Profile of Executive Functioning and Lifetime History of Acquired Brain Injury in Young Adults Experiencing Homelessness: A Pilot Study
Abstract
1. Introduction
2. Materials and Methods
2.1. Participants and Procedures
2.2. Measures
2.2.1. Presence of Lifetime Acquired Brain Injury
2.2.2. Executive Functioning Measures
2.3. Data Analysis
3. Results
3.1. Participant Characteristics
3.2. OSU TBI-ID+ABI
3.3. Executive Functioning
3.4. Executive Functioning and Number of Injuries
3.5. Executive Functioning and Injury Mechanism
4. Discussion
Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
YYEH | Youth and young adults experiencing homelessness |
EF | Executive functioning |
ABI | Acquired brain injury |
ACE | Adverse childhood event |
QUEST | Quitting Using Executive Strategy Training |
OSU TBI-ID+ABI | The Ohio State University Traumatic Brain Injury Identification Method |
BRIEF | Behavior Rating Inventory of Executive Functioning |
GEC | Global executive composite |
BRI | Behavioral rating index |
DCCS | Dimensional change card sort |
LOC | Loss of consciousness |
TBI | Traumatic brain injury |
HAI | Hypoxic/anoxic injury |
Appendix A
Q1. Please think about injuries you have had during your entire lifetime, especially those that affected your head or neck. It might help to remember times you went to the hospital or emergency department. Think about injuries you may have received from a car or motorcycle wreck, bicycle crash, being hit by someone, playing sports, or an injury during military service.1a. Thinking about any injuries you have had in your lifetime, were you ever knocked out, or did you lose consciousness?1b. What was the longest time you were knocked out or unconscious?1c. How old were you the first time you were knocked out or lost consciousness?Q2. Have you ever had a period of time in which you experienced multiple, repeated impacts to your head (e.g., history of abuse, contact sports, military duty)?Q3. Have you ever lost consciousness from a drug overdose or being choked?
References
- United Nations. Guidelines for the Implementation of the Right to Adequate Housing [Internet]; United Nations: Geneva, Switzerland, 2019; p. 3, Report No.: A/HRC/43/43; Available online: https://documents.un.org/doc/undoc/gen/g19/353/90/pdf/g1935390.pdf (accessed on 7 January 2025).
- United States Interagency Council on Homelessness. Homelessness in America: Focus on Youth [Internet]. 2018. Available online: https://www.usich.gov/sites/default/files/document/Homelessness_in_America_Youth.pdf (accessed on 15 August 2023).
- Barnes, A.J.; Gower, A.L.; Sajady, M.; Lingras, K.A. Health and adverse childhood experiences among homeless youth. BMC Pediatr. 2021, 21, 164. [Google Scholar] [CrossRef]
- Centers for Disease Control and Prevention. About Adverse Childhood Experiences. Adverse Childhood Experiences (ACEs). 2024. Available online: https://www.cdc.gov/aces/about/index.html (accessed on 12 August 2024).
- Guinn, A.S.; Ports, K.A.; Ford, D.C.; Breiding, M.; Merrick, M.T. Associations between adverse childhood experiences and acquired brain injury, including traumatic brain injuries, among adults: 2014 BRFSS North Carolina. Inj Prev. 2019, 25, 514–520. [Google Scholar] [CrossRef] [PubMed]
- Nemeth, J.M.; Glasser, A.M.; Hinton, A.; Macisco, J.M.; Wermert, A.; Smith, R.; Kemble, H.; Sasser, G. Brain injury is prevalent and precedes tobacco use among youth and young adults experiencing homelessness. Int. J. Environ. Res. Public Health 2023, 20, 5169. [Google Scholar] [CrossRef]
- Mackelprang, J.L.; Harpin, S.B.; Grubenhoff, J.A.; Rivara, F.P. Adverse outcomes among homeless adolescents and young adults who report a history of traumatic brain injury. Am. J. Public Health 2014, 104, 1986–1992. [Google Scholar] [CrossRef] [PubMed]
- Taylor, C.A.; Bell, J.M.; Breiding, M.J.; Xu, L. Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths-United States, 2007 and 2013. MMWR Surveill. Summ. 2017, 66, 1–16. [Google Scholar] [CrossRef]
- McDonald, B.C.; Flashman, L.A.; Saykin, A.J. Executive dysfunction following traumatic brain injury: Neural substrates and treatment strategies. NeuroRehabilitation 2002, 17, 333–344. [Google Scholar] [CrossRef]
- Diamond, A. Executive Functions. Annu. Rev. Psychol. 2013, 64, 135–168. [Google Scholar] [CrossRef] [PubMed]
- Miyake, A.; Friedman, N.P.; Emerson, M.J.; Witzki, A.H.; Howerter, A.; Wager, T.D. The Unity and Diversity of Executive Functions and Their Contributions to Complex “Frontal Lobe” Tasks: A Latent Variable Analysis. Cogn. Psychol. 2000, 41, 49–100. [Google Scholar] [CrossRef]
- Cristofori, I.; Grafman, J. Executive functions after traumatic brain injury: From deficit to recovery. In Executive Functions in Health and Disease; Elsevier Academic Press: San Diego, CA, USA, 2017; pp. 421–443. [Google Scholar]
- Corrigan, J.D.; Bogner, J. Initial reliability and validity of the Ohio State University TBI Identification Method. J. Head Trauma Rehabil. 2007, 22, 318–329. [Google Scholar] [CrossRef]
- Bogner, J.; Corrigan, J.D. Reliability and predictive validity of the Ohio State University TBI identification method with prisoners. J. Head Trauma Rehabil. 2009, 24, 279–291. [Google Scholar] [CrossRef]
- Gioia, G.; Isquith, P.; Guy, S.; Kenworthy, L. Behavior Rating Inventory of Executive Function; Psychological Assessment Resources: Odessa, FL, USA, 2000. [Google Scholar]
- Roth, R.M.; Lance, C.E.; Isquith, P.K.; Fischer, A.S.; Giancola, P.R. Confirmatory Factor Analysis of the Behavior Rating Inventory of Executive Function-Adult Version in Healthy Adults and Application to Attention-Deficit/Hyperactivity Disorder. Arch. Clin. Neuropsychol. 2013, 28, 425–434. [Google Scholar] [CrossRef]
- Roth, R.M.; Isquith, P.K.; Gioia, G.A. BRIEF-A: Behavior Rating Inventory of Executive Function-Adult Version; Psychological Assessment Resources: Lutz, FL, USA, 2005. [Google Scholar]
- Waid-Ebbs, J.K.; Wen, P.S.; Heaton, S.C.; Donovan, N.J.; Velozo, C. The item level psychometrics of the behaviour rating inventory of executive function-adult (BRIEF-A) in a TBI sample. Brain Inj. 2012, 26, 1646–1657. [Google Scholar] [CrossRef] [PubMed]
- Carlozzi, N.; Goodnight, S.; Casaletto, K.; Goldsmith, A.; Heaton, R.; Wong, A.; Baum, C.M.; Gershon, R.; Heinemann, A.W.; Tulsky, D.S. Validation of the NIH Toolbox in Individuals with Neurologic Disorders. 2017. Available online: https://www-ncbi-nlm-nih-gov.proxy.lib.ohio-state.edu/pmc/articles/PMC5860275/ (accessed on 24 January 2022).
- Zelazo, P.D.; Anderson, J.E.; Richler, J.; Wallner-Allen, K.; Beaumont, J.L.; Conway, K.P.; Gershon, R.; Weintraub, S. NIH Toolbox Cognition Battery (CB): Validation of executive function measures in adults. J. Int. Neuropsychol. Soc. 2014, 20, 620–629. [Google Scholar] [CrossRef] [PubMed]
- Heaton, R.K.; Akshoomoff, N.; Tulsky, D.; Mungas, D.; Weintraub, S.; Dikmen, S.; Beaumont, J.; Casaletto, K.B.; Conway, K.; Slotkin, J.; et al. Reliability and Validity of Composite Scores from the NIH Toolbox Cognition Battery in Adults. J. Int. Neuropsychol. Soc. 2014, 20, 588–598. [Google Scholar] [CrossRef] [PubMed]
- IBM Corp. IBM SPSS Statistics for Macintosh; IBM Corp: Armonk, NY, USA, 2023. [Google Scholar]
- Institute of Global Homelessness. State of Homelessness in Countries with Developed Economies. 2019. Available online: https://www.un.org/development/desa/dspd/wp-content/uploads/sites/22/2019/05/CASEY_Louise_Paper.pdf (accessed on 15 April 2025).
- Op den Kelder, R.; Van den Akker, A.L.; Geurts, H.M.; Lindauer, R.J.L.; Overbeek, G. Executive functions in trauma-exposed youth: A meta-analysis. Eur. J. Psychotraumatol. 2018, 9, 1450595. [Google Scholar] [CrossRef]
- Clausen, A.N.; Meyers, K.R.; Stamey, H.M.; Spilman, S.K. Traumatic Brain Injury, Psychological Trauma Exposure, and Anxious and Depressive Symptoms in a Clinical Population. J. Trauma Nurs. 2024, 31, 82–89. [Google Scholar] [CrossRef]
- Kulik, D.M.; Gaetz, S.; Crowe, C.; Ford-Jones, E. Homeless youth’s overwhelming health burden: A review of the literature. Paediatr. Child Health 2011, 16, e43–e47. [Google Scholar] [CrossRef]
- Society for Adolescent Health and Medicine. The Healthcare Needs and Rights of Youth Experiencing Homelessness. J. Adolesc. Health 2018, 63, 372–375. [Google Scholar] [CrossRef]
- Lewis, F.D.; Horn, G.J. Comparison of TBI and CVA outcomes: Durability of gains following post-hospital neurological rehabilitation. NeuroRehabilitation 2023, 52, 425–433. [Google Scholar] [CrossRef]
- Bender, K.; Brown, S.M.; Thompson, S.J.; Ferguson, K.M.; Langenderfer, L. Multiple Victimizations Before and After Leaving Home Associated With PTSD, Depression, and Substance Use Disorder Among Homeless Youth. Child Maltreat. 2015, 20, 115–124. [Google Scholar] [CrossRef]
- Conti, A.A.; McLean, L.; Tolomeo, S.; Steele, J.D.; Baldacchino, A. Chronic tobacco smoking and neuropsychological impairments: A systematic review and meta-analysis. Neurosci. Biobehav. Rev. 2019, 96, 143–154. [Google Scholar] [CrossRef] [PubMed]
Total Sample | No ABI | Number of Injuries | Injury Mechanism | |||
---|---|---|---|---|---|---|
(n = 23) | (n = 3) | Single (n = 4) | Multiple (n = 16) | TBI Only (n = 9) | HAI/Mixed (n = 11) | |
Age | ||||||
Mean | 21.13 | 22.00 | 20.75 | 21.06 | 20.78 | 21.18 |
SD | 1.66 | 1.00 | 0.96 | 1.88 | 1.09 | 2.14 |
Age at first ABI | (n = 14) | (n = 4) | (n = 10) | (n = 6) | (n = 9) | |
Mean | 16.79 | N/A | 16.25 | 17.00 | 16.67 | 16.88 |
SD | 3.53 | N/A | 4.50 | 3.33 | 3.88 | 3.52 |
n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | |
Gender a | ||||||
Male | 11 (47.83) | 3 (100) | 2 (50.00) | 6 (37.50) | 5 (55.56) | 3 (27.27) |
Female | 12 (52.17) | 0 (0) | 2 (50.00) | 10 (62.50) | 4 (44.44) | 8 (72.73) |
Sexual Orientation | ||||||
Bisexual | 5 (21.74) | 0 (0) | 0 (0) | 5 (31.25) | 1 (11.11) | 4 (36.36) |
Gay or Lesbian | 1 (4.35) | 0 (0) | 0 (0) | 1 (6.25) | 0 (0) | 1 (9.09) |
Heterosexual | 13 (56.52) | 2 (66.67) | 4 (100) | 7 (43.75) | 7 (77.78) | 4 (36.36) |
Self-Describe | 3 (13.04) | 1 (33.33) | 0 (0) | 2 (12.50) | 1 (11.11) | 1 (9.09) |
Prefer not to answer | 1 (4.35) | 0 (0) | 0 (0) | 1 (6.25) | 0 (0) | 1 (9.09) |
Race | ||||||
American Indian or Alaska Native | 1 (4.35) | 0 (0) | 0 (0) | 1 (6.25) | 0 (0) | 1 (9.09) |
Black or African American | 14 (60.87) | 3 (100) | 3 (75.00) | 8 (50.00) | 7 (77.78) | 4 (36.36) |
Native Hawaiian Pacific Islander | 1 (4.35) | 0 (0) | 1 (25.00) | 0 (0) | 1 (11.11) | 0 (0) |
White | 4 (17.39) | 0 (0) | 0 (0) | 4 (25.00) | 1 (11.11) | 3 (27.27) |
Multiracial | 2 (8.70) | 0 (0) | 0 (0) | 2 (12.50) | 0 (0) | 2 (18.18) |
Prefer not to answer | 1 (4.35) | 0 (0) | 0 (0) | 1 (6.25) | 0 (0) | 1 (9.09) |
Length of Loss of Consciousness | ||||||
None | 9 (39.13) | 3 (100) | 0 (0) | 6 (37.50) | 3 (33.33) | 3 (27.27) |
<30 min | 11 (47.83) | 0 (0) | 3 (75.00) | 8 (50.00) | 5 (55.56) | 6 (54.55) |
30 min–24 h | 2 (8.70) | 0 (0) | 0 (0) | 2 (12.25) | 0 (0) | 2 (18.18) |
>24 h | 1 (4.35) | 0 (0) | 1 (25.00) | 0 (0) | 1 (11.11) | 0 (0) |
Total Sample (n = 23) | No ABI (n = 3) | |
---|---|---|
BRIEF-A | Median [IQR] | Median [Range] |
Inhibit | 63 [53–74] | 57 [53–63] |
Shift | 60 [47–64] | 56 [39–64] |
Emotional Control | 54 [49–69] | 43 [40–49] |
Self-Monitor | 59 [50–76] | 59 [46–72] |
BRI | 62 [51–70] | 53 [46–58] |
Initiate | 56 [47–63] | 56 [53–60] |
Working Memory | 59 [53–73] | 53 [49–66] |
Plan Organize | 57 [46–68] | 52 [52–57] |
Task Monitor | 54 [45–63] | 45 [45–54] |
Organization of Materials | 50 [45–56] | 47 [45–47] |
Metacognition | 56 [48–66] | 52 [50–56] |
GEC | 61 [50–70] | 53 [48–58] |
NIH Toolbox | ||
DCCS | 87 [83–94] a | 78 [76–101] |
Flanker | 84 [72–97] | 89 [69–99] |
Number of Injuries (n = 20) | Injury Mechanism (n = 20) | |||||
---|---|---|---|---|---|---|
Single (n = 4) | Multiple (n = 16) | p | TBI Only (n = 9) | HAI/Mixed (n = 11) | p | |
BRIEF-A | Median [IQR] | Median [IQR] | Median [IQR] | Median [IQR] | ||
Inhibit | 58.50 [47–67] | 65 [54–76.25] | 0.25 | 67 [48–80.50] | 63 [53–74] | 0.94 |
Shift | 47 [41–53.75] | 60 [49.25–69] | 0.04 * | 47 [45–66.50] | 60 [56–69] | 0.20 |
Emotional Control | 51.50 [44.50–65.25] | 62.50 [54–71.25] | 0.21 | 54 [48–70.50] | 60 [54–67] | 0.84 |
Self-Monitor | 50 [47–53] | 67.50 [52.25–79] | 0.02 * | 54 [48–78] | 63 [59–76] | 0.23 |
BRI | 51.50 [42.25–63] | 67 [54–76.50] | 0.06 | 54 [48.50–79.50] | 67 [57–70] | 0.41 |
Initiate | 43 [40.75–55.75] | 61.50 [47.75–67.50] | 0.08 | 47 [41.50–68] | 63 [53–63] | 0.20 |
Working Memory | 56 [47.75–59] | 69 [56–73] | 0.12 | 59 [49.50–76] | 69 [56–73] | 0.60 |
Plan Organize | 46.50 [41.75–57.25] | 65 [48–77.50] | 0.08 | 49 [44–70.50] | 65 [54–78] | 0.30 |
Task Monitor | 45 [41.25–48.75] | 59 [50–71] | 0.02 * | 50 [45–65.50] | 59 [50–68] | 0.20 |
Organization of Materials | 47.50 [42.75–52.25] | 56 [47.75–58] | 0.18 | 53 [43.50–59.50] | 53 [47–56] | 0.82 |
Metacognition | 46.50 [44.25–54] | 63.50 [53–69.75] | 0.08 | 52 [44.50–69.50] | 63 [56–69] | 0.37 |
GEC | 49 [44.75–58.50] | 66 [51.25–71] | 0.05 * | 51 [46–75.50] | 64 [55–70] | 0.37 |
NIH Toolbox | ||||||
DCCS | 87 [83–99] a,b | 87 [83.25–92.75] | 0.88 | 87 [80.75–92.75] c | 87 [84–94] | 0.72 |
Flanker | 96 [86.75–98.50] | 75 [69.75–95.50] | 0.15 | 81 [71.50–96] | 92 [72–101] | 0.66 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Viola, N.; Nemeth, J.M.; Hinton, A.; Lundine, J.P. Profile of Executive Functioning and Lifetime History of Acquired Brain Injury in Young Adults Experiencing Homelessness: A Pilot Study. Int. J. Environ. Res. Public Health 2025, 22, 790. https://doi.org/10.3390/ijerph22050790
Viola N, Nemeth JM, Hinton A, Lundine JP. Profile of Executive Functioning and Lifetime History of Acquired Brain Injury in Young Adults Experiencing Homelessness: A Pilot Study. International Journal of Environmental Research and Public Health. 2025; 22(5):790. https://doi.org/10.3390/ijerph22050790
Chicago/Turabian StyleViola, Nicole, Julianna M. Nemeth, Alice Hinton, and Jennifer P. Lundine. 2025. "Profile of Executive Functioning and Lifetime History of Acquired Brain Injury in Young Adults Experiencing Homelessness: A Pilot Study" International Journal of Environmental Research and Public Health 22, no. 5: 790. https://doi.org/10.3390/ijerph22050790
APA StyleViola, N., Nemeth, J. M., Hinton, A., & Lundine, J. P. (2025). Profile of Executive Functioning and Lifetime History of Acquired Brain Injury in Young Adults Experiencing Homelessness: A Pilot Study. International Journal of Environmental Research and Public Health, 22(5), 790. https://doi.org/10.3390/ijerph22050790