Sleep and health-related quality of life in women following a cancer diagnosis: results from the Women's Wellness after Cancer Program in Australia.

PURPOSE: Sleep disturbance after cancer treatment could compromise recovery. This paper examined the associations between post-treatment sleep problems and health-related quality of life (HRQoL), and the effectiveness of an e-enabled lifestyle intervention on sleep outcomes. METHODS: The Women's Wellness after Cancer Program (WWACP) was examined in a single blinded, multi-centre randomised controlled trial. Data were collected from 351 women (Mage = 53.2, SD = 8.8; intervention n = 175, control group n = 176) who had completed surgery, chemotherapy and/or radiotherapy for breast, gynaecological or blood cancers within the previous 24 months. Participants completed the Pittsburgh Sleep Quality Index (PSQI) at baseline (prior to intervention randomisation), and at 12 and 24 weeks later. Sociodemographic information, menopausal symptoms (Greene Climacteric Scale) and HRQoL (36-Item Short Form Health Survey; SF-36) were also collected. Linear panel regression was used to examine the association between sleep variables and SF36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. A difference-in-difference regression model approach was used to examine the intervention effect on the sleep outcomes. RESULTS: After adjustment for potential confounders, the sleep variables (except sleep duration) significantly predicted physical, but not mental, HRQoL. There was no statistically significant effect of the intervention on sleep outcomes at 12 or 24 weeks. CONCLUSION: Women who have completed treatment for cancer experience sleep problems that are associated with decreased physical HRQoL. Improving sleep through targeted interventions should improve their physical HRQoL. Improved targeting of the sleep components of the WWACP should be explored.

Psychological Predictors of Postconcussive Symptoms Following Traumatic Injury.

OBJECTIVE: To determine the contribution of demographics, injury type, pain, and psychological factors on postconcussive symptoms. SETTING AND PARTICIPANTS: Recently injured (n = 54) and noninjured (n = 184) adults were recruited from a hospital emergency department or the community. Thirty-eight individuals met the diagnostic criteria for a mild traumatic brain injury and 16 individuals received treatment for a minor traumatic non-brain injury. MAIN MEASURES: Standardized tests were administered to assess 4 postconcussion symptom types and theorized predictors including a "physiogenic" variable (injury type) and "psychogenic" variables (symptoms of anxiety, depression, and stress) within 1 month of the injury. RESULTS: In the injured sample, after controlling for injury type, demographics, and pain (chronic and current), a hierarchical regression analysis revealed that the combination of psychological symptoms predicted affective (F10,42 = 2.80, P = .009, Rchange = 0.27) but not other postconcussion symptoms types. Anxiety (ß = .48), stress (ß = .18), and depression (ß = -.07) were not statistically significant individual predictors (P > .05). Cognitive and vestibular postconcussion symptoms were not predicted by the modeled factors, somatic sensory postconcussion symptoms were predicted by demographic factors only, and the pattern of predictors for the symptom types differed for the samples. CONCLUSIONS: Traditional explanatory models do not account for these findings. The predictors are multifactorial, different for injured versus noninjured samples, and symptom specific.

Actigraphically Measured Sleep-Wake Behavior After Mild Traumatic Brain Injury: A Case-Control Study.

OBJECTIVE: To characterize and compare the sleep-wake behavior of individuals following a mild traumatic brain injury (mTBI) with that of noninjured healthy controls. SETTING: Community. PARTICIPANTS: Fourteen participants with a recent mTBI (Mage = 28.07; SD = 10.45; n = 10 females) and 34 noninjured controls (Mage = 23.70; SD = 7.30; n = 31 females). DESIGN: Cross-sectional. MAIN MEASURES: Battery of subjective sleep measures and 14 days of sleep-wake monitoring via actigraphy (objective measurement) and concurrent daily sleep diary. RESULTS: Participants who had sustained an mTBI self-reported significantly higher sleep-related impairment, poorer nightly sleep quality, and more frequently met criteria for clinical insomnia, compared with controls (d = 0.76-1.11, large effects). The only significant between-group difference on objective sleep metrics occurred on sleep timing. On average, people with a recent history of mTBI fell asleep and woke approximately 1 hour earlier than did the controls (d = 0.62-0.92, medium to large effects). CONCLUSION: Participants with a history of mTBI had several subjective sleep complaints but relatively few objective sleep changes with the exception of earlier sleep timing. Future research is needed to understand the clinical significance of these findings and how these symptoms can be alleviated. Interventions addressing subjective sleep complaints (eg, cognitive behavior therapy for insomnia) should be tested in this population.

Resilience and Other Possible Outcomes After Mild Traumatic Brain Injury: a Systematic Review.

The relation between resilience and mild traumatic brain injury (TBI) outcome has been theorized but empirical studies have been scarce. This systematic review aimed to describe the research in this area. Electronic databases (Medline, CINAHL, PsychINFO, SPORTdiscus, and PILOTS) were searched from inception to August 2015 for studies in which resilience was measured following TBI. The search terms included 'TBI' 'concussion' 'postconcussion' 'resilience' and 'hardiness'. Inclusion criteria were peer reviewed original research reports published in English, human participants aged 18 years and over with brain injury, and an accepted definition of mild TBI. Hand searching of identified articles was also undertaken. Of the 71 studies identified, five studies were accepted for review. These studies were formally assessed for risk of bias by two independent reviewers. Each study carried a risk of bias, most commonly a detection bias, but none were excluded on this basis. A narrative interpretation of the findings was used because the studies reflected fundamental differences in the conceptualization of resilience. No studies employed a trajectory based approach to measure a resilient outcome. In most cases, the eligible studies assessed trait resilience with a scale and used it as a predictor of outcome (postconcussion symptoms). Three of these studies showed that greater trait resilience was associated with better mild TBI outcomes (fewer symptoms). Future research of the adult mild TBI response that predicts a resilient outcome is encouraged. These studies could yield empirical evidence for a resilient, and other possible mild TBI outcomes.

New vignettes for the experimental manipulation of injury cause in prospective mild traumatic brain injury research.

PURPOSE: This study developed standardized vignettes that depict a mild traumatic brain injury (TBI) from one of several causes and subjected them to formal expert review. METHOD: A base vignette was developed using the World Health Organization operational criteria for mild TBI. Eight specific causes (e.g. sport vs assault) were examined. A convenience sample of mild TBI experts with a discipline background of Neuropsychology from North America, Australasia and Europe (n = 21) used an online survey to evaluate the vignettes and rated the role of cause on outcome. RESULTS: The vignette suite was rated as fitting the mild TBI WHO operational diagnostic criteria at least moderately well. When compared to other factors, cause was not rated as significantly contributing to outcome. When evaluated in isolation, approximately half of the sample rated cause as important or very important and at least two of three clinical outcomes were associated with a different cause. DISCUSSION: The vignettes may be useful in experimental mild TBI research. They enable the injury parameters to be controlled so that the effects of cause can be isolated and examined empirically. Such studies should advance understanding of the role of this factor in mild TBI outcome.

Diagnostic terminology is not associated with contact-sport players' expectations of outcome from mild traumatic brain injury.

PRIMARY OBJECTIVE: To investigate the influence of the diagnostic terms 'concussion' and 'mild traumatic brain injury' (mTBI) on contact-sport players' injury perceptions and expected symptoms from a sport-related mTBI. It was hypothesized that contact-sport players would hold more negative injury perceptions and expect greater symptom disturbance from a sport-related injury that was diagnosed as an 'mTBI' compared to 'concussion' or an undiagnosed injury. METHODS AND PROCEDURES: One hundred and twenty-two contact-sport players were randomly allocated to one of three conditions in which they read a sport-related mTBI vignette that varied only according to whether the person depicted in the vignette was diagnosed with concussion (n = 40), mTBI (n = 41) or received no diagnosis (control condition; n = 41). After reading the vignette, participants rated their injury perceptions (perceived undesirability, chronicity and consequences) and expectations of post-concussion syndrome (PCS) and post-traumatic stress disorder (PTSD) symptoms 6 months post-injury. MAIN OUTCOMES: There were no significant differences in contact-sport players' injury perceptions or symptom expectations from a sport-related mTBI when it was diagnosed as an mTBI, concussion or when no diagnosis was given. CONCLUSIONS: Diagnostic terminology does not appear to have a potent influence on symptom expectation and injury perceptions in contact-sport players.

The effect of injury diagnosis on illness perceptions and expected postconcussion syndrome and posttraumatic stress disorder symptoms.

OBJECTIVE: To determine if systematic variation of diagnostic terminology (ie, concussion, minor head injury [MHI], mild traumatic brain injury [mTBI]) following a standardized injury description produced different expected symptoms and illness perceptions. We hypothesized that worse outcomes would be expected of mTBI, compared with other diagnoses, and that MHI would be perceived as worse than concussion. METHOD: 108 volunteers were randomly allocated to conditions in which they read a vignette describing a motor vehicle accident-related mTBI followed by a diagnosis of mTBI (n = 27), MHI (n = 24), concussion (n = 31), or, no diagnosis (n = 26). All groups rated (a) event "undesirability," (b) illness perception, and (c) expected postconcussion syndrome (PCS) and posttraumatic stress disorder (PTSD) symptoms 6 months after injury. RESULTS: There was a statistically significant group effect on undesirability (mTBI > concussion and MHI), PTSD symptomatology (mTBI and no diagnosis > concussion), and negative illness perception (mTBI and no diagnosis > concussion). CONCLUSION: In general, diagnostic terminology did not affect anticipated PCS symptoms 6 months after injury, but other outcomes were affected. Given that these diagnostic terms are used interchangeably, this study suggests that changing terminology can influence known contributors to poor mTBI outcome.

Method of symptom assessment influences cognitive, affective and somatic post-concussion-like symptom base rates.

PRIMARY OBJECTIVE: To investigate whether assessment method influences the type of post-concussion-like symptoms. METHODS AND PROCEDURES: Participants were 73 Australian undergraduate students (Mage = 24.14, SD = 8.84; 75.3% female) with no history of mild traumatic brain injury (mTBI). Participants reported symptoms experienced over the previous 2 weeks in response to an open-ended question (free report), mock interview and standardized checklist (British Columbia Post-concussion Symptom Inventory; BC-PSI). MAIN OUTCOMES AND RESULTS: In the free report and checklist conditions, cognitive symptoms were reported significantly less frequently than affective (free report: p < 0.001; checklist: p < 0.001) or somatic symptoms (free report: p < 0.001; checklist: p = 0.004). However, in the mock structured interview condition, cognitive and somatic symptoms were reported significantly less frequently than affective symptoms (both p < 0.001). No participants reported at least one symptom from all three domains when assessed by free report, whereas most participants did so when symptoms were assessed by a mock structured interview (75%) or checklist (90%). CONCLUSIONS: Previous studies have shown that the method used to assess symptoms affects the number reported. This study shows that the assessment method also affects the type of reported symptoms.

A critical evaluation of written discharge advice for people with mild traumatic brain injury: what should we be looking for?

OBJECTIVE: To formally evaluate the written discharge advice for people with mild traumatic brain injury (mTBI). METHODS: Eleven publications met the inclusion criteria: (1) intended for adults; (2) ≤two A4 pages; (3) published in English; (4) freely accessible; and (5) currently used (or suitable for use) in Australian hospital emergency departments or similar settings. Two independent raters evaluated the content and style of each publication against established standards. The readability of the publication, the diagnostic term(s) contained in it and a modified Patient Literature Usefulness Index (mPLUI) were also evaluated. RESULTS: The mean content score was 19.18 ± 8.53 (maximum = 31) and the mean style score was 6.8 ± 1.34 (maximum = 8). The mean Flesch-Kincaid reading ease score was 66.42 ± 4.3. The mean mPLUI score was 65.86 ± 14.97 (maximum = 100). Higher scores on these metrics indicate more desirable properties. Over 80% of the publications used mixed diagnostic terminology. One publication scored optimally on two of the four metrics and highly on the others. DISCUSSION: The content, style, readability and usefulness of written mTBI discharge advice was highly variable. The provision of written information to patients with mTBI is advised, but this variability in materials highlights the need for evaluation before distribution. Areas are identified to guide the improvement of written mTBI discharge advice.

Perceived Neighborhood Characteristics and Sleep in Australian Adults.

BACKGROUND: Poor sleep can contribute to poorer health and socioemotional outcomes. Sleep health can be influenced by a range of individual and other socioecological factors. Perceptions of neighborhood physical and social characteristics reflect broader social-level factors that may influence sleep, which have not been well studied in the Australian context. This study examined the association between perceived neighborhood characteristics and sleep in a large sample of Australians. METHODS: Data were from 9,792 people aged 16 years or older, from Waves 16 and 17 of the nationally representative Household, Income and Labour Dynamics in Australia Survey. Associations between perceived neighborhood characteristics (neighborly interaction and support, environmental noise, physical condition, and insecurity) and self-reported sleep duration, sleep disturbance, and napping were examined using multiple logistic regression models. RESULTS: "Neighborhood interaction and support" and "neighborhood physical condition" were not significantly associated with any sleep outcomes after adjusting for relevant covariates. However, "environmental noise" and "neighborhood insecurity" remained significantly associated with sleep duration and sleep disturbance. None of the neighborhood characteristics were associated with napping. Furthermore, associations did not significantly vary by gender. CONCLUSIONS: This study highlights the potential benefit of public health policies to address noise and safety in neighborhoods to improve sleep.

Reducing crash risk for young drivers: Protocol for a pragmatic randomised controlled trial to improve young driver sleep.

Background: Road trauma is a leading cause of death and disability for young Australians (15-24 years). Young adults are overrepresented in crashes due to sleepiness, with two-thirds of their fatal crashes attributed to sleepy driving. This trial aims to examine the effectiveness of a sleep extension and education program for improved road safety in young adults. Methods: Young adults aged 18-24 years (n = 210) will be recruited for a pragmatic randomised controlled trial employing a placebo-controlled, parallel-groups design. The intervention group will undergo sleep extension and receive education on sleep, whereas the placebo control group will be provided with information about diet and nutrition. The primary outcomes of habitual sleep and on-road driving performance will be assessed via actigraphy and in-vehicle accelerometery. A range of secondary outcomes including driving behaviours (driving simulator), sleep (diaries and questionnaire) and socio-emotional measures will be assessed. Discussion: Sleep is a modifiable factor that may reduce the risk of sleepiness-related crashes. Modifying sleep behaviour could potentially help to reduce the risk of young driver sleepiness-related crashes. This randomised control trial will objectively assess the efficacy of implementing sleep behaviour manipulation and education on reducing crash risk in young adult drivers.

A comparison of new and existing mild traumatic brain injury vignettes: recommendations for research into post-concussion syndrome.

OBJECTIVE: To review and compare the mild traumatic brain injury (mTBI) vignettes used in postconcussion syndrome (PCS) research, and to develop 3 new vignettes. METHOD: The new vignettes were devised using World Health Organization (WHO) mTBI diagnostic criteria [1]. Each vignette depicted a very mild (VM), mild (M), or severe (S) brain injury. Expert review (N = 27) and readability analysis was used to validate the new vignettes and compare them to 5 existing vignettes. RESULTS: The response rate was 44%. The M vignette and existing vignettes were rated as depicting a mTBI; however, the fit-to-criteria of these vignettes differed significantly. The fit-to-criteria of the M vignette was as good as that of 3 existing vignettes and significantly better than 2 other vignettes. As expected, the VM and S vignettes were a poor fit-to-criteria. CONCLUSIONS: These new vignettes will assist PCS researchers to test the limits of important etiology factors by varying the severity of depicted injuries.

Prevalence and predictors of sleep problems in women following a cancer diagnosis: results from the women's wellness after cancer program.

PURPOSE: Using a discrete dataset from the Women's Wellness after Cancer Program (WWACP), we examine the prevalence and predictors of self-reported sleep problems in women previously treated for cancer. METHODS: Participants were 351 women (Mage = 53.2, SD = 8.8) from the WWACP who had completed surgery, chemotherapy and/or radiotherapy for breast, gynaecological or blood cancers within the previous 24 months. Sleep problems were measured using the Pittsburgh Sleep Quality Index (PSQI). Baseline data (i.e. prior to intervention randomisation) were analysed. RESULTS: Most women (59%) reported clinically significant sleep disturbance (PSQI > 5), 40% reported insufficient sleep duration (< 7 h), 38% self-reported poor sleep quality and 28% reported poor habitual sleep efficiency (sleep efficiency < 75%). Fewer psychological and vasomotor climacteric symptoms, age < 45 years and having a partner were associated with reduced odds (AOR < 1) of sleep problems. Higher levels of pain-related disability, and an intermediate compared to 'high' level of education, were associated with increased odds (AOR > 1) of sleep problems. CONCLUSIONS: These findings confirm previous studies that have found a high prevalence of sleep problems in women previously treated for cancer. A range of sociodemographic, climacteric and pain-related factors were associated with sleep problems in this study. IMPLICATIONS FOR CANCER SURVIVORS: Targeted interventions to improve sleep quality after cancer treatment should be explored in this population. Predictors identified in this study could inform intervention targeting and development.

An examination of the expected symptoms of postconcussion syndrome in a nonclinical sample.

OBJECTIVES: This study examined the robustness of the postconcussion syndrome (PCS) expectation-as-etiology hypothesis using a variation on the typical study design and different symptom assessment methods. METHODS: Participants were 51 university students with no history of brain injury or neurological disease. Participants reported expected PCS symptoms after being exposed to an established vignette in which they were asked to imagine that they had had a car accident (expectation condition). One week later, they reported their current symptoms (control condition). Symptoms were elicited in both test sessions using each of 3 methods administered in the following fixed order: an open-ended question (eg, how have you been feeling over the past couple of weeks?), prompted interview questions (eg, have you experienced any troubling physical symptoms over the past few weeks?), and checklist (the British Columbia Postconcussion Symptom Inventory). All 3 methods were administered in a paper-and-pencil format. RESULTS: Findings revealed that (a) when responding to structured interview questions or the checklist, participants expected more PCS symptoms from an imagined mild traumatic brain injury when compared with their baseline, (b) the expectation effect was not present when symptoms were elicited by an open-ended question, and (c) almost all participants (approximately 98% of those reporting expected symptoms) met a caseness criterion when symptoms were assessed using a checklist or structured interview. Contrary to predictions, personal knowledge of someone with mild traumatic brain injury did not alter PCS expectancies. CONCLUSIONS: The expectation-as-etiology hypothesis, which is one of several factors that has been associated with PCS, may be partly dependent on method of symptom assessment.

The good-old-days bias and post-concussion syndrome symptom reporting in a non-clinical sample.

PRIMARY OBJECTIVE: To investigate the good-old-days bias, a psychosocial factor associated with post-concussion syndrome (PCS). STUDY DESIGN: Repeated measures comparison of PCS symptoms reported 6 months prior (retrospectively) and currently. A non-clinical sample was used to determine if this bias is a general recall bias. METHODS AND PROCEDURES: Fifty-seven university students with no history of brain injury or neurological disease completed the British Columbia Post-concussion Symptom Inventory. Symptoms were reported on two occasions, spaced 1 week apart, commencing with current symptoms. MAIN OUTCOMES AND RESULTS: Using PCS symptom frequency by severity product scores, there was no significant difference in the 13 PCS symptoms reported across occasions, nor the relevant summary score (p = 0.199). These data do not support the presence of a general recall bias. However, significant differences emerged when analysed using a simple count of the total number of endorsed symptoms (p = 0.002, d = 0.39, small-to-medium effect) or the sample percentage that endorsed each symptom (four symptoms were endorsed by fewer participants retrospectively than currently). CONCLUSIONS: There is only weak evidence of a general recall bias in this non-clinical sample. Further consideration of the methods used to study this bias and its role clinically is needed.

Psychological approaches for the management of persistent postconcussion symptoms after mild traumatic brain injury: a systematic review.

Background: To evaluate the evidence for psychological treatments for persistent postconcussion symptoms following mild traumatic brain injury. There is scant evidence from limited clinical trials to direct the psychological management of persistent symptoms.Method: Databases were searched for studies that: (1) included adults (≥ aged 16 years) following injury (from any cause); (2) tested interventions for postconcussion symptoms after the acute injury period (e.g., after hospital discharge), but prior to established chronicity (e.g., not more than 12 months post-injury), and; (3) applied one of five broadly-defined psychological interventions (cognitive behavioural therapy, counselling, psychoeducation, education/reassurance, or mindfulness). All controlled trials were eligible for inclusion.Results: Of the 20,945 articles identified, 10 underwent risk-of-bias analysis by two independent reviewers. Nine were retained for data extraction. They used: cognitive behaviour therapy (n = 2), counselling (n = 2), psychoeducation (n = 2), education/reassurance (n = 2), or compared cognitive behaviour therapy to counselling (n = 1).Conclusion: Counselling or cognitive behaviour therapy have the most support but the evidence remains limited. We encourage further randomized controlled trials of early interventions in samples at risk for persistent symptoms, including closer study of psychological risk-factors and the 'active' ingredient. To advance the field, future trials must include additional methodological controls and improved reporting.Implications for rehabilitationPersistent symptoms following mild traumatic brain injury can be disabling and psychological management for rehabilitation may be proposed.However, Controlled trials show that while some psychological approaches hold promise for this purpose, there are significant gaps in the underpinning evidence.The best results are seen when postconcussion programs use counselling or cognitive behaviour therapy and are targetted for people with an increased risk of persistent symptoms.

Correlates of naptime behaviors in preschool aged children.

Purpose: Major changes in the timing, duration, and function of sleep occur during childhood. These changes include the transition from habitual napping to infrequent napping. This transition is likely to reflect, at least in part, neurocognitive development. This study sought to identify factors that discriminate between four groups of children with different teacher-reported responses to naptime in childcare: those who nap (nappers), sometimes nap (transitioners), do not nap (resters), and neither nap, nor lie still (problem nappers). Methods: Standardized observations of sleep and sleep behaviors, daytime behaviors across a number of domains, and direct neurocognitive assessment of 158 preschool aged children (aged 49-72 months; 54% male) attending childcare centers in Queensland (QLD), Australia, were adopted as part of a large longitudinal study of early childhood, the Effective Early Education Experiences (E4Kids) study. Discriminant function analysis was used to examine how age, parent education, nighttime sleep duration, cognitive functioning, behavior problems, and temperament differentiated the four groups. Results: Three discriminant functions were identified and defined as maturation (strong loadings of nighttime sleep duration, cognitive function, and age), socioeconomic status (parental education), and behavioral problems (externalizing behavior, temperament, and internalizing behavior). These functions accounted for 62.9%, 32.6%, and 4.5% of the between-groups variance, respectively. Children defined as nappers (n=44) had significantly shorter duration of nighttime sleep, were younger, and had lower cognitive functioning scores than did other groups. Problem nappers, (n=25) were more likely to have parents with lower levels of education than did transitioners (n=41). Standard behavior and temperament measures did not significantly differentiate the groups. Conclusion: The findings support an interaction between cognitive development, sleep behaviors, and the individual needs and circumstances of children. Further research in this area could make a strong contribution to theory and practice in early childhood education, and a strong contribution to understanding of children's development.

Changing patterns in the prevalence of posttraumatic stress disorder, major depressive episode and generalized anxiety disorder over 24 months following a road traffic crash: Results from the UQ SuPPORT study.

OBJECTIVE: To examine the prevalence and changing patterns of PTSD, major depressive episode (MDE), and generalized anxiety disorder (GAD) in adult claimants who sustained a non-catastrophic injury in a road traffic crash (RTC) in Queensland, Australia. METHOD: Participants (N = 284) were assessed at approximately 6, 12, and 24 months post-RTC using the composite international diagnostic interview (CIDI) modules for PTSD, and CIDI-short form for MDE, and GAD. RESULTS: The prevalence of at least one of these disorders was 48.2%, 52.5%, and 49.3%, at 6, 12, and 24 months, respectively. Comorbidity was common (20.8% at 6 months, 27.1% at 12 months, and 21.1% at 24 months) and only 33.1% of participants never met PTSD, GAD, or MDE criteria. A substantial proportion of participants (42.3%) had an unstable diagnostic pattern over time. Participants with multiple diagnoses at 6 months were more likely to continue to meet diagnostic criteria for any disorder at 12 and 24 months than participants with a single diagnosis. Participants with PTSD (with or without MDE/GAD) were more likely to meet criteria for any disorder at 24 months than participants with another diagnosis. Preinjury psychiatric history increased the likelihood of any disorder at 24 months post-injury, but did not significantly increase the likelihood of PTSD. CONCLUSIONS: People injured in a RTC are at risk of having complex psychological presentations over time. Interventions to prevent mental disorders, especially PTSD, in the early post-injury period are needed to prevent chronic psychological injury, including consideration of comorbidity and dynamic course.

Neurocognitive predictors of posttraumatic stress disorder symptoms in children 6 months after traumatic brain injury: A prospective study.

OBJECTIVE: Various neurocognitive mechanisms have been proposed to explain the development of Posttraumatic Stress Disorder (PTSD) symptoms. However, the neurocognitive mechanisms underlying comorbid PTSD following Traumatic Brain Injury (TBI) have not been fully investigated, especially among children. This study prospectively examined the influence of theorized neurocognitive deficits at 3 months post pediatric TBI on the development of PTSD symptoms 6 months postinjury. METHOD: One hundred sixty-six children aged between 6 and 14 years were recruited after sustaining a TBI. Their demographic information and injury severity were assessed at 2 months postinjury, their neurocognitive outcomes in selective attention, sustained attention, verbal learning, working memory, and processing speed were assessed at 3 months postinjury, and PTSD symptoms were measured at 6 months postinjury. RESULTS: Consistent with the Neurobiological Theory of PTSD, sustained attention deficits 3 months postinjury emerged as the key predictor for greater future PTSD severity at 6 months, especially following a mild TBI. However, contrary to the expectations of the Emotional Processing Theory and Dual Representation Theory, verbal learning and working memory deficits at 3 months postinjury protected children from the development of PTSD symptoms 6 months postinjury. CONCLUSIONS: PTSD involves a complex interplay between attention and memory functions post pediatric TBI. When trauma memory is relatively intact, difficulties disengaging from distractors contribute to the development of PTSD symptoms. (PsycINFO Database Record