to evaluate the co-development and its temporal pattern of internalizing and externalizing behavior problems on a nationally representative sample of 9791 kindergarteners from the Early Childhood Longitudinal Study-Kindergarten Class of 1998-99 (ECLS-K). There was a moderate positive association between the evolutions of the two behavior problems with correlation coefficient of 0.319. The evolution of association between the two behaviors was increasing over time with the correlation coefficient from 0.195 at the Fall of kindergarten to 0.291 by the time of fifth grade in general. Race and age groups act differently on the evolution of association. The associations were getting stronger for the Asian group and older groups than their peer groups. This investigation of the association of evolutions and the evolution of association between the internalizing and externalizing behaviors show that the two problem behaviors reciprocally reinforce each other and lead to increases in the other in a moderate strength and the strength is increasing over time.

Gender differences and the correlates of violent behaviors among high school students in a post-conflict area in Indonesia.

Adolescent violence is a public health problem worldwide. Studies show that challenging environments, such as poverty and war, increase the risk of adolescent violence. This paper aims to assess gender differences in violent behaviors among adolescents in a post-conflict area in Indonesia. The other aim of this study is to investigate the correlates of adolescents' violent behaviors using the socio-ecological framework. This is a school-based study involving 511 students from six randomly selected high schools in Kotamadya Ambon. Active and verbal violent behaviors and the potential correlates were measured and assessed using backward linear regression analyses. Boys were involved in more violent behaviors than girls. However, some of the boys and girls reported being involved in all types of violent behaviors. The most significant correlates of violent behaviors across genders were community violence exposure and some types of behavioral problems. This study highlighted the interconnectedness between community violence exposure and violent behaviors among adolescents living in a post-conflict area. The study also emphasizes the association between problem behaviors and violent behaviors. The results demonstrate the importance of both reducing community violence exposure and identifying adolescents with behavioral problems in the prevention of violent behaviors.

Students' Problem Behaviors as Sources of Teacher Stress in Special Needs Schools for Individuals With Intellectual Disabilities

Students with intellectual disabilities in special needs schools often exhibit high levels of problem behaviors. Besides the challenges such behaviors present for the students themselves, their peers, and their caregivers, problem behaviors can also be a source of stress for teachers. However, less is known on the degree to which different types of problem behaviors are perceived as stressful in special needs schools for students with intellectual disabilities. Using paper-pencil questionnaires, 295 special needs school teachers (47.81 years, SD = 10.49; 83.4% female) in Switzerland ranked the perceived stressfulness (from 0 = not stressful to 3 = very stressful) of 93 student behaviors. These 93 behavior descriptions stemmed from the Developmental Behavior Checklist (Einfeld & Tonge, 1995). Results suggest behaviors endangering the student or others, such as kicking, hitting, biting, or talking about suicide, were rated as most stressful. Behaviors from the domain disruptive/antisocial behaviors were reported as most stressful and behaviors from the domain of communication disturbances as least stressful. Implications for work-related stress prevention in relation to different types of student problem behaviors for special needs school teachers are discussed.

The relation between behavioral problems and social competence: A correlational Meta-analysis

BackgroundPrevious studies have shown that children who display behavioral problems also tend to display low social competence. The relation does however vary according to type of behavior being measured, as well as demographic characteristics of the respondent. The present meta-analysis examined the correlation between different types of behavioral problems and social competence among children aged 3–13, and investigated possible moderators in this relation.MethodsA systematic literature search was conducted for English language studies from January 2008 to January 2018 that reported correlations between three types of behavioral problems (i.e., externalizing behaviors, conduct problems, or aggression) and two types of social competence (i.e., social competence or social skills). The studies included reports from parents and teachers, or both as a dyad. The review included data from 54 independent studies and a total of 46,828 participants. Effect sizes were estimated using a random effects approach and moderator analyses between subsets of categorical variables were tested by the significant Q test.ResultsResults showed an overall correlation between behavioral problems and social competence of medium effect size (r = −.42, p < .01). Moderation analyses indicated no significant differences for different types of behavioral problems or social competence. However, a significant difference was found with regard to type of respondent; the correlation was significantly higher when both measures were reported by the same respondent (teacher or parent) compared to when measures were reported by parent-teacher as a dyad.ConclusionsFindings summarized and quantified a robust negative correlation between behavioral problems and social competence. The results indicate that intervention programs targeting problem behaviors in children would benefit from reducing behavioral problems and in concert, increase social competence to help children with emerging or present problem behaviors.

Gratitude and Problem Behaviors in Adolescents: The Mediating Roles of Positive and Negative Coping Styles.

The current study investigated the relationship between gratitude, internalizing and externalizing problem behaviors, along with the mediating roles of positive and negative coping styles therein. A sample of 589 Chinese adolescents completed the Gratitude Questionnaire (GQ-6), the Simplified Coping Style Questionnaire (SCSQ), the Irritability, Depression, and Anxiety Scale (IDAS), and the Aggression Questionnaire (AQ). Results of structural equation modeling showed that (1) the total effects of gratitude on both internalizing and externalizing problem behaviors were all significant and (2) both positive and negative coping styles mediated the links between gratitude and two types of problem behaviors. Thus, cultivating gratitude and developing adaptive coping style may help adolescents rectify problem behaviors.

I won't obey!: Psychologically Controlling Parenting and (Non)-Clinical Adolescents' Responses to Rule-setting.

This study examined associations between maternal psychologically controlling parenting and adolescents' responses to rule-setting as well as the link between both study variables and adolescents' internalizing and externalizing problems. Both clinical and nonclinical adolescents reported upon maternal psychological control, responses to rule-setting (i.e., oppositional defiance, submissive compliance, negotiation, and accommodation) and both adolescents and mothers reported upon adolescents' problems. Perceived psychological control related positively to adolescents' oppositional defiance and submissive compliance and negatively to negotiation and accommodation. Further, an integrated path model indicated that psychological control related to externalizing problems via oppositional defiance and internalizing problems via submissive compliance. Psychological control relates to different types of problem behaviors via diverse responses to maternal rule-setting. The discussion emphasizes the importance of future prevention and intervention programs to focus on both parenting and on adolescents' active contribution to their socialization process.

Samoocena młodzieży korzystającej z treści erotycznych w Internecie

One of the properties of the Internet is an immediate availability of its content, including the erotic content. A lot of research indicates that using erotic websites leads to the dysfunctional development of children and adolescents. This fact requires taking prophylactic measures in order to reduce this type of problem behaviour. The article seeks to establish protective factors and risk factors related to the self-esteem of young people who use or do not use erotic websites. The aim is to establish the relationship between self-esteem and accessing erotic content on the Internet. EPIDAL-VIII inventory edited by Z.B. Gaś as well as MSEI Multidimensional Self-Assessment Inventory by E.J. O’Brien and S. Epstein were used as research tools. The study was conducted on a group of 3774 higher-secondary school students from five voivodships in central and eastern Poland.

Risky Sexual Behavior of Modern Teenagers in Russia. Part II

This work is a continuation of the article on risky sexual behavior among young people. In this part, based on a review of various studies, as well as the results of their own surveys of students of schools, colleges and universities, such forms of sexually dangerous behavior as promiscuity, sexual intercourse with alcohol and drug use, child-teen prostitution are considered. It is revealed that different forms of deviant behavior and sexually dangerous behavior very often accompany each other. Teenagers having one type of problem behavior, are likely to have the others. Alcohol and drug use is a central element of risky behavior among adolescents and young people. In particular, the relationship between substance use and sexual behavior has been identified. The influence of the Internet on sexual behavior of teenagers is considered, modern types of virtual sexual activity of teenagers on the Internet and the associated risks are analyzed risks are analyzed.

Behavioral problems in children with epilepsy: a case–control study

Background Epilepsy is a disease that is not inclusive of seizures only, as there are behavioral, psychiatric, and cognitive disorders linked to it. Objective This study aims to compare the frequency and type of behavioral problems in children with epilepsy less than 5 years old versus healthy controls. Patients and methods This study is a case–control study conducted from April 2016 to April 2018 in the Neurology Clinic of Mansoura University Children Hospital. Inclusion criteria were age between 1.6 and 5 years old, diagnosis of epilepsy for 1 year at least, and regular follow-up. Excluded were children with cerebral palsy, developmental delay, mental retardation, and neurodegenerative and metabolic disorders. For matching by age and sex, the healthy group was sampled after the epilepsy group. The parents of both groups were interviewed to complete the child behavior checklist. Results The patients with epilepsy had higher child behavior checklist scores when compared with healthy children in different domains of withdrawal (P=0.001), sleep problems (P=0.02), attention-deficit problems (P Conclusion Childhood epilepsy can be associated with behavioral problems, which could be related to the age of onset, type of seizure, antiepileptic drugs, and duration of epilepsy.

What Protects Adolescents with Youth Subculture Affiliation from Excessive Internet Use?

Youth subculture affiliation (SA) appears to be an important risk factor with regard to adolescents’ problem behavior. Excessive Internet use (EIU) has emerged as a new type of problem behavior; however, it has not yet been studied in adolescents affiliated with youth subcultures. Thus, the aim of this study was to assess the association between SA and EIU and to explore the role of selected protective factors. We used data from the Health Behaviour in School-aged Children (HBSC) study conducted in 2014 in Slovakia. The final sample for this study comprised 532 adolescents (mean age: 15.4; 49.6% boys). Hierarchical linear regression analysis was conducted to examine the associations of EIU with SA. Adolescents with SA were more likely to report EIU. Adjustment for protective factors decreased the association between EIU and SA. From all tested interactions, only the interaction of SA with family support was found to be significant. The relationship between family support and EIU was mediated via Monitoring by the mother only in adolescents without SA. Our findings imply that the risk of EIU is higher in adolescents with SA. There was a difference in how protective factors worked in adolescents with and without SA.

The rolling hotspot? Perceptions of behavioral problems on school buses among a nationally representative sample of transportation officials

ABSTRACTThis study presents results from a nationally representative survey of school district transportation officials (N = 2,595) to understand how common seven types of behavioral problems (fighting, bullying, substance use, sexual harassment, sexual behaviors, profanity, violations of basic rules) are perceived to be on school buses. Ordinary least-squares regression is used to examine respondent- and district-level predictors of behavioral problems. Results indicate that violations of basic rules (e.g., moving seats), profanity, and bullying are perceived to be the most common problems on the nation’s buses. Several respondent (e.g., sex, race, title) and district characteristics (e.g., percentage of special education students) are statistically associated with perceptions of misconduct, number of disciplinary reports filed in the previous school year, or the frequency with which reports were filed. Implications of findings are discussed.

Language Disorders and Problem Behaviors: A Meta-analysis.

A large number of studies have shown a relationship between language disorders and problem behaviors; however, methodological differences have made it difficult to draw conclusions from this literature. To determine the overall impact of language disorders on problem behaviors in children and adolescents between the ages of birth and 18 years and to investigate the role of informant type, age, and type of problem behavior on this relationship. We searched PubMed, EBSCO, and ProQuest. Studies were included when a group of children with language disorders was compared with a group of typically developing children by using at least 1 measure of problem behavior. Effect sizes were derived from all included measures of problem behaviors from each study. We included 47 articles (63 153 participants). Meta-analysis of these studies revealed a difference in ratings of problem behaviors between children with language disorders and typically developing children of moderate size (g = 0.43; 95% confidence interval 0.34 to 0.53; P < .001). Age was entered as a moderator variable, and results showed that the difference in problem behavior ratings increases with child age (increase in g for each additional year in age = 0.06; 95% confidence interval 0.02 to 0.11; P = .004). There was considerable heterogeneity in the measures of problem behaviors used across studies. Children with language disorders display greater rates of problem behaviors compared with their typically developing peers, and this difference is more pronounced in older children.

Risk for Childhood Internalizing and Externalizing Behavior Problems in the Context of Prenatal Alcohol Exposure: A Meta-Analysis and Comprehensive Examination of Moderators.

Prenatal alcohol exposure (PAE) is associated with a constellation of physical, neurocognitive, and behavioral abnormalities in offspring. The presence of internalizing (e.g., anxiety, mood disorders) and externalizing (e.g., oppositional defiant and conduct disorders) behavior problems has devastating and often long-lasting impacts on children, adolescents, and their families. The present meta-analysis explored the strength of the association between PAE and behavior problems, as well as factors that increase or mitigate risk. The current meta-analysis included 65 studies comparing children and adolescents with PAE to non- or light-exposed controls and attention-deficit/hyperactivity disorder (ADHD) samples, on a variety of internalizing and externalizing behavior outcomes. Results indicated that individuals with PAE are at increased risk for internalizing (d=0.71, medium effect) and externalizing (d=0.90, large effect) problems compared to control samples. The occurrence of total behavior problems was similar to that seen in ADHD samples. The strength of the association between internalizing and externalizing behavior problems and PAE was significantly moderated by several distinct sample characteristics, such as sample age, socioeconomic status, severity of exposure, and type of behavior problem. These findings further our understanding of the behavior problems experienced by children and adolescents with PAE.

The Prevalence of Behavioral Problems Among Primary School Children in Outskirts of Mashhad City, Iran

Background: Planning to decrease mental health problems in children requires knowledge of the extent and type of behavioral problems in this age group. Given that children comprise a large proportion of the population in the outskirt areas of cities, evaluation of the prevalence of behavioral problems in children in outskirt areas could be effective in the prevention and treatment of mental disorders. Objectives: The aim of this study, performed during year 2015, was to detect the prevalence of behavioral problems in children in the outskirt areas of Mashhad city, Iran. Methods: This was a descriptive study. The study sample that was selected by the accessible sampling method consisted of 450 males, who were in the first to fifth grade. The instrument used to measure behavioral problems was the Achenbach child behavior checklist, which was completed by parents. The findings were analyzed by the SPSS 19 software using descriptive statistics. Results: The prevalence of behavioral problems on elementary school males was 36.44% on outskirts of Mashhad. The most common behavioral problem was defiant behavioral problems with 23.11% prevalence and social problems with the lowest prevalence of 7.33%. On scholastic grades, the students of the second grade most commonly had behavioral problems with a prevalence of 25.6% and the students of the fifth grade least frequently had behavioral problems with a prevalence of 13.4%. Conclusions: The prevalence of childhood behavioral problems in outskirts of Mashhad was large. These results suggest that more attention to children of outskirt areas and precise planning for reducing their behavioral problems is necessary.

Electroconvulsive Therapy for Agitation and Aggression in Dementia: A Systematic Review

Many patients with dementia develop agitation or aggression in the course of their disease. In some severe cases, behavioral, environmental, and pharmacological interventions are not sufficient to alleviate these potentially life-threatening symptoms. It has been suggested that in those cases, electroconvulsive therapy (ECT) could be an option. This review summarizes the scientific literature on ECT for agitation and aggression in dementia. We performed a systematic review in accordance with PRISMA guidelines. A search was conducted in Ovid MEDLINE, EMBASE, and PsycINFO. Two reviewers extracted the following data from the retrieved articles: number of patients and their age, gender, diagnoses, types of problem behavior, treatments tried before ECT, specifications of the ECT treatment, use of rating scales, treatment results, follow-up data, and adverse effects. The initial search yielded 264 articles, 17 of which fulfilled the inclusion criteria. Of these studies, one was a prospective cohort study, one was a case-control study, and the others were retrospective chart reviews, case series, or case reports. Clinically significant improvement was observed in the majority (88%) of the 122 patients described, often early in the treatment course. Adverse effects were most commonly mild, transient, or not reported. The reviewed articles suggest that ECT could be an effective treatment for severe and treatment-refractory agitation and aggression in dementia, with few adverse consequences. Nevertheless, because of the substantial risk of selection bias, the designs of the studies reviewed, and their small number, further prospective studies are needed to substantiate these preliminary positive results.

Distinctive effects between cognitive stimulation and reminiscence therapy on cognitive function and quality of life for different types of behavioural problems in dementia.

Among the various complementary therapies for patients with dementia (PwD), cognitive stimulation therapy (CST) and reminiscence therapy (RT) are frequently used to improve cognitive function and quality of life. However, no studies have examined the use of complementary therapies applied to different types of behavioural and psychological symptoms of dementia in PwD. The purpose of this study was to investigate the distinctive effects of CST and RT on cognitive function and quality of life for PwD with three types of behavioural problems - the dispute, return and dissociate types. A quasi-experimental design was employed. A total of PwD residing in 10 long-term care institutions participated in the study and were divided into three groups. The CST and RT groups received 50-minute sessions of intervention therapy once a week for 10 continuous weeks, and the control group participated in regular activities. The pretest (week 1), post-test (week 12) and follow-up (week 24) data were collected using the Mini-Mental State Examination and Quality of Life-Alzheimer's Disease. Two-way analysis of variance was used for data analysis. The results of our study revealed CST and RT interventions had positive effects on cognition and quality of life of PwD. For short-term effects on cognitive function, CST was the most positive intervention for the dispute type. With regard to short-term effects on quality of life, CST was greater than RT for PwD. For follow-up effects, CST and RT may have potentially sustained effects. This study suggests that CST and RT could be applied to improve the cognitive function and quality of life for PwD, as well as contribute to the effectiveness of nonpharmacological approaches to PwD with certain types of behavioural problems.

Maternal hypothyroxinaemia in early pregnancy and problem behavior in 5-year-old offspring

IntroductionThere is evidence, though not consistent, that offspring born to mothers with subtle decreases in thyroid function early in their pregnancies may be at risk of cognitive impairments and attention problems. However, other types of problem behavior have not been addressed thus far. We tested whether maternal thyroid function in early pregnancy is associated with several types of problem behavior in offspring at age 5–6 years. MethodsThis was a longitudinal study that included the data of 2000 mother-child pairs from the Amsterdam Born Children and their Development study. At a median gestational age of 12.9 (interquartile range: 11.9–14.1) weeks, maternal blood was sampled for assessment of free T4 and TSH. Overall problem behavior, hyperactivity/inattention, conduct problems, emotional problems, peer relationship problems and prosocial behavior were measured at age 5–6 years using the Strengths and Difficulties Questionnaire, which was filled out by both parents and teachers. ResultsMaternal hypothyroxinaemia <5th percentile was associated with a 1.70 (95% confidence interval (CI): 1.01–2.86) increased odds of teacher-reported hyperactivity/inattention after adjustment for confounders. By increasing the cut-off level to <10th percentile, the odds ratio became 1.47 (95% CI: 0.99–2.20). There were no associations between maternal thyroid function parameters and hyperactivity/inattention as reported by parents, nor with teacher or parent reports of other types of problem behavior. ConclusionsOur results partially confirm previous observations, showing that early disruptions in the maternal thyroid hormone supply may be associated with ADHD symptoms in offspring. Our study adds that there is no evidence for an effect on other types of problem behavior.

Differential Perception of Problem Behaviors between Parents, Teachers and Therapists

Background: Identification, listing, and prioritizing problem behaviors, and identification of rewards require unanimity among caregivers for effective management of children. Differential perception between the child handlers can endanger behavior correction program. Method: This cross sectional survey enlists the nature, frequency and intensity of problem behaviors, examines rank order preferences for target setting, and elicits reward preferences as reported separately by 94 father-mother-teacher-therapist caregivers for and on behalf of their 31 children with intellectual/developmental disabilities. Data was collected using standardized problem behavior tool and evocative procedures like open ended interviews and key informant reports. Results: There is greater propensity toward externalizing than internalizing forms of problem behaviors in the children. The point prevalence overall frequency count of problem behaviors per respondent is 20.15 and per child is 15.44. Significant differences and inverse correlations are seen between informants on all aspects of reporting frequency, intensity and/or types of problem behavior, their prioritizing and listing of rewards. Mothers report highest number of problem behaviors in their children compared to teachers, fathers and therapists. The implications of this poor agreement are presented and discussed for optimizing problem behavior remediation programs.

Introduction to the Special Issue—Functional Behavioral Assessment: Eighteen Years Later

? Building on an emerging knowledge base grounded firmly in the principles of applied behavior analysis, the 1997 reauthorization of the Individuals with Disabilities Education Act (IDEA) mandated the use of functional behavioral assessment (FBA) to guide the development of individualized behavior support plans for students who are repeatedly removed from school due to problem behavior. At that point, the majority of research identifying essential features of FBA and delineating key procedural steps was guided by work conducted within clinical settings with young adults with severe disabilities and intense challenging behavior. Shortly after the mandate and an expanded focus of FBA practices that included students with mild disabilities within educational settings, Sasso, Conroy, Stichter, and Fox (2001) encouraged the field to slow down the bandwagon (p. 282) and work toward creating a national research agenda and consensus within the field on critical features.Almost 20 years since the mandate, the field is still lacking sufficient empirical evidence across the wide range of disabilities, ages, settings, and types of behavioral problems regarding the necessary training to conduct FBAs with fidelity and the key system components that must be in place school wide to lead to effective and efficient behavioral supports. However, there are clear empirical demonstrations that (a) multicomponent FBAs are necessary to identify hypotheses about what occasions and maintains problem behavior, (b) targeted training and professional development are key to building an effective assessment and intervention process, and (c) function-based interventions are more effective than non-function-based interventions.The goal of this special issue of Behavioral Disorders is to present current research and discussion on the topic of FBA and functional analysis (FA) in school settings. The articles in this special issue were selected because they include a range of methodologies and conceptual frameworks to address multiple issues associated with school-based FBA and FA. These issues include the accuracy and precision of FBAs in comparison to FAs, implementation of FBAs and function-based interventions for students with stereotypical behaviors, education of preservice teachers in the FBA process, social validity of FBAs, and treatment integrity in function-based interventions.The first two papers in this issue focus on classroom applications of FBA and FA procedures. Lewis, Mitchell, Harvey, Green, and McKenzie begin the special issue by comparing and contrasting FBA with FA. In their review of the literature, they point out that early work in this area suggested FBA was limited in comparison to FA. Given the IDEA mandate for FBA in specific circumstances and the very controlled conditions required for FA, they examined the convergence of FBA and FA results conducted by school personnel with behavioral expertise. Findings indicated that, in general, there was considerable overlap between functions identified through FBA and FA by school personnel. Limitations and implications for practice are discussed, including a call for further applied research in educational settings.To this end, the next paper focuses on FBA in high school settings for students with stereotypical behaviors. Bruhn and colleagues begin by explaining that although most research suggests these behaviors serve only a sensory function, a limited body of research indicates some stereotypical behaviors may serve a social function such as access to attention or escape from task demands. Thus, they conducted FBAs with two students exhibiting topographically different stereotypical behaviors and found each student's behavior served a different function-one sensory-maintained and the other attention-maintained. Using single-subject designs, they demonstrated function-based interventions reduced stereotypical behaviors for both students. Implications for research and practice are discussed. …

Early Computed Tomography Frontal Abnormalities Predict Long-Term Neurobehavioral Problems But Not Affective Problems after Moderate to Severe Traumatic Brain Injury.

Behavioral problems are serious consequences of moderate to severe traumatic brain injury (TBI) and have a negative impact on outcome. There may be two types: neurobehavioral problems, manifesting as inadequate social behavior resulting from prefrontal system damage, and affective behavioral problems, resulting from emotional distress as a reaction to the brain injury. In the present study we investigated whether these two types of behavioral problems, as indicated by proxies, could be distinguished in a group of chronic TBI patients and whether early indicators of prefrontal damage on imaging could predict long-term neurobehavioral problems. Computed tomography (CT) imaging data on admission were used to identify frontal lesions. Three hundred twenty-three moderate to severe TBI survivors received 2 to 16 years post-trauma an aftercare survey with seven questions asking for changes in behavior and affect, presented both to patients and their proxies. One hundred eighty-six patients (59%) answered the behavioral questions; 42% had frontal lesions on CT. Ordinal common factor analysis on proxy scores yielded two factors, with behavior and affective items clearly separated and the anger item mediocre related to both factors. Three scales were created: Behavior, Affective and Anger. Frontal patients scored significantly higher on the Behavior and Anger scales. Logistic regression analysis showed a fourfold increase of long-term neurobehavioral problems in patients with frontal lesions. Long-term neurobehavioral problems were significantly correlated to one-year outcome and return to work in the long term. We conclude that in patients with moderate to severe TBI neurobehavioral and affective problems can be distinguished. Early CT frontal abnormalities predict long-term neurobehavioral problems, but not affective problems.