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To examine long-term outcomes from child traumatic brain injury (TBI) and relevance of injury severity.A retrospective cross-sectional design.One hundred and twenty-four young adult survivors of childhood TBI (81 men), aged 18 to 30 years at evaluation (mean = 23.5, SD = 2.9), with injury on average 13.7 years prior to evaluation divided according to injury severity: mild (n = 60), moderate (n = 27), and severe (n = 37).Questionnaires assessed educational and employment status, psychosocial function, and quality-of-life issues.Functional difficulties persisted into adulthood. Injury severity was a particularly strong predictor of long-term outcomes, with environmental factors playing a less consistent role. Survivors of severe TBI were particularly vulnerable, demonstrating global impairment: poorer school performance, employment difficulties, poor quality of life, and increased risk of mental health problems. Mild and moderate TBI were more benign, although lower educational attainment and employment status were identified, and moderate TBI was associated with late developing mental health issues.Traumatic brain injury is a lifelong problem, compromising the individual's capacity to meet developmental expectations across a wide range of functional domains.