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Wislocki K, Kratz HE, Martin G, Becker-Haimes EM. The Relationship Between Trauma Exposure and Obsessive-Compulsive Disorder in Youth: A Systematic Review. Child Psychiatry Hum Dev 2023; 54:1624-1652. [PMID: 35488083 DOI: 10.1007/s10578-022-01352-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
Abstract
Extant literature suggests a possible relationship between childhood trauma exposure and the development and trajectory of obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD); however, this relationship is poorly understood. We conducted a systematic review that examined trauma exposure and OCS/OCD in youth. Primary inclusion criteria were English-language articles that addressed a sample with participants under 18 years of age. 46 articles met criteria for review, and were categorized into three groups of overlap: Post-traumatic Stress Disorder (PTSD) and OCS or OCD (n = 3), clearly defined Criterion A event trauma exposure and OCS or OCD (n = 30), and less well-defined potential trauma exposure and OCS or OCD (n = 13). There was mixed evidence linking trauma exposure and the development of OCS or OCD in youth. Major methodological limitations preclude formal conclusions. More research on co-occurring trauma exposure and OCD/OCS in youth is needed to advance research and improve treatment.
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Affiliation(s)
- Katherine Wislocki
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., #3001, Philadelphia, PA, 19104, USA.
- Department of Psychological Science, University of California, Irvine, CA, USA.
| | - Hilary E Kratz
- Department of Psychology, La Salle University, Philadelphia, PA, USA
| | - Gerald Martin
- Department of Psychology, La Salle University, Philadelphia, PA, USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., #3001, Philadelphia, PA, 19104, USA
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, USA
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Huang MX, Angeles-Quinto A, Robb-Swan A, De-la-Garza BG, Huang CW, Cheng CK, Hesselink JR, Bigler ED, Wilde EA, Vaida F, Troyer EA, Max JE. Assessing Pediatric Mild Traumatic Brain Injury and Its Recovery Using Resting-State Magnetoencephalography Source Magnitude Imaging and Machine Learning. J Neurotrauma 2023; 40:1112-1129. [PMID: 36884305 PMCID: PMC10259613 DOI: 10.1089/neu.2022.0220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
The objectives of this machine-learning (ML) resting-state magnetoencephalography (rs-MEG) study involving children with mild traumatic brain injury (mTBI) and orthopedic injury (OI) controls were to define a neural injury signature of mTBI and to delineate the pattern(s) of neural injury that determine behavioral recovery. Children ages 8-15 years with mTBI (n = 59) and OI (n = 39) from consecutive admissions to an emergency department were studied prospectively for parent-rated post-concussion symptoms (PCS) at: 1) baseline (average of 3 weeks post-injury) to measure pre-injury symptoms and also concurrent symptoms; and 2) at 3-months post-injury. rs-MEG was conducted at the baseline assessment. The ML algorithm predicted cases of mTBI versus OI with sensitivity of 95.5 ± 1.6% and specificity of 90.2 ± 2.7% at 3-weeks post-injury for the combined delta-gamma frequencies. The sensitivity and specificity were significantly better (p < 0.0001) for the combined delta-gamma frequencies compared with the delta-only and gamma-only frequencies. There were also spatial differences in rs-MEG activity between mTBI and OI groups in both delta and gamma bands in frontal and temporal lobe, as well as more widespread differences in the brain. The ML algorithm accounted for 84.5% of the variance in predicting recovery measured by PCS changes between 3 weeks and 3 months post-injury in the mTBI group, and this was significantly lower (p < 10-4) in the OI group (65.6%). Frontal lobe pole (higher) gamma activity was significantly (p < 0.001) associated with (worse) PCS recovery exclusively in the mTBI group. These findings demonstrate a neural injury signature of pediatric mTBI and patterns of mTBI-induced neural injury related to behavioral recovery.
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Affiliation(s)
- Ming-Xiong Huang
- Department of Radiology, University of California, San Diego, California, USA
- Radiology and Research Services, VA San Diego Healthcare System, San Diego, California, USA
| | - Annemarie Angeles-Quinto
- Department of Radiology, University of California, San Diego, California, USA
- Radiology and Research Services, VA San Diego Healthcare System, San Diego, California, USA
| | - Ashley Robb-Swan
- Department of Radiology, University of California, San Diego, California, USA
- Radiology and Research Services, VA San Diego Healthcare System, San Diego, California, USA
| | | | - Charles W. Huang
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Chung-Kuan Cheng
- Department of Computer Science and Engineering, University of California, San Diego, California, USA
| | - John R. Hesselink
- Department of Radiology, University of California, San Diego, California, USA
| | - Erin D. Bigler
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | | | - Florin Vaida
- Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego, California, USA
| | - Emily A. Troyer
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Jeffrey E. Max
- Department of Psychiatry, University of California, San Diego, California, USA
- Department of Psychiatry, Rady Children's Hospital, San Diego, California, USA
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Cámara-Barrio S, Esteso-Orduña B, Vara-Arias MT, Rodríguez-Palero S, Fournier-Del Castillo MC. A neuropsychological approach in a paediatric acquired brain injury unit under the public health system. Neurologia 2023; 38:8-14. [PMID: 36162700 DOI: 10.1016/j.nrleng.2020.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 04/01/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Paediatric acquired brain injury (ABI) causes cognitive and behavioural difficulties and alters the course of child development. The ABI unit at Hospital Infantil Universitario Niño Jesús is the first within the public Spanish health system to provide comprehensive coverage to these patients and their families. OBJECTIVE This study aims to show the working methodology followed with patients and their families, and to describe the clinical characteristics of the patients treated and the outcomes of treatment. PATIENTS Fifty-three patients aged between 3 months and 16 and a half years received treatment. The conditions treated were brain tumours, stroke, traumatic brain injury, damage secondary to epilepsy surgery, and hypoxia. METHODS All patients were evaluated at admission and at discharge. Treatments were adapted to each patient's difficulties and their severity, as well as to the patient's age. Families received individual and group therapy. RESULTS Older age was associated with better cognitive recovery and shorter duration of treatment. Different conditions show differential impact on intelligence quotient and developmental quotient scores at the beginning of treatment, with hypoxia and encephalitis being associated with greatest severity. Intelligence quotient and developmental quotient scores and visual memory and attention scores at discharge improved significantly after the faceted neuropsychological treatment with respect to scores registered at admission. CONCLUSIONS The care of patients with ABI should include neuropsychological rehabilitation programmes and provide emotional support to the family so that they may actively participate in the recovery of the child or adolescent.
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Affiliation(s)
- S Cámara-Barrio
- Unidad de Daño Cerebral Adquirido, Unidad de Neuropsicología Clínica, Servicio de Psiquiatría y Psicología, Hospital Universitario Niño Jesús, Madrid, Spain.
| | - B Esteso-Orduña
- Unidad de Daño Cerebral Adquirido, Unidad de Neuropsicología Clínica, Servicio de Psiquiatría y Psicología, Hospital Universitario Niño Jesús, Madrid, Spain
| | - M T Vara-Arias
- Unidad de Daño Cerebral Adquirido, Servicio de Rehabilitación, Hospital Universitario Niño Jesús, Madrid, Spain
| | - S Rodríguez-Palero
- Unidad de Daño Cerebral Adquirido, Servicio de Rehabilitación, Hospital Universitario Niño Jesús, Madrid, Spain
| | - M C Fournier-Del Castillo
- Unidad de Neuropsicología Clínica, Servicio de Psiquiatría y Psicología, Hospital Universitario Niño Jesús, Madrid, Spain
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Max JE, Drake I, Vaida F, Hesselink JR, Ewing-Cobbs L, Schachar RJ, Chapman SB, Bigler ED, Wilde EA, Saunders AE, Yang TT, Tymofiyeva O, Levin HS. Novel Psychiatric Disorder 6 Months After Traumatic Brain Injury in Children and Adolescents. J Neuropsychiatry Clin Neurosci 2022; 35:141-150. [PMID: 35989573 PMCID: PMC10317586 DOI: 10.1176/appi.neuropsych.21120301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the factors predictive of novel psychiatric disorders in the interval 0-6 months following traumatic brain injury (TBI). METHODS Children ages 5-14 years consecutively hospitalized for mild to severe TBI at five hospitals were recruited. Participants were evaluated at baseline (soon after injury) for pre-injury characteristics including psychiatric disorders, socioeconomic status (SES), psychosocial adversity, family function, family psychiatric history, and adaptive function. In addition to the psychosocial variables, injury severity and lesion location detected with acquisition of a research MRI were measured to develop a biopsychosocial predictive model for development of novel psychiatric disorders. Psychiatric outcome, including occurrence of a novel psychiatric disorder, was assessed 6 months after the injury. RESULTS The recruited sample numbered 177 children, and 141 children (80%) returned for the six-month assessment. Of the 141 children, 58 (41%) developed a novel psychiatric disorder. In univariable analyses, novel psychiatric disorder was significantly associated with lower SES, higher psychosocial adversity, and lesions in frontal lobe locations, such as frontal white matter, superior frontal gyrus, inferior frontal gyrus, and orbital gyrus. Multivariable analyses found that novel psychiatric disorder was independently and significantly associated with frontal-lobe white matter, superior frontal gyrus, and orbital gyrus lesions. CONCLUSION The results demonstrate that occurrence of novel psychiatric disorders following pediatric TBI requiring hospitalization is common and has identifiable psychosocial and specific biological predictors. However, only the lesion predictors were independently related to this adverse psychiatric outcome.
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Affiliation(s)
- Jeffrey E. Max
- University of California, San Diego, Department of Psychiatry
- Rady Children’s Hospital, San Diego
| | | | - Florin Vaida
- University of California, San Diego, Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics
| | | | | | | | | | - Erin D. Bigler
- Brigham Young University, Department of Psychology
- University of Utah, TBI and Concussion Center, Department of Neurology
| | - Elisabeth A. Wilde
- University of Utah, TBI and Concussion Center, Department of Neurology
- Baylor College of Medicine, Department of Physical Medicine and Rehabilitation
| | | | - Tony T. Yang
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences
| | - Olga Tymofiyeva
- University of California, San Francisco, Department of Radiology and Biomedical Imaging
| | - Harvey S. Levin
- Baylor College of Medicine, Department of Physical Medicine and Rehabilitation
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Max JE, Judd N, Bigler ED, Wilde EA, Patterson JE, Edwards TM, Calahorra A, De La Garza BG, Vaida F. Three-Month Psychiatric Outcome of Pediatric Mild Traumatic Brain Injury: A Controlled Study. J Neurotrauma 2021; 38:3341-3351. [PMID: 34714155 DOI: 10.1089/neu.2021.0324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The objective was to clarify occurrence, phenomenology, and risk factors for novel psychiatric disorder (NPD) in the first 3 months after mild traumatic brain injury (mTBI) and orthopedic injury (OI). Children aged 8-15 years with mTBI (n = 220) and with OI but no TBI (n = 110) from consecutive admissions to an emergency department were followed prospectively at baseline and 3 months post-injury with semi-structured psychiatric interviews to document the number of NPDs that developed in each participant. Pre-injury child variables (adaptive, cognitive, and academic function, and psychiatric disorder), pre-injury family variables (socioeconomic status, family psychiatric history, and family function), and injury severity were assessed and analyzed as potential confounders and predictors of NPD. NPD occurred at a significantly higher frequency in children with mTBI versus OI in analyses unadjusted (mean ratio [MR] 3.647, 95% confidence interval [CI95] (1.264, 15.405), p = 0.014) and adjusted (MR = 3.724, CI95 (1.264, 15.945), p = 0.015) for potential confounders. In multi-predictor analyses, the factors besides mTBI that were significantly associated with higher NPD frequency after adjustment for each other were pre-injury lifetime psychiatric disorder [MR = 2.284, CI95 (1.026, 5.305), p = 0.043]; high versus low family psychiatric history [MR = 2.748, CI95 (1.201, 6.839), p = 0.016], and worse socio-economic status [MR = 0.618 per additional unit, CI95 (0.383, 0.973), p = 0.037]. These findings demonstrate that mild injury to the brain compared with an OI had a significantly greater deleterious effect on psychiatric outcome in the first 3 months post-injury. This effect was present even after accounting for specific child and family variables, which were themselves independently related to the adverse psychiatric outcome.
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Affiliation(s)
- Jeffrey E Max
- Department of Psychiatry, Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, California, USA.,Rady Children's Hospital, San Diego, San Diego, California, USA
| | - Nicholas Judd
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Erin D Bigler
- Department of Psychiatry, University of Utah School of Medicine, Provo, Utah, USA.,Department of Neurology, University of Utah School of Medicine, Provo, Utah, USA.,Department of Psychology and Neuroscience, Brigham Young University, Provo, Utah, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Provo, Utah, USA
| | - Jo Ellen Patterson
- Marital and Family Therapy Program, University of San Diego, San Diego, California, USA
| | - Todd M Edwards
- Marital and Family Therapy Program, University of San Diego, San Diego, California, USA
| | - Ainara Calahorra
- Department of Psychiatry, Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, California, USA
| | - Bianca G De La Garza
- Department of Psychiatry, Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, California, USA
| | - Florin Vaida
- Division of Biostatistics, Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, California, USA
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Asarnow RF, Newman N, Weiss RE, Su E. Association of Attention-Deficit/Hyperactivity Disorder Diagnoses With Pediatric Traumatic Brain Injury: A Meta-analysis. JAMA Pediatr 2021; 175:1009-1016. [PMID: 34251435 PMCID: PMC8276124 DOI: 10.1001/jamapediatrics.2021.2033] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There are conflicting accounts about the risk for attention-deficit/hyperactivity disorder (ADHD) following traumatic brain injury (TBI), possibly owing to variations between studies in acute TBI severity or when ADHD was assessed postinjury. Analysis of these variations may aid in identifying the risk. OBJECTIVE To conduct a meta-analysis of studies assessing ADHD diagnoses in children between ages 4 and 18 years following concussions and mild, moderate, or severe TBI. DATA SOURCES PubMed, PsycInfo, and Cochrane Central Register of Controlled Trials (1981-December 19, 2019) were searched including the terms traumatic brain injury, brain injuries, closed head injury, blunt head trauma, concussion, attention deficit disorders, ADHD, and ADD in combination with childhood, adolescence, pediatric, infant, child, young adult, or teen. STUDY SELECTION Limited to English-language publications in peer-reviewed journals and patient age (4-18 years). Differences about inclusion were resolved through consensus of 3 authors. DATA EXTRACTION AND SYNTHESIS MOOSE guidelines for abstracting and assessing data quality and validity were used. Odds ratios with 95% credible intervals (CrIs) are reported. MAIN OUTCOMES AND MEASURES The planned study outcome was rate of ADHD diagnoses. RESULTS A total of 12 374 unique patients with TBI of all severity levels and 43 491 unique controls were included in the 24 studies in this review (predominantly male: TBI, 61.8%; noninjury control, 60.9%; other injury control, 66.1%). The rate of pre-TBI ADHD diagnoses was 16.0% (95% CrI, 11.3%-21.7%), which was significantly greater than the 10.8% (95% CrI, 10.2%-11.4%) incidence of ADHD in the general pediatric population. Compared with children without injuries, the odds for ADHD were not significantly increased following concussion (≤1 year: OR, 0.32; 95% CrI, 0.05-1.13), mild TBI (≤1 year: OR, 0.56; 0.16-1.43; >1 year: OR, 1.07; 95% CrI, 0.35-2.48), and moderate TBI (≤1 year: OR, 1.28; 95% CrI, 0.35-3.34; >1 year: OR, 3.67; 95% CrI, 0.83-10.56). The odds for ADHD also were not significantly increased compared with children with other injuries following mild TBI (≤1 year: OR, 1.07; 95% CrI, 0.33-2.47; >1 year: OR, 1.18; 95% CrI, 0.32-3.12) and moderate TBI (≤1 year: OR, 2.34; 95% CrI, 0.78-5.47; >1 year: OR, 3.78; 95% CrI, 0.93-10.33). In contrast, the odds for ADHD following severe TBI were increased at both time points following TBI compared with children with other injuries (≤1 year: OR, 4.81; 95% CrI, 1.66-11.03; >1 year: OR, 6.70; 95% CrI, 2.02-16.82) and noninjured controls (≤1 year: OR, 2.62; 95% CrI, 0.76-6.64; >1 year: OR, 6.25; 95% CrI, 2.06-15.06), as well as those with mild TBI (≤1 year OR, 5.69; 1.46-15.67: >1 year OR, 6.65; 2.14-16.44). Of 5920 children with severe TBI, 35.5% (95% CrI, 20.6%-53.2%) had ADHD more than 1 year postinjury. CONCLUSIONS AND RELEVANCE This study noted a significant association between TBI severity and ADHD diagnosis. In children with severe but not mild and moderate TBI, there was an association with an increase in risk for ADHD. The high rate of preinjury ADHD in children with TBI suggests that clinicians should carefully review functioning before a TBI before initiating treatment.
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Affiliation(s)
- Robert F. Asarnow
- Department of Psychiatry, University of California, Los Angeles,Department of Psychology, University of California, Los Angeles,Brain Research Institute, University of California, Los Angeles
| | - Nina Newman
- School of Psychology, Fielding Graduate University, Playa Vista, California
| | - Robert E. Weiss
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California
| | - Erica Su
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California
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Behavior Problems Following Childhood TBI: The Role of Sex, Age, and Time Since Injury. J Head Trauma Rehabil 2021; 35:E393-E404. [PMID: 32108717 DOI: 10.1097/htr.0000000000000567] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the frequency of behavioral problems after childhood traumatic brain injury (TBI) and their associations with injury severity, sex, and social environmental factors. SETTING Children's hospitals in the Midwestern/Western United States. PARTICIPANTS 381 boys and 210 girls with moderate (n = 359) and severe (n = 227) TBI, with an average age at injury of 11.7 years (range 0.3-18) who were injured ≤3 years ago. DESIGN Secondary data analysis of a multistudy cohort. MAIN MEASURES Child Behavior Checklist (CBCL) administered pretreatment. RESULTS Thirty-seven percent had borderline/clinical elevations on the CBCL Total Problem Scale, with comparable rates of Internalizing and Externalizing problems (33% and 31%, respectively). Less parental education was associated with higher rates of internalizing, externalizing, and total problems. Time since injury had a linear association with internalizing symptoms, with greater symptoms at longer postinjury intervals. Younger boys had significantly higher levels of oppositional defiant symptoms than girls, whereas older girls had significantly greater attention-deficit hyperactivity disorder symptoms than boys. CONCLUSIONS Pediatric TBI is associated with high rates of behavior problems, with lower socioeconomic status predicting substantially elevated risk. Associations of higher levels of internalizing symptoms with greater time since injury highlight the importance of tracking children over time.
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Traumatic brain injury in adolescence: A review of the neurobiological and behavioural underpinnings and outcomes. DEVELOPMENTAL REVIEW 2021. [DOI: 10.1016/j.dr.2020.100943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Cámara Barrio S, Esteso Orduña B, Vara Arias MT, Rodríguez Palero S, Fournier Del Castillo MC. A neuropsychological approach in a paediatric acquired brain injury unit under the public health system. Neurologia 2020; 38:S0213-4853(20)30127-4. [PMID: 32586695 DOI: 10.1016/j.nrl.2020.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 03/06/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Paediatric acquired brain injury (ABI) causes cognitive and behavioural difficulties and alters the course of child development. The ABI unit at Hospital Infantil Universitario Niño Jesús is the first within the public Spanish health system to provide comprehensive coverage to these patients and their families. OBJECTIVE This study aims to show the working methodology followed with patients and their families, and to describe the clinical characteristics of the patients treated and the outcomes of treatment. PATIENTS Fifty-three patients aged between three months and 16 and a half years received treatment. The conditions treated were brain tumours, stroke, traumatic brain injury, damage secondary to epilepsy surgery, and hypoxia. METHODS All patients were evaluated at admission and at discharge. Treatments were adapted to each patient's difficulties and their severity, as well as to the patient's age. Families received individual and group therapy. RESULTS Older age was associated with better cognitive recovery and shorter duration of treatment. Different conditions show differential impact on intelligence quotient and developmental quotient scores at the beginning of treatment, with hypoxia and encephalitis being associated with greatest severity. Intelligence quotient and developmental quotient scores and visual memory and attention scores at discharge improved significantly after the faceted neuropsychological treatment with respect to scores registered at admission. CONCLUSIONS The care of patients with ABI should include neuropsychological rehabilitation programmes and provide emotional support to the family so that they may actively participate in the recovery of the child or adolescent.
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Affiliation(s)
- S Cámara Barrio
- Unidad de Daño Cerebral Adquirido, Unidad de Neuropsicología Clínica, Servicio de Psiquiatría y Psicología, Hospital Universitario Niño Jesús, Madrid, España.
| | - B Esteso Orduña
- Unidad de Daño Cerebral Adquirido, Unidad de Neuropsicología Clínica, Servicio de Psiquiatría y Psicología, Hospital Universitario Niño Jesús, Madrid, España
| | - M T Vara Arias
- Unidad de Daño Cerebral Adquirido, Servicio de Rehabilitación, Hospital Universitario Niño Jesús, Madrid, España
| | - S Rodríguez Palero
- Unidad de Daño Cerebral Adquirido, Servicio de Rehabilitación, Hospital Universitario Niño Jesús, Madrid, España
| | - M C Fournier Del Castillo
- Unidad de Neuropsicología Clínica, Servicio de Psiquiatría y Psicología, Hospital Universitario Niño Jesús, Madrid, España
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10
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Parbhoo P. Biopsychosocial outcome indicators in traumatic brain injuries. NeuroRehabilitation 2020; 46:157-166. [PMID: 32083600 DOI: 10.3233/nre-192969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) remains a silent and global epidemic which creates an aftermath of convoluted dynamics. Despite significant incidence rates and increasing awareness over the long-term catastrophic implications, there remain marked contrasts between acute vs. post-acute rehabilitation processes in the United States. OBJECTIVE To explore existing research and highlight the complexity of TBIs to inform vital changes needed to reduce the significant differences and inconsistencies across post-acute treatment settings. To highlight how psychologists/neuropsychologists and other rehabilitation professionals maintain a prominent operational presence in post-acute settings resulting in key leadership opportunities to support a more efficient longitudinal continuation of care model. METHODS Literature search of various health science databases was completed for articles between 1987 to 2019 to explore the range and depth of post-acute treatment, model, and outcomes research. RESULTS Despite progressive medical advancements, translation of relevant rehabilitation research and practices into post-acute treatment settings remains inconsistent. CONCLUSIONS Significant barriers remain for objective and comprehensive evaluation(s) of post-acute program quality and purported patient outcomes in the United States. There remains a lack of consensually relevant and objective metrics. Further investigation is recommended for: consensus on longitudinal post-acute brain injury outcome measures; functional relevance of program accreditations/certifications; outcome differences based on team composition and program resources; and patient/stakeholder variables/input to support optimal post-acute service access and delivery.
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Affiliation(s)
- Pritesh Parbhoo
- NeuroInternational Healthcare, LLC, 1876 Barber Rd, Building A, Sarasota, FL 34240, USA. Tel.: +1 (813) 401 6728; E-mail:
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11
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Dolanbay T, Gül HF, Şimşek AT, Aras M. Severe Traumatic Brain Injury Cases among Children Younger than 24 Months. Pediatr Neurosurg 2020; 55:12-16. [PMID: 32062658 DOI: 10.1159/000505935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/12/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Accidental head injuries are known to cause serious traumatic brain injury (TBI). Children younger than 2 years of age build a separate group that is more difficult to assess clinically. Investigations targeting TBIs in pediatric cases, particularly in those between 0 and 2 years of age, are limited. OBJECTIVE In this study, we reviewed a number of severe accidental head injuries in a cohort of children aged 0-2 years to evaluate the relative incidence, distribution, and clinical success in determining the nature of the cases in the Kars Province of Turkey. METHODS The study targeted 26 -cases who presented to the Emergency Department of Kars Harakani Hospital for TBI between 2017 and 2019 through retrospective chart review. RESULTS AND CONCLUSIONS Among the children who presented to the emergency clinic, 2 were newborns, 7 were <1 year of age, and the remaining 17 cases were between 1 and 2 years old. The number of male and female patients was equal, and 5 fatality cases were observed. The most frequent cause of head trauma were falls. We deduced that 6 cases had subarachnoid hemorrhage, 2 cases had subdural hemorrhage, 3 cases had epidural hemorrhage, and 4 cases had contusion. We compared the mean level of the two blood parameters hemoglobin (HGB) and hematocrit (HCT) between fatal and surviving cases and detectedthat both values decreased dramatically in exitus cases. The higher fatality rate in the present study could be attributed to the fact that we targeted only the severe TBI cases. Severe TBI in children younger than 2 years results in a life-threating situation. The risk of fatality might be deduced from the reduction of the HGB and HCT levels as it is significantly lower in fatal cases than in surviving cases.
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Affiliation(s)
- Turgut Dolanbay
- Department of Medical Emergency, Kafkas University Medical School, Kars, Turkey,
| | - Hüseyin Fatih Gül
- Department of Medical Emergency, Kafkas University Medical School, Kars, Turkey
| | | | - Murat Aras
- Department of Medical Emergency, Kafkas University Medical School, Kars, Turkey
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12
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Effects of Web-Based Parent Training on Caregiver Functioning Following Pediatric Traumatic Brain Injury: A Randomized Control Trial. J Head Trauma Rehabil 2019; 33:E19-E29. [PMID: 29601344 DOI: 10.1097/htr.0000000000000388] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effects of a Web-based parenting intervention (I-InTERACT), and an abbreviated version (Express), on caregiver depression, psychological distress, parenting stress, and parenting efficacy following pediatric traumatic brain injury (TBI). SETTING Four children's hospitals and 1 general hospital in the United States. PARTICIPANTS 148 caregivers of 113 children aged 3 to 9 years with a moderate to severe TBI. DESIGN Multicenter randomized controlled trial. Participants were randomly assigned to I-InTERACT, Express, or an active control condition. Caregiver data were collected at baseline and postintervention (6 months later). INTERVENTION I-InTERACT (10-14 sessions) and Express (7 sessions) combine live coaching of parenting skills and positive parenting strategies. MAIN MEASURES Center for Epidemiologic Studies Depression Scale (CES-D); Global Severity Index of the Symptom Checklist-90-R (GSI), Parenting Stress Index (PSI), and Caregiver Self-Efficacy Scale (CSES). RESULTS Analyses revealed no main effects of treatment on caregiver distress (GSI), parenting stress (PSI), or parenting efficacy (CSES). However, analyses examining baseline severity as a moderator found that caregivers with elevated levels of depression in I-InTERACT experienced significantly greater reductions in CES-D scores compared with caregivers in the active control condition. CONCLUSIONS I-InTERACT reduced caregiver depression but no other facets of caregiver psychological functioning. Modifications to the treatment content may be necessary to reduce parenting stress and improve caregiver efficacy.
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Recovery Trajectories of Child and Family Outcomes Following Online Family Problem-Solving Therapy for Children and Adolescents after Traumatic Brain Injury. J Int Neuropsychol Soc 2019; 25:941-949. [PMID: 31405391 PMCID: PMC6939303 DOI: 10.1017/s1355617719000778] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We conducted joint analyses from five randomized clinical trials (RCTs) of online family problem-solving therapy (OFPST) for children with traumatic brain injury (TBI) to identify child and parent outcomes most sensitive to OFPST and trajectories of recovery over time. METHODS We examined data from 359 children with complicated mild to severe TBI, aged 5-18, randomized to OFPST or a control condition. Using profile analyses, we examined group differences on parent-reported child (internalizing and externalizing behavior problems, executive function behaviors, social competence) and family outcomes (parental depression, psychological distress, family functioning, parent-child conflict). RESULTS We found a main effect for measure for both child and family outcomes [F(3, 731) = 7.35, p < .001; F(3, 532) = 4.79, p = .003, respectively], reflecting differing degrees of improvement across measures for both groups. Significant group-by-time interactions indicated that children and families in the OFPST group had fewer problems than controls at both 6 and 18 months post baseline [t(731) = -5.15, p < .001, and t(731) = -3.90, p = .002, respectively, for child outcomes; t(532) = -4.81, p < .001, and t(532) = -3.80, p < .001, respectively, for family outcomes]. CONCLUSIONS The results suggest limited differences in the measures' responsiveness to treatment while highlighting OFPST's utility in improving both child behavior problems and parent/family functioning. Group differences were greatest at treatment completion and after extended time post treatment.
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Ng R, Lai P, Brown TT, Järvinen A, Halgren E, Bellugi U, Trauner D. Neuroanatomical correlates of emotion-processing in children with unilateral brain lesion: A preliminary study of limbic system organization. Soc Neurosci 2018; 13:688-700. [PMID: 28990866 PMCID: PMC6117211 DOI: 10.1080/17470919.2017.1386126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 08/12/2017] [Indexed: 12/27/2022]
Abstract
In this study, MRI and DTI were employed to examine subcortical volume and microstructural properties (FA, MD) of the limbic network, and their relationships with affect discrimination in 13 FL (6 right FL, M = 10.17 years; 7 left FL; M = 10.09) and 13 typically-developing children (TD; M = 10.16). Subcortical volume of the amygdala, hippocampus and thalamus and FA and MD of the fornix and anterior thalamic radiation (ATR) were examined. Results revealed no group differences across emotion-perception tasks or amygdalar volume. However, contrasting neuroanatomical patterns were observed in right versus left FL youth. Right FL participants showed increased left hippocampal and thalamic volume relative to left FL participants; whereas, the latter group showed increased right thalamic volume. DTI findings also indicated right FL children show greater MD of right fornix than other groups, whereas, left FL youth showed greater MD of left fornix. Right FL youth also showed lower FA of right fornix than left FL children, whereby the latter showed greater FA of left fornix and ATR. Differential associations between DTI indices and auditory/visual emotion-perception were observed across FL groups. Findings indicate diverging brain-behavioral relationships for emotion-perception among right and left FL children.
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Affiliation(s)
- Rowena Ng
- Laboratory for Cognitive Neuroscience; Salk Institute for Biological Studies, 10010 N. Torrey Pines Rd., La Jolla, CA, 92037
- Institute of Child Development; University of Minnesota, Twin Cities, 51 East River Road, Minneapolis, MN, 55455
| | - Philip Lai
- San Diego State University/University of California, San Diego Joint Doctoral Program in Language and Communicative Disorders, 6330 Alvarado Court #208, San Diego, CA 92120
| | - Timothy T. Brown
- Center for Multimodal Imaging and Genomics; University of California San Diego, 8950 Villa La Jolla Drive, Suite C101, La Jolla, CA 92037
- Department of Radiology; University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 93094
| | - Anna Järvinen
- Laboratory for Cognitive Neuroscience; Salk Institute for Biological Studies, 10010 N. Torrey Pines Rd., La Jolla, CA, 92037
| | - Eric Halgren
- Center for Multimodal Imaging and Genomics; University of California San Diego, 8950 Villa La Jolla Drive, Suite C101, La Jolla, CA 92037
- Department of Radiology; University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 93094
| | - Ursula Bellugi
- Laboratory for Cognitive Neuroscience; Salk Institute for Biological Studies, 10010 N. Torrey Pines Rd., La Jolla, CA, 92037
| | - Doris Trauner
- Department of Neurosciences; University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 93094
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15
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Relevance of neuroimaging for neurocognitive and behavioral outcome after pediatric traumatic brain injury. Brain Imaging Behav 2018; 12:29-43. [PMID: 28092022 PMCID: PMC5814510 DOI: 10.1007/s11682-017-9673-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study aims to (1) investigate the neuropathology of mild to severe pediatric TBI and (2) elucidate the predictive value of conventional and innovative neuroimaging for functional outcome. Children aged 8–14 years with trauma control (TC) injury (n = 27) were compared to children with mild TBI and risk factors for complicated TBI (mildRF+, n = 20) or moderate/severe TBI (n = 17) at 2.8 years post-injury. Neuroimaging measures included: acute computed tomography (CT), volumetric analysis on post-acute conventional T1-weighted magnetic resonance imaging (MRI) and post-acute diffusion tensor imaging (DTI, analyzed using tract-based spatial statistics and voxel-wise regression). Functional outcome was measured using Common Data Elements for neurocognitive and behavioral functioning. The results show that intracranial pathology on acute CT-scans was more prevalent after moderate/severe TBI (65%) than after mildRF+ TBI (35%; p = .035), while both groups had decreased white matter volume on conventional MRI (ps ≤ .029, ds ≥ −0.74). The moderate/severe TBI group further showed decreased fractional anisotropy (FA) in a widespread cluster affecting all white matter tracts, in which regional associations with neurocognitive functioning were observed (FSIQ, Digit Span and RAVLT Encoding) that consistently involved the corpus callosum. FA had superior predictive value for functional outcome (i.e. intelligence, attention and working memory, encoding in verbal memory and internalizing problems) relative to acute CT-scanning (i.e. internalizing problems) and conventional MRI (no predictive value). We conclude that children with mildRF+ TBI and moderate/severe TBI are at risk of persistent white matter abnormality. Furthermore, DTI has superior predictive value for neurocognitive out-come relative to conventional neuroimaging.
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Morse AM, Garner DR. Traumatic Brain Injury, Sleep Disorders, and Psychiatric Disorders: An Underrecognized Relationship. Med Sci (Basel) 2018; 6:E15. [PMID: 29462866 PMCID: PMC5872172 DOI: 10.3390/medsci6010015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 12/28/2022] Open
Abstract
Traumatic brain injury (TBI) is commonplace among pediatric patients and has a complex, but intimate relationship with psychiatric disease and disordered sleep. Understanding the factors that influence the risk for the development of TBI in pediatrics is a critical component of beginning to address the consequences of TBI. Features that may increase risk for experiencing TBI sometimes overlap with factors that influence the development of post-concussive syndrome (PCS) and recovery course. Post-concussive syndrome includes physical, psychological, cognitive and sleep-wake dysfunction. The comorbid presence of sleep-wake dysfunction and psychiatric symptoms can lead to a more protracted recovery and deleterious outcomes. Therefore, a multidisciplinary evaluation following TBI is necessary. Treatment is generally symptom specific and mainly based on adult studies. Further research is necessary to enhance diagnostic and therapeutic approaches, as well as improve the understanding of contributing pathophysiology for the shared development of psychiatric disease and sleep-wake dysfunction following TBI.
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Affiliation(s)
- Anne M Morse
- Janet Weis Children's Hospital, Department of Pediatric Neurology and Sleep Medicine, Geisinger Medical Center, MC 14-12, 100 N Academy Blvd, Danville, PA 17822, USA.
| | - David R Garner
- Department of Pediatrics, Geisinger Medical Center, Danville, PA 17822, USA.
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Doser K, Poulsen I, Wuensch A, Norup A. Psychological outcome after severe traumatic brain injury in adolescents and young adults: The chronic phase. Brain Inj 2017; 32:64-71. [PMID: 29156990 DOI: 10.1080/02699052.2017.1363408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Young individuals surviving severe traumatic brain injury (TBI) frequently experience a wide range of cognitive, emotional and behavioural consequences. This cross-sectional follow-up study investigated psychological outcome of young survivors in the chronic phase, and whether psychological outcome was associated with improvement of functional abilities during sub-acute admission. METHODS Patients, who acquired a severe TBI during adolescence or early adulthood (n = 36) and received early intensive rehabilitation, were contacted for follow-up assessment concerning psychological outcome and completed the Adult Self Report 18-59 (ASR18-59). Demographic data, functional outcomes and severity measures were obtained from the local database. RESULTS The participants had a mean age of 24.1 years (SD = 4.1) at follow-up, and the mean time since injury was 72.1 months (SD = 44.2). Results showed significantly higher scores compared with the normative reference population in relation to the subscales withdrawal/isolation (p = 0.013), attention problems (p = 0.008) and intrusive behaviour (p = 0.046). Pearson correlation analyses showed that young survivors experiencing more functional improvement during inpatient rehabilitation had fewer psychological problems during the chronic phase in the subscales: withdrawal/isolation, rule breaking, intrusive behaviour and total problems. CONCLUSION Young patients reported psychological problems in several areas during the chronic phase of injury, which may hinder complete reintegration and participation in society. Larger functional improvement during sub-acute rehabilitation seemed to be associated with less psychological problems in the chronic phase.
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Affiliation(s)
- Karoline Doser
- a Survivorship Unit , Danish Cancer Society Research Center , Copenhagen , Denmark.,b Department of Clinical Pedagogic and Therapeutic Studies , Catholic University of Applied Sciences , Freiburg , Germany.,c Department of Neurorehabilitation, Traumatic Brain Injury , Research Unit on Brain Injury Rehabilitation Copenhagen, (RUBRIC) Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - Ingrid Poulsen
- c Department of Neurorehabilitation, Traumatic Brain Injury , Research Unit on Brain Injury Rehabilitation Copenhagen, (RUBRIC) Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - Alexander Wuensch
- d Department of Psychosomatic Medicine and Psychotherapy, Medical Center , University of Freiburg, Faculty of Medicine , Freiburg , Germany
| | - Anne Norup
- e Department of Neurology, National Study of Young Brain Injury Survivors , Rigshospitalet, Copenhagen University Hospital , Glostrup , Denmark
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18
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Königs M, van Heurn LWE, Bakx R, Vermeulen RJ, Goslings JC, Poll-The BT, van der Wees M, Catsman-Berrevoets CE, Oosterlaan J, Pouwels PJW. The structural connectome of children with traumatic brain injury. Hum Brain Mapp 2017; 38:3603-3614. [PMID: 28429381 DOI: 10.1002/hbm.23614] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 01/24/2017] [Accepted: 04/06/2017] [Indexed: 01/02/2023] Open
Abstract
This study aimed to investigate the impact of mild to severe pediatric TBI on the structural connectome. Children aged 8-14 years with trauma control (TC) injury (n = 27) were compared to children with mild TBI and risk factors for complicated TBI (mildRF+ , n = 20) or moderate/severe TBI (n = 16) at 2.8 years post-injury. Probabilistic tractography on diffusion tensor imaging data was used in combination with graph theory to study structural connectivity. Functional outcome was measured using neurocognitive tests and parent and teacher questionnaires for behavioral functioning. The results revealed no evidence for an impact of mildRF+ TBI on the structural connectome. In contrast, the moderate/severe TBI group showed longer characteristic path length (P = 0.022, d = 0.82) than the TC group. Furthermore, longer characteristic path length was related to poorer intelligence and poorer working memory in children with TBI. In conclusion, children have abnormal organization of the structural connectome after moderate/severe TBI, which may be implicated in neurocognitive dysfunction associated with pediatric TBI. These findings should be interpreted in the context of our exploratory analyses, which indicate that the definition and weighting of connectivity (e.g., streamline density, fractional anisotropy) influence the properties of the reconstructed connectome and its sensitivity to the impact and outcome of pediatric TBI. Hum Brain Mapp 38:3603-3614, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Marsh Königs
- Clinical Neuropsychology Section, VU University Amsterdam, Amsterdam, The Netherlands.,Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - L W Ernest van Heurn
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital Academic Medical Center and VU University Medical Center, Amsterdam, The Netherlands
| | - Roel Bakx
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital Academic Medical Center and VU University Medical Center, Amsterdam, The Netherlands
| | - R Jeroen Vermeulen
- Department of Pediatric Neurology, VU University Medical Center, Amsterdam, The Netherlands.,Department of Pediatric Neurology, Maastricht UMC+, Maastricht, The Netherlands
| | - J Carel Goslings
- Trauma Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - Bwee Tien Poll-The
- Department of Pediatric Neurology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - Marleen van der Wees
- Libra Rehabilitation Medicine and Audiology, 'Blixembosch', Eindhoven, The Netherlands
| | - Coriene E Catsman-Berrevoets
- Department of Pediatric Neurology, Erasmus University Hospital/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jaap Oosterlaan
- Clinical Neuropsychology Section, VU University Amsterdam, Amsterdam, The Netherlands.,Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.,Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Petra J W Pouwels
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands.,Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
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Tlustos SJ, Kirkwood MW, Taylor HG, Stancin T, Brown TM, Wade SL. A randomized problem-solving trial for adolescent brain injury: Changes in social competence. Rehabil Psychol 2016; 61:347-357. [PMID: 27831729 PMCID: PMC5113734 DOI: 10.1037/rep0000098] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE Traumatic brain injury (TBI) in adolescence has well documented effects on social competence. Few studies have examined the effects of behavioral interventions on social competence or identified factors associated with changes in social competence after injury. Research Method/Design: Adolescents with moderate to severe TBI ages 12-17 years were randomized within 6 months of injury to either a problem solving and communication (CAPS) group that received online counseling (n = 65) or an Internet resources comparison (IRC) group (n = 67) for a comparative effectiveness trial. Parent-report measures of social competence (Child Behavior Checklist, CBCL; Home and Community Social Behavior Scales, HCSBS; Behavioral and Emotional Rating Scale, BERS-2) were administered at baseline (preintervention) and approximately 6 months later. Analyses examined these measures in relation to treatment group, TBI severity, and age. Regression analyses were also conducted to examine baseline measures of cognition as predictors of social competence after TBI. RESULTS CAPS had a more positive effect than the comparison condition on the HCSBS and BERS-2 for younger teens with moderate TBI and older teens with severe TBI. More parent-rated executive dysfunction at baseline was related to both lower concurrent levels of social competence and less positive gains in competence over time, whereas higher baseline IQ predicted greater gains in competence. CONCLUSIONS/IMPLICATIONS CAPS may be effective for improving social competence for teens after TBI, with benefits dependent on the teen's age and injury severity. Parent-rated executive dysfunction, moreover, has utility in predicting both lower concurrent levels of social competence and subsequent postinjury gains in competence. (PsycINFO Database Record
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Affiliation(s)
- Sarah J Tlustos
- Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado
| | - Michael W Kirkwood
- Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado
| | - H Gerry Taylor
- Division of Developmental and Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University
| | - Terry Stancin
- Division of Pediatric Psychology, Department of Pediatrics, MetroHealth Medical Center
| | | | - Shari L Wade
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center
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Abstract
AbstractObjectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.
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Emery CA, Barlow KM, Brooks BL, Max JE, Villavicencio-Requis A, Gnanakumar V, Robertson HL, Schneider K, Yeates KO. A Systematic Review of Psychiatric, Psychological, and Behavioural Outcomes following Mild Traumatic Brain Injury in Children and Adolescents. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:259-69. [PMID: 27254800 PMCID: PMC4841286 DOI: 10.1177/0706743716643741] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence regarding longer-term psychiatric, psychological, and behavioural outcomes (for example, anxiety, mood disorders, depression, and attention disorders) following mild traumatic brain injury (mTBI) in children and adolescents has not been previously synthesized. OBJECTIVE To conduct a systematic review of the available evidence examining psychiatric, psychological, and behavioural outcomes following mTBI in children and adolescents. MATERIALS AND METHODS Nine electronic databases were systematically searched from 1980 to August 2014. Studies selected met the following criteria: original data; study design was a randomized controlled trial, quasi-experimental design, cohort or historical cohort study, case-control study, or cross-sectional study; exposure included mTBI (including concussion); population included children and adolescents (<19 years) at the time of mTBI, as well as a comparison group (for example, healthy children, children with orthopaedic injuries); and included psychiatric, psychological, or behavioural outcomes (for example, anxiety, mood disorders, depression, attention disorders). Two authors independently assessed the quality and level of evidence with the Downs and Black (DB) criteria and Oxford Centre of Evidence-Based Medicine (OCEBM) model, respectively, for each manuscript. RESULTS Of 9472 studies identified in the initial search, 30 were included and scored. Heterogeneity in methodology and injury definition precluded meta-analyses. The median methodological quality for all 30 studies, based on the DB criteria, was 15/33 (range 6 to 19). The highest level of evidence demonstrated by all reviewed studies was level 2b based on OCEBM criteria, with the majority (28/30 studies) classified at this level. Based on the literature included in this systematic review, psychological and psychiatric problems in children with a history of mTBI were found to be more prevalent when mTBI is associated with hospitalization, when assessment occurs earlier in the recovery period (that is, resolves over time), when there are multiple previous mTBIs, in individuals with preexisting psychiatric illness, when outcomes are based on retrospective recall, and when the comparison group is noninjured healthy children (as opposed to children with injuries not involving the head). CONCLUSIONS Overall, few rigorous prospective studies have examined psychological, behavioural, and psychiatric outcomes following mTBI. In the absence of true reports of preinjury problems and when ideally comparing mild TBI to non-TBI injured controls, there is little evidence to suggest that psychological, behavioural, and/or psychiatric problems persist beyond the acute and subacute period following an mTBI in children and adolescents.
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Affiliation(s)
- Carolyn A Emery
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen M Barlow
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey E Max
- Rady Children's Hospital, San Diego, California, USA Neuropsychiatric Research, Department of Psychiatry, University of California, San Diego, California, USA
| | - Angela Villavicencio-Requis
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vithya Gnanakumar
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Kathryn Schneider
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Königs M, van Heurn LWE, Vermeulen RJ, Goslings JC, Luitse JSK, Poll-Thé BT, Beelen A, van der Wees M, Kemps RJJK, Catsman-Berrevoets CE, Luman M, Oosterlaan J. Feedback learning and behavior problems after pediatric traumatic brain injury. Psychol Med 2016; 46:1473-1484. [PMID: 26951460 DOI: 10.1017/s0033291716000106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Feedback learning is essential for behavioral development. We investigated feedback learning in relation to behavior problems after pediatric traumatic brain injury (TBI). METHOD Children aged 6-13 years diagnosed with TBI (n = 112; 1.7 years post-injury) were compared with children with traumatic control (TC) injury (n = 52). TBI severity was defined as mild TBI without risk factors for complicated TBI (mildRF- TBI, n = 24), mild TBI with ⩾1 risk factor for complicated TBI (mildRF+ TBI, n = 51) and moderate/severe TBI (n = 37). The Probabilistic Learning Test was used to measure feedback learning, assessing the effects of inconsistent feedback on learning and generalization of learning from the learning context to novel contexts. The relation between feedback learning and behavioral functioning rated by parents and teachers was explored. RESULTS No evidence was found for an effect of TBI on learning from inconsistent feedback, while the moderate/severe TBI group showed impaired generalization of learning from the learning context to novel contexts (p = 0.03, d = -0.51). Furthermore, the mildRF+ TBI and moderate/severe TBI groups had higher parent and teacher ratings of internalizing problems (p's ⩽ 0.04, d's ⩾ 0.47) than the TC group, while the moderate/severe TBI group also had higher parent ratings of externalizing problems (p = 0.006, d = 0.58). Importantly, poorer generalization of learning predicted higher parent ratings of externalizing problems in children with TBI (p = 0.03, β = -0.21) and had diagnostic utility for the identification of children with TBI and clinically significant externalizing behavior problems (area under the curve = 0.77, p = 0.001). CONCLUSIONS Moderate/severe pediatric TBI has a negative impact on generalization of learning, which may contribute to post-injury externalizing problems.
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Affiliation(s)
- M Königs
- Department of Clinical Neuropsychology,VU University Amsterdam,Amsterdam,The Netherlands
| | - L W E van Heurn
- Pediatric Surgical Center of Amsterdam,Emma Children's Hospital Academic Medical Center and VU University Medical Center,Amsterdam,The Netherlands
| | - R J Vermeulen
- Department of Pediatric Neurology,VU University Medical Center,Amsterdam,The Netherlands
| | - J C Goslings
- Trauma Unit,Academic Medical Center,Amsterdam,The Netherlands
| | - J S K Luitse
- Department of Emergency Medicine,Academic Medical Center,Amsterdam,The Netherlands
| | - B T Poll-Thé
- Department of Pediatric Neurology,Emma Children's Hospital Academic Medical Center,Amsterdam,The Netherlands
| | - A Beelen
- Department of Rehabilitation,Academic Medical Center,Amsterdam,The Netherlands
| | - M van der Wees
- Libra Rehabilitation Center 'Blixembosch',Eindhoven,The Netherlands
| | - R J J K Kemps
- Libra Rehabilitation Center 'Leijpark',Tilburg,The Netherlands
| | | | - M Luman
- Department of Clinical Neuropsychology,VU University Amsterdam,Amsterdam,The Netherlands
| | - J Oosterlaan
- Department of Clinical Neuropsychology,VU University Amsterdam,Amsterdam,The Netherlands
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23
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Königs M, Weeda WD, van Heurn LWE, Vermeulen RJ, Goslings JC, Luitse JSK, Poll-Thé BT, Beelen A, van der Wees M, Kemps RJJK, Catsman-Berrevoets CE, Oosterlaan J. Impaired Visual Integration in Children with Traumatic Brain Injury: An Observational Study. PLoS One 2015; 10:e0144395. [PMID: 26637182 PMCID: PMC4670090 DOI: 10.1371/journal.pone.0144395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/17/2015] [Indexed: 01/25/2023] Open
Abstract
Background Axonal injury after traumatic brain injury (TBI) may cause impaired sensory integration. We aim to determine the effects of childhood TBI on visual integration in relation to general neurocognitive functioning. Methods We compared children aged 6–13 diagnosed with TBI (n = 103; M = 1.7 years post-injury) to children with traumatic control (TC) injury (n = 44). Three TBI severity groups were distinguished: mild TBI without risk factors for complicated TBI (mildRF- TBI, n = 22), mild TBI with ≥1 risk factor (mildRF+ TBI, n = 46) or moderate/severe TBI (n = 35). An experimental paradigm measured speed and accuracy of goal-directed behavior depending on: (1) visual identification; (2) visual localization; or (3) both, measuring visual integration. Group-differences on reaction time (RT) or accuracy were tracked down to task strategy, visual processing efficiency and extra-decisional processes (e.g. response execution) using diffusion model analysis. General neurocognitive functioning was measured by a Wechsler Intelligence Scale short form. Results The TBI group had poorer accuracy of visual identification and visual integration than the TC group (Ps ≤ .03; ds ≤ -0.40). Analyses differentiating TBI severity revealed that visual identification accuracy was impaired in the moderate/severe TBI group (P = .05, d = -0.50) and that visual integration accuracy was impaired in the mildRF+ TBI group and moderate/severe TBI group (Ps < .02, ds ≤ -0.56). Diffusion model analyses tracked impaired visual integration accuracy down to lower visual integration efficiency in the mildRF+ TBI group and moderate/severe TBI group (Ps < .001, ds ≤ -0.73). Importantly, intelligence impairments observed in the TBI group (P = .009, d = -0.48) were statistically explained by visual integration efficiency (P = .002). Conclusions Children with mildRF+ TBI or moderate/severe TBI have impaired visual integration efficiency, which may contribute to poorer general neurocognitive functioning.
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Affiliation(s)
- Marsh Königs
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Wouter D. Weeda
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
- Department of Methods, VU University Amsterdam, Amsterdam, The Netherlands
- Institute of Psychology, Department of Methodology and Statistics, Leiden University, Leiden, The Netherlands
| | - L. W. Ernest van Heurn
- Pediatric Surgical Center of Amsterdam, Emma Children’s Hospital Academic Medical Center and VU University Medical Center, Amsterdam, The Netherlands
| | - R. Jeroen Vermeulen
- Department of Pediatric Neurology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Pediatric Neurology, Maastricht University, Medical Center, Maastricht, The Netherlands
| | | | - Jan S. K. Luitse
- Department of Emergency Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Bwee Tien Poll-Thé
- Department of Pediatric Neurology, Emma Children’s Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - Anita Beelen
- Merem Rehabilitation Center ‘De Trappenberg’, Huizen, The Netherlands
- Department of Rehabilitation, Academic Medical Center, Amsterdam, The Netherlands
| | - Marleen van der Wees
- Libra Rehabilitation Medicine and Audiology, ‘Blixembosch’, Eindhoven, The Netherlands
| | | | | | - Jaap Oosterlaan
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
- Emma Children’s Hospital Academic Medical Center, Amsterdam, the Netherlands
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Van Patten R, Keith C, Bertolin M, Wright JD. The effect of premorbid attention-deficit/hyperactivity disorder on neuropsychological functioning in individuals with acute mild traumatic brain injuries. J Clin Exp Neuropsychol 2015; 38:12-22. [PMID: 26588804 DOI: 10.1080/13803395.2015.1091064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Mild traumatic brain injury (mTBI) is a frequent, yet undertreated condition that typically manifests with transient neurological and cognitive symptoms that resolve over the course of several weeks. In contrast, attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that presents initially in childhood but often persists into adulthood. mTBI and ADHD include overlapping symptomatology, making it difficult for clinicians to disentangle the sequelae of each condition when they co-occur in the same individual. We hypothesized that neuropsychological tests would be sensitive to preexisting ADHD in inpatients with acute mTBIs. METHOD We retrospectively examined the medical charts of 100 inpatients, aged 18-40 years (96% Caucasian; 77% male) with mTBIs in an acute care setting, half of whom had self-reported the presence of premorbid ADHD, and half of whom were matched controls. We analyzed group differences across neuropsychological tests of attention, processing speed, and executive functions, examined the profile ratings of independent, blinded, board-certified neuropsychologists, and correlated cognitive performance with time from traumatic injury to testing. RESULTS Individuals with premorbid ADHD (a) performed significantly worse than their matched counterparts on several tests of attention, processing speed, and working memory, and (b) were significantly more likely to produce profiles later rated as impaired by independent, board-certified clinical neuropsychologists. In addition, time from traumatic injury to testing was found to be negatively correlated with neurocognitive performance. CONCLUSIONS These findings (a) argue for the utility of a brief assessment of premorbid ADHD in the acute care of individuals with mTBIs and (b) provide clinicians with a barometer for gauging the relative contributions of premorbid ADHD to neuropsychological impairments in the neurocognitive profiles of individuals with mTBIs. Reported effect sizes will assist clinicians in accurately weighing the impact of premorbid ADHD when interpreting such profiles.
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Affiliation(s)
- Ryan Van Patten
- a Department of Psychology , Saint Louis University , Saint Louis , MO , USA.,b Department of Neuroscience , Mercy Hospital in Saint Louis , Saint Louis , MO , USA
| | - Cierra Keith
- a Department of Psychology , Saint Louis University , Saint Louis , MO , USA.,b Department of Neuroscience , Mercy Hospital in Saint Louis , Saint Louis , MO , USA
| | - Madison Bertolin
- a Department of Psychology , Saint Louis University , Saint Louis , MO , USA
| | - John D Wright
- b Department of Neuroscience , Mercy Hospital in Saint Louis , Saint Louis , MO , USA
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Königs M, Heij HA, van der Sluijs JA, Vermeulen RJ, Goslings JC, Luitse JSK, Poll-Thé BT, Beelen A, van der Wees M, Kemps RJJK, Catsman-Berrevoets CE, Oosterlaan J. Pediatric Traumatic Brain Injury and Attention Deficit. Pediatrics 2015; 136:534-41. [PMID: 26240208 DOI: 10.1542/peds.2015-0437] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We investigated the impact of pediatric traumatic brain injury (TBI) on attention, a prerequisite for behavioral and neurocognitive functioning. METHODS Children aged 6 to 13 years who were diagnosed with TBI (n = 113; mean 1.7 years postinjury) were compared with children with a trauma control injury (not involving the head) (n = 53). TBI severity was defined as mild TBI with or without risk factors for complicated TBI (mild(RF+) TBI, n = 52; mild(RF-) TBI, n = 24) or moderate/severe TBI (n = 37). Behavioral functioning was assessed by using parent and teacher questionnaires, and the Attention Network Test assessed alerting, orienting, and executive attention. Ex-Gaussian modeling determined the contribution of extremely slow responses (lapses of attention) to mean reaction time (MRT). RESULTS The TBI group showed higher parent and teacher ratings of attention and internalizing problems, higher parent ratings of externalizing problems, and lower intelligence than the control group (P < .05, d ≥ 0.34). No effect of TBI on alerting, orienting, and executive attention was observed (P ≥ .55). MRT was slower in the TBI group (P = .008, d = 0.45), traced back to increased lapses of attention (P = .002, d = 0.52). The mild(RF-) TBI group was unaffected, whereas the mild(RF+) TBI and moderate/severe TBI groups showed elevated parent ratings of behavior problems, lower intelligence, and increased lapses of attention (P ≤ .03, d ≥ 0.48). Lapses of attention fully explained the negative relation between intelligence and parent-rated attention problems in the TBI group (P = .02). CONCLUSIONS Lapses of attention represent a core attention deficit in children with mild(RF+) TBI (even in the absence of intracranial pathology) or moderate/severe TBI, and relate to daily life problems after pediatric TBI.
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Affiliation(s)
- Marsh Königs
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, Netherlands;
| | - Hugo A Heij
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital Academic Medical Centre and VU University Medical Center, Amsterdam, Netherlands
| | | | - R Jeroen Vermeulen
- Pediatric Neurology, VU University Medical Center, Amsterdam, Netherlands
| | | | | | | | - Anita Beelen
- Merem Rehabilitation Center 'De Trappenberg,' Huizen, Netherlands; Department of Rehabilitation, Academic Medical Centre, Amsterdam Netherlands
| | - Marleen van der Wees
- Libra Rehabilitation Medicine and Audiology 'Blixembosch', Eindhoven, Netherlands
| | - Rachèl J J K Kemps
- Libra Rehabilitation Medicine and Audiology 'Leijpark', Tilburg, Netherlands
| | | | - Jaap Oosterlaan
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, Netherlands; Emma Children's Hospital Academic Medical Centre, Amsterdam. Netherlands
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Max JE, Friedman K, Wilde EA, Bigler ED, Hanten G, Schachar RJ, Saunders AE, Dennis M, Ewing-Cobbs L, Chapman SB, Yang TT, Levin HS. Psychiatric disorders in children and adolescents 24 months after mild traumatic brain injury. J Neuropsychiatry Clin Neurosci 2015; 27:112-20. [PMID: 25923850 PMCID: PMC5007244 DOI: 10.1176/appi.neuropsych.13080190] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study aimed to better understand the occurrence of novel psychiatric disorders (NPDs) in children with mild traumatic brain injury (mTBI) in relation to preinjury variables, injury-related variables, and concurrent neurocognitive outcome. Eighty-seven children aged 5-14 years who had experienced mTBI were studied from consecutive hospital admissions with semistructured psychiatric interviews soon after injury (baseline). Fifty-four children were reassessed 24 months postinjury. Standardized instruments were used to evaluate injury severity, lesion characteristics, preinjury variables (lifetime psychiatric disorder, family psychiatric history, family function, socioeconomic status, psychosocial adversity, adaptive function, and academic function), and finally, postinjury neurocognitive and adaptive function. At 24 months postinjury, NPDs had occurred in 17 of 54 (31%) participants. NPD at 24 months was related to frontal white matter lesions and was associated with estimated preinjury reading, preinjury adaptive function, and concurrent deficits in reading, processing speed, and adaptive function. These findings extend earlier reports that the psychiatric morbidity after mTBI in children is more common than previously thought, and moreover, it is linked to preinjury individual variables and injury characteristics and is associated with postinjury adaptive and neurocognitive functioning.
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T. Woods D, Catroppa C, Godfrey C, Giallo R, Matthews J, A. Anderson V. Challenging behaviours following paediatric acquired brain injury (ABI): the clinical utility for a manualised behavioural intervention programme. ACTA ACUST UNITED AC 2014. [DOI: 10.1108/scn-03-2013-0006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Children with acquired brain injury (ABI) are at significant risk of serious behavioural and social difficulties. The burgeoning growth of research documenting behavioural sequelae after paediatric ABI has not been met with a concomitant level of research aimed at treating the problem. The purpose of this paper is to investigate whether a manualised behavioural intervention support programme could reduce challenging behaviours in children with ABI and improve family-parental well-being and functioning.
Design/methodology/approach
– A total of 61 parents (48 mothers and 13 fathers) of 48 children aged between three and 12 years with mild, moderate, or severe ABI received an ABI adapted “Signposts for Building Better Behaviour” programme (Hudson et al., 2001) in group-support (GS) or telephone-support (TS) format. Trained “Signposts” practitioners delivered the programme over a five-month period. The programme consisted of nine information booklets, a DVD, and workbook. All families completed pre-intervention and post-intervention evaluations.
Findings
– On an average parents completed 7.92 out of a possible nine intervention sessions (range 7-9). Parents in both TS and GS formats reported significant reductions in challenging child behaviours irrespective of injury severity. They also reported significant reductions in dysfunctional parenting practices, stress and family burden.
Originality/value
– Overall, the current research provides support for Signposts to be used with families of children with ABI in an attempt to ameliorate negative outcomes for family, parent, and child.
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Age at injury, emotional problems and executive functioning in understanding disrupted social relationships following childhood acquired brain injury. ACTA ACUST UNITED AC 2014. [DOI: 10.1108/scn-08-2013-0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Clinically significant childhood acquired brain injury (ABI) is associated with increased risk of emotional and behavioural dysfunction and peer relationship problems. The purpose of this paper is to determine how emotional and peer related problems for children with ABI compare with those of children referred to mental health services, and to identify clinical predictors of peer relationship problems in a heterogeneous sample typical of a specialist community rehabilitation setting.
Design/methodology/approach
– Participants were 51 children with clinically significant ABI (32 traumatic brain injury; 29 male) referred for outpatient neuropsychological rehabilitation. Emotional, behavioural and social outcomes were measured using the Strengths and Difficulties Questionnaire (SDQ), and executive functioning was measured with the Behaviour Rating Inventory of Executive Functions. Correlational analyses were used to explore variables associated with peer relationships. A subgroup (n=27) of children with ABI were compared to an age and sex matched mental health group to determine differences on SDQ subscales.
Findings
– The SDQ profiles of children with clinically significant ABI did not significantly differ from matched children referred to mental health services. Time since injury, peer relationship problems, metacognitive, and behavioural problems correlated with age at injury. These variables and SDQ emotional problems correlated with peer relationship problems. Linear multiple regression analysis indicated that only metacognitive skills remained a significant predictor of peer relationship problems, and metacognitive skills were found to significantly mediate between age at injury and peer relationship problems.
Research limitations/implications
– The study confirms the significant effect of childhood ABI on relationships with peers and mental health, those injured at a younger age faring worst. Within the methodological constraints of this study, the results tentatively suggest that age of injury influences later peer relationships via the mediating role of poor metacognitive skills within a heterogeneous clinical sample.
Originality/value
– This is the first study to examine the roles of emotional, behavioural and executive variables on the effect of age at injury on peer relationship problems in a sample with a wide range of ages and ages of injury.
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Adolescents' internalizing problems following traumatic brain injury are related to parents' psychiatric symptoms. J Head Trauma Rehabil 2014; 28:E1-12. [PMID: 22935574 DOI: 10.1097/htr.0b013e318263f5ba] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A small body of previous research has demonstrated that pediatric traumatic brain injury (TBI) increases risk for internalizing problems, but findings have varied regarding their predictors and correlates. METHODS We examined the level and correlates of internalizing symptoms in 130 teens who had sustained a complicated mild to severe TBI within the past 1 to 6 months. Internalizing problems were measured via both maternal- and paternal-report Child Behavior Checklist. We also measured family functioning, parent psychiatric symptoms, and postinjury teen neurocognitive function. RESULTS Mean parental ratings of internalizing problems were within the normal range. Depending on informant, 22% to 26% of the sample demonstrated clinically elevated internalizing problems. In multiple and binary logistic regression models, only parent psychiatric symptoms consistently provided unique prediction of teen internalizing symptoms. For maternal but not paternal report, female gender was associated with greater internalizing problems. CONCLUSION Parent and teen emotional problems are associated following adolescent TBI. Possible reasons for this relationship, including the effects of TBI on the family unit, are discussed.
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Abstract
Pediatric traumatic brain injury (TBI) is a major public health problem. Psychiatric disorders with onset before the injury are more common than population base rates. Novel (postinjury onset) psychiatric disorders (NPD) are also common and complicate child function after injury. Novel disorders include personality change due to TBI, secondary attention-deficit/hyperactivity disorder, other disruptive behavior disorders, and internalizing disorders. This article reviews preinjury psychiatric disorders as well as biopsychosocial risk factors and treatments for NPD.
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Affiliation(s)
- Jeffrey E. Max
- Department of Psychiatry, University of California, San Diego and Director, Neuropsychiatric Research, Rady Children's Hospital, San Diego 3020 Children's Way, MC 5018, San Diego, CA 92123-4282; Tel: 858 966 5832 x5743; FAX: 858 622 1265;
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Limond J, Adlam AL, Cormack M. A Model for Pediatric Neurocognitive Interventions: Considering the Role of Development and Maturation in Rehabilitation Planning. Clin Neuropsychol 2014; 28:181-98. [DOI: 10.1080/13854046.2013.873083] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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T. Woods D, Catroppa C, Godfrey C, Giallo R, Matthews J, A. Anderson V. A telehealth intervention for families caring for a child with traumatic brain injury (TBI). ACTA ACUST UNITED AC 2014. [DOI: 10.1108/scn-01-2013-0002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to determine the preliminary clinical utility of a telephone-support format of the “Signposts” (Hudson et al., 2003) behavioural intervention programme to be used with a paediatric traumatic brain injury (TBI) population.
Design/methodology/approach
– Nine families caring for a child with moderate or severe TBI, participated in a pilot study of a TBI adapted “Signposts for Building Better Behaviour” manualised programme. The programme is designed to help parents learn positive parenting skills and strategies that empower them to successfully manage their child's challenging behaviour post-TBI. The programme consists of seven core sessions and two supplemental sessions. Parents work through the sessions with an accompaniment of guiding information booklets, a DVD with scenes modelling positive parenting strategies, and a workbook containing written exercises. At the completion of each session parents receive a telephone-support call from a trained Signposts practitioner who provides assistance and feedback on programme content.
Findings
– On average parents completed eight sessions (range seven to nine) and every family completed the seven core sessions. Participation in the telephone-support calls was high with 96 per cent of calls having been successfully received by families. All parents agreed that the telephone calls were a useful part of the programme and felt that the materials were helpful for managing challenging behaviour. Paired-samples t-tests showed significant reductions for challenging behaviour from pre- to post-intervention. Parenting practices also significantly improved over the course of the intervention. In general, parents rated a high level of consumer satisfaction with the Signposts programme and its content.
Originality/value
– Overall, these preliminary findings support the potential clinical utility of a telephone-support version of the Signposts programme to improve parenting skills and to reduce challenging child behaviour following TBI. This study has provided the impetus for a larger clinical research trial to be conducted.
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Tsai MC, Tsai KJ, Wang HK, Sung PS, Wu MH, Hung KW, Lin SH. Mood disorders after traumatic brain injury in adolescents and young adults: a nationwide population-based cohort study. J Pediatr 2014; 164:136-141.e1. [PMID: 24112864 DOI: 10.1016/j.jpeds.2013.08.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 07/02/2013] [Accepted: 08/21/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To delineate the relationship between traumatic brain injury (TBI) and mood disorders from population-based data in Taiwan. STUDY DESIGN This prospectively followed cohort study involved a subset of the National Health Insurance Research Database containing complete inpatient and outpatient data of 1 million randomly drawn beneficiaries. We included 10- to 24-year-old patients (n = 15,203) receiving the diagnosis of TBI in ambulatory visits or hospitalization from 2000-2004 and their age- and sex-matched comparison insureds using health service in the same year (n = 76,015). Diagnosis of mood disorders was recorded within 5 years after the traumatic event or index use of health service. Baseline demographics, clinical characteristics, and premorbid psychiatric conditions were compared using χ(2) analysis. Increased risk during the 5-year follow-up period was represented by crude and adjusted hazard ratios with 95% CI using a Cox proportional hazard regression. RESULTS A total of 451/15,203 patients with TBI (2.97%) received a diagnosis of mood disorders in the 5-year follow-up period compared with 1153/97,445 individuals (1.52%) without antecedent TBI. After adjusting for select premorbid comorbidities, TBI remained a significant predisposing factor with a 1.96-fold (95% CI 1.74-2.22) increase in risk of mood disorders. CONCLUSIONS Our findings show a higher likelihood of manifesting mood disorders in adolescents and young adults who sustained a prior TBI. Health professionals should carefully monitor both the physical and psychological impacts of head trauma.
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Affiliation(s)
- Meng-Che Tsai
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuen-Jer Tsai
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Kuang Wang
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Pi-Shan Sung
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ming-Hsiu Wu
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Kuo-Wei Hung
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan.
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Kurowski BG, Wade SL, Kirkwood MW, Brown TM, Stancin T, Taylor HG. Behavioral predictors of outpatient mental health service utilization within 6 months after traumatic brain injury in adolescents. PM R 2013; 5:1026-34. [PMID: 23973505 DOI: 10.1016/j.pmrj.2013.08.589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 06/03/2013] [Accepted: 08/10/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To characterize utilization of mental health services and determine the ability of a behavior problem and clinical functioning assessment to predict utilization of such services within the first 6 months after moderate and severe traumatic brain injury in a large cohort of adolescents. DESIGN Multicenter cross-sectional study. SETTING Outpatient setting of 4 tertiary pediatric hospitals, 2 tertiary general medical centers, and 1 specialized children's hospital. PARTICIPANTS Adolescents age 12-17 years (n = 132), 1-6 months after moderate-to-severe traumatic brain injury. METHODS Logistic regression was used to determine the association of mental health service utilization with clinical functioning as assessed by the Child and Adolescent Functional Assessment Scale and behavior problems assessed by the Child Behavioral Checklist. MAIN OUTCOME MEASUREMENT Mental health service utilization measured by the Service Assessment for Children and Adolescents. RESULTS Behavioral or functional impairment occurred in 37%-56%. Of the total study population, 24.2% reported receiving outpatient mental health services, 8.3% reported receiving school services, and 28.8% reported receiving any type of mental health service. Use of any (school or outpatient) mental health service was associated with borderline to impaired total Child and Adolescent Functional Assessment Scale (odds ratio 3.50 [95% confidence interval, 1.46-8.40]; P < .01) and the Child Behavioral Checklist Total Competence (odds ratio 5.08 [95% confidence interval, 2.02-12.76]; P < .01). CONCLUSIONS A large proportion of participants had unmet mental health needs. Both the Child and Adolescent Functional Assessment Scale and the Child Behavioral Checklist identified individuals who would likely benefit from mental health services in outpatient or school settings. Future research should focus on methods to ensure early identification by health care providers of adolescents with traumatic brain injury in need of mental health services.
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Affiliation(s)
- Brad G Kurowski
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, 3333 Burnet Ave. MLC 4009, Cincinnati, OH 45229-3039(∗).
| | - Shari L Wade
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH(†)
| | - Michael W Kirkwood
- Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO(‡)
| | - Tanya M Brown
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN(§)
| | - Terry Stancin
- Division of Pediatric Psychology, Department of Psychiatry, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH(¶)
| | - H Gerry Taylor
- Division of Developmental and Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH(‖)
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Thushara Woods D, Catroppa C, Eren S, Godfrey C, A. Anderson V. Helping families to manage challenging behaviour after paediatric traumatic brain injury (TBI): a model approach and review of the literature. ACTA ACUST UNITED AC 2013. [DOI: 10.1108/scn-01-2013-0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Liu J, Li L. Parent-reported mild head injury history and behavioural performance in children at 6 years. Brain Inj 2013; 27:1263-70. [PMID: 23875827 DOI: 10.3109/02699052.2013.804205] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Mild head and brain injuries have gained increasing attention from health professionals and researchers. Little is known about mild injuries, which may not always be diagnosed or brought to medical attention. This study examines the associations between parent-reported history of mild head injury and behavioural problems in a large community-based sample of Chinese children. METHOD Subjects included 725 children from China. Parents reported on children's head injury history and behaviour at age 6 years using the Chinese version of the Child Behavior Checklist. Mild head injury was defined as injury without loss of consciousness or hospitalization. Standardized T-scores were compared for each of the seven clinical sub-scales and three summary behavioural measures, adjusting for confounders. Logistic models were used to calculate odds ratios (ORs) between head injury and behavioural problems. RESULTS Parents reported that 97 children (14%) had a single injury and 70 (10%) had multiple injuries. Compared to the controls, head-injured children had worse behavioural outcomes and a higher prevalence of behavioural problems. Multiple injuries were associated with higher risk of certain internalizing and externalizing problems. CONCLUSION Mild head injuries, especially incurred repeatedly, may still be a significant risk for adverse behaviours in children.
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Affiliation(s)
- Jianghong Liu
- University of Pennsylvania, Schools of Nursing and Medicine , Philadelphia, PA , USA
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Linden MA, Braiden HJ, Miller S. Educational professionals' understanding of childhood traumatic brain injury. Brain Inj 2013; 27:92-102. [PMID: 23252440 DOI: 10.3109/02699052.2012.722262] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVES To determine the understanding of educational professionals around the topic of childhood brain injury and explore the factor structure of the Common Misconceptions about Traumatic Brain Injury Questionnaire (CM-TBI). RESEARCH DESIGN Cross-sectional postal survey. METHODS AND PROCEDURES The CM-TBI was posted to all educational establishments in one region of the UK. One representative from each school was asked to complete and return the questionnaire (n = 388). MAIN OUTCOMES AND RESULTS Differences were demonstrated between those participants who knew someone with a brain injury and those who did not, with a similar pattern being shown for those educators who had taught a child with brain injury. Participants who had taught a child with brain injury demonstrated greater knowledge in areas such as seatbelts/prevention, brain damage, brain injury sequelae, amnesia, recovery and rehabilitation. Principal components analysis suggested the existence of four factors and the discarding of half the original items of the questionnaire. CONCLUSIONS In the first European study to explore this issue, it is highlighted that teachers are ill-prepared to cope with children who have sustained a brain injury. Given the importance of a supportive school environment in return to life following hospitalization, the lack of understanding demonstrated by teachers in this research may significantly impact on a successful return to school.
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Affiliation(s)
- Mark A Linden
- School of Nursing & Midwifery, The Queen's University of Belfast, UK.
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Ornstein TJ, Max JE, Schachar R, Dennis M, Barnes M, Ewing-Cobbs L, Levin HS. Response inhibition in children with and without ADHD after traumatic brain injury. J Neuropsychol 2013; 7:1-11. [PMID: 23464806 PMCID: PMC4439416 DOI: 10.1111/j.1748-6653.2012.02027.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Children with attention-deficit hyperactivity disorder (ADHD) and traumatic brain injury (TBI) show deficient response inhibition. ADHD itself is a common consequence of TBI, known as secondary ADHD (S-ADHD). Similarity in inhibitory control in children with TBI, S-ADHD, and ADHD would implicate impaired frontal-striatal systems; however, it is first necessary to delineate similarities and differences in inhibitory control in these conditions. We compared performance of children with ADHD and those with TBI without pre-injury ADHD on a stop signal, response inhibition task. Participants were 274 children aged 6-14 years. There were 92 children with ADHD, 103 children with TBI, and 79 typically developing children who served as controls. Among the TBI participants, injury severity ranged from mild to severe. Children with ADHD and TBI showed deficient inhibition. The deficit in children with ADHD was as great as or greater than that in children with TBI, regardless of degree of TBI severity or the presence of S-ADHD. The finding indicates that TBI results in deficient inhibition regardless of the development of S-ADHD.
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Karver CL, Wade SL, Cassedy A, Taylor HG, Stancin T, Yeates KO, Walz NC. Age at injury and long-term behavior problems after traumatic brain injury in young children. Rehabil Psychol 2013; 57:256-65. [PMID: 22946613 DOI: 10.1037/a0029522] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined the effects of age at injury on the persistence of behavior problems and social skill deficits in young children with complicated mild to severe traumatic brain injury (TBI). METHOD A concurrent cohort/prospective research design was used with repeated assessments of children with TBI (n = 82) or Orthopedic Injury (OI) (n = 114). Parents completed the Child Behavior Checklist, the Behavior Rating Inventory of Executive Functions, and the Preschool and Kindergarten Behavior Scales or the Home and Community Social and Behavior Scales shortly after injury to assess preinjury functioning, and at an extended follow-up an average of 38 months postinjury. Generalized linear modeling was used to examine the relationship of age at injury to the maintenance of behavior problems, and logistic regression was used to examine the persistence of clinically significant behavior problems. RESULTS At the extended follow-up, severe TBI was associated with significantly greater anxiety problems relative to the Group OI. With increasing time since injury, children who sustained a severe TBI at an earlier age had significantly higher levels of parent-reported symptoms of ADHD and anxiety than children who were older at injury. CONCLUSIONS Findings suggest that longer-term treatment for behavior problems may be needed after severe TBI, particularly for those injured at an earlier age.
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Affiliation(s)
- Christine L Karver
- Department of Psychology, University of Cincinnati, 1 Edwards Center ML 0376, Cincinnati, OH 45221, USA.
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Abstract
AIM To review systematically the empirical evidence on traumatic brain injury (TBI) during childhood and subsequent behavioral problems. METHOD An initial literature search with keywords 'brain injury,''children,' and 'behavior' was conducted using Web of Knowledge and PubMed databases. Ancestry was also used. Original research studies published between 1990 and February 2012 focusing on behavioral outcomes of children sustaining TBI from ages 0 to 18 years were included. RESULTS Fifty studies, varying considerably in methodologies, were included in the review. Findings showed that up to 50% of brain-injured children are at risk for presenting with specific behavioral problems and disorders. These problems may emerge shortly or several years after injury and often persist and even worsen with time. These behavioral impairments appear to be moderated by the family environment. INTERPRETATION Survivors of childhood TBI are at risk for developing and sustaining behavioral impairments. Stronger research is needed to identify cognitive and environmental factors that contribute to the onset and maintenance of these problems. Healthcare providers should ensure adequate follow-up and assessment of a child's behavioral, social, and neurocognitive domains. Caregivers should be encouraged to provide positive environments and parenting styles, which may help reduce chronic behavioral problems after brain injury.
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Affiliation(s)
- Linda Li
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4217, USA
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Catroppa C, Godfrey C, Rosenfeld JV, Hearps SSJC, Anderson VA. Functional recovery ten years after pediatric traumatic brain injury: outcomes and predictors. J Neurotrauma 2012; 29:2539-47. [PMID: 22846066 DOI: 10.1089/neu.2012.2403] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Functional impairments (adaptive, behavioral, educational) are common after preschool traumatic brain injury (TBI). In comparison with cognitive outcome, functional outcomes have received limited attention, with little evidence to determine whether these difficulties persist in the long term. The aim of this study was to examine functional outcomes at 10 years post-injury and identify predictors of outcome. The study compared children with a diagnosis of TBI (n=40) to a healthy age-, gender-, and socioeconomic status (SES)-matched control group (n=19) at 10 years post-injury. Outcomes and predictors of functional skills were investigated. Poorer adaptive skills were evident for those with more severe injury. Behavioral difficulties were present regardless of injury severity. Post-injury, arithmetic skills were the most compromised in the longer term. Pre-injury status, interventions accessed, and acute intellectual function were significant predictors of outcome. These results highlight the importance of monitoring functional skills in the long term, especially for those children presenting with risk factors.
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Affiliation(s)
- Cathy Catroppa
- Critical Care and Neurosciences, Murdoch Childrens Research Institute, Melbourne, Australia.
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Abstract
Traumatic brain injury (TBI) and orthopedic injury (OI) patients are prone to anxiety and mood disorders. In the present study, we integrated anatomical and diffusion tensor neuroimaging to investigate structural properties of the amygdala and hippocampus, gray matter regions implicated in anxiety and mood disorders. Children and adolescents were evaluated during the late sub-acute phase of recovery following trauma resulting from either moderate to severe TBI or OI. Mean diffusivity (MD) of the amygdala and hippocampus was elevated following TBI. An interaction of hemisphere, structure, and group revealed that MD of the right amygdala was elevated in females with TBI. Self-reported anxiety scores were not related to either volume or microstructure of the hippocampus, or to volume or fractional anisotropy of the amygdala. Left amygdala MD in the TBI group accounted for 17.5% of variance in anxiety scores. Anxiety symptoms may be mediated by different mechanisms in patients with TBI or OI.
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Kaldoja ML, Kolk A. Social-emotional behaviour in infants and toddlers with mild traumatic brain injury. Brain Inj 2012; 26:1005-13. [PMID: 22632684 DOI: 10.3109/02699052.2012.660516] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Paediatric head trauma is a serious health concern often leading to neurological, behavioural and cognitive impairments. In Estonia head trauma incidence is especially high in children up to 4 years. OBJECTIVE The aim was to investigate young children's pre-injury social-emotional behaviour to discover potential risk signs for brain trauma and to study social-emotional outcome 9 months post-injury. METHODS Thirty-five 3-65 month old children with mild traumatic brain injury (MTBI) and 70 matched controls were retrospectively assessed with child monitoring system Ages and Stages Questionnaires: Social-Emotional. During follow-up 27 patients and 54 controls were re-assessed after 9 months. RESULTS Children with MTBI showed altered social-emotional development already before the injury. Deficits were evident in self-regulation and autonomy. Age-specific social-emotional risk signs for MTBI were found. Compared to controls more pre-injury affective problems were seen in 12-month olds, self-regulation, and communication difficulties in 30-month olds and autonomy disturbances in 60-month old children. 9 months post-injury impairments in autonomy and self-regulation were still present and new difficulties in interaction had developed. CONCLUSIONS Childhood MTBI has a serious negative effect on further development of interaction skills. To prevent possible traumas, parents should be informed of different age-specific pre-injury social-emotional risk signs.
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Woods DT, Catroppa C, Barnett P, Anderson VA. Parental disciplinary practices following acquired brain injury in children. Dev Neurorehabil 2012; 14:274-82. [PMID: 21870951 DOI: 10.3109/17518423.2011.586371] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study describes the disciplinary practices of parents following acquired brain injury (ABI) of their child and examines the relationship between disciplinary use, family-parental adversities and children's behavioural sequelae. METHOD Participants were 48 parent respondents of children between 3-12 years with mild, moderate and severe ABI. Parents provided demographic information and completed questionnaires investigating disciplinary strategy use, parental-family functioning and child behaviour. RESULTS Over-reactive and lax disciplinary strategies were endorsed most by parents. Dysfunctional levels of disciplinary use were associated with children who displayed more behaviour problems, parents with elevated distress and families experiencing more dysfunction and social adversity. CONCLUSION Dysfunctional parenting practices, if not ameliorated, could exacerbate problematic child behaviour following ABI, as well as parent and family difficulties. Parental assessment may be useful as a method of screening for parental factors that put children at risk for ongoing behaviour problems and families for ongoing stress.
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Affiliation(s)
- Damith T Woods
- Murdoch Children's Research Institute, Melbourne, Australia.
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Thaler NS, Mayfield J, Reynolds CR, Hadland C, Allen DN. Teacher-Reported Behavioral Disturbances in Children With Traumatic Brain Injury: An Examination of the BASC-2. APPLIED NEUROPSYCHOLOGY-CHILD 2012; 1:30-7. [DOI: 10.1080/21622965.2012.665776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Max JE, Keatley E, Wilde EA, Bigler ED, Schachar RJ, Saunders AE, Ewing-Cobbs L, Chapman SB, Dennis M, Yang TT, Levin HS. Depression in children and adolescents in the first 6 months after traumatic brain injury. Int J Dev Neurosci 2011; 30:239-45. [PMID: 22197971 DOI: 10.1016/j.ijdevneu.2011.12.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 12/08/2011] [Accepted: 12/09/2011] [Indexed: 11/17/2022] Open
Abstract
The objective was to assess the nature, rate, predictive factors, and neuroimaging correlates of novel (new-onset) depressive disorders, both definite and subclinical, after traumatic brain injury (TBI). Children with TBI from consecutive admissions were enrolled and studied with psychiatric interviews soon after injury (baseline), and again 6 months post-injury. Novel definite/subclinical depressive disorders at 6-month follow up occurred in 11% (n=15) of the children and subsets of children with non-anxious depression (n=9) and anxious depression (n=6) were identified. Novel definite/subclinical depressive disorder was significantly associated with older age at the time of injury, family history of anxiety disorder, left inferior frontal gyrus (IFG) lesions, and right frontal white matter lesions. Non-anxious depressions were associated with older age at injury, left IFG and left temporal pole lesions. Anxious depressions were associated with family history of anxiety disorder, Personality Change due to TBI, right frontal white matter lesions, and left parietal lesions. These findings, which are similar to those reported after adult TBI, identify both similarities and differences in non-anxious and anxious depression following childhood TBI with respect to lesion laterality, genetic factors (in the form of family psychiatric history of anxiety disorder), age at injury, and more generalized affective dysregulation.
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Affiliation(s)
- Jeffrey E Max
- Department of Psychiatry, University of California, San Diego, CA 92123, United States.
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Cohen ML, Heaton SC, Ginn N, Eyberg SM. Parent-Child Interaction Therapy as a Family-Oriented Approach to Behavioral Management Following Pediatric Traumatic Brain Injury: A Case Report. J Pediatr Psychol 2011; 37:251-61. [DOI: 10.1093/jpepsy/jsr086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Thaler NS, Barney SJ, Reynolds CR, Mayfield J, Allen DN. Differential Sensitivity of TOMAL Subtests and Index Scores to Pediatric Traumatic Brain Injury. ACTA ACUST UNITED AC 2011; 18:168-78. [DOI: 10.1080/09084282.2011.595443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Dasarathi M, Grace J, Kelly T, Forsyth R. Utilization of mental health services by survivors of severe paediatric traumatic brain injury: a population-based study. Child Care Health Dev 2011; 37:418-21. [PMID: 21276036 DOI: 10.1111/j.1365-2214.2010.01199.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A study of general and specialist mental health and psychology service provider records confirms very high rates of utilization by a population of survivors of severe paediatric traumatic brain injury.
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Affiliation(s)
- M Dasarathi
- Department of Child Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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A randomized trial of teen online problem solving for improving executive function deficits following pediatric traumatic brain injury. J Head Trauma Rehabil 2011; 25:409-15. [PMID: 21076241 DOI: 10.1097/htr.0b013e3181fb900d] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the efficacy of teen online problem solving (TOPS) in improving executive function (EF) deficits following traumatic brain injury (TBI) in adolescence. METHODS Families of adolescents (aged 11-18 years) with moderate to severe TBI were recruited from the trauma registry of 2 tertiary-care children's hospitals and then randomly assigned to receive TOPS (n = 20), a cognitive-behavioral, skill-building intervention, or access to online resources regarding TBI (Internet resource comparison; n = 21). Parent and teen reports of EF were assessed at baseline and a posttreatment follow-up (mean = 7.88 months later). RESULTS Improvements in self-reported EF skills were moderated by TBI severity, with teens with severe TBI in the TOPS treatment reporting significantly greater improvements than did those with severe TBI in the Internet resource comparison. The treatment groups did not differ on parent ratings of EF at the follow up. CONCLUSIONS Findings suggest that TOPS may be effective in improving EF skills among teens with severe TBI.
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