Predictors of neurocognitive outcome in pediatric ischemic and hemorrhagic stroke.

This clinical study examined the impact of eight predictors (age at stroke, stroke type, lesion size, lesion location, time since stroke, neurologic severity, seizures post-stroke, and socioeconomic status) on neurocognitive functioning following pediatric stroke. Youth with a history of pediatric ischemic or hemorrhagic stroke (n = 92, ages six to 25) underwent neuropsychological testing and caregivers completed parent-report questionnaires. Hospital records were accessed for medical history. Spline regressions, likelihood ratios, one-way analysis of variance, Welch's t-tests, and simple linear regressions examined associations between predictors and neuropsychological outcome measures. Large lesions and lower socioeconomic status were associated with worse neurocognitive outcomes across most neurocognitive domains. Ischemic stroke was associated with worse outcome in attention and executive functioning compared to hemorrhagic stroke. Participants with seizures had more severe executive functioning impairments than participants without seizures. Youth with cortical-subcortical lesions scored lower on a few measures than youth with cortical or subcortical lesions. Neurologic severity predicted scores on few measures. No differences were found based on time since stroke, lesion laterality, or supra- versus infratentorial lesion. In conclusion, lesion size and socioeconomic status predict neurocognitive outcome following pediatric stroke. An improved understanding of predictors is valuable to clinicians who have responsibilities related to neuropsychological assessment and treatments for this population. Findings should inform clinical practice through enhanced appraisals of prognosis and the use of a biopsychosocial approach when conceptualizing neurocognitive outcome and setting up support services aimed at fostering optimal development for youth with stroke.

Screening for Anxiety and Depression Symptoms Using Concussion Symptom Scales Among Varsity Athletes.

OBJECTIVE: This study examined associations between Sport Concussion Assessment Tool-5 (SCAT-5) symptom reporting and gold-standard measures of anxiety and depression, and explored the utility SCAT-5 symptom subscales to identify anxiety and depression symptomology. DESIGN: Prospective cross-sectional study. SETTING: York University in Toronto, Canada. PARTICIPANTS: Preseason data were collected for varsity athletes (N = 296) aged between 17 and 25 years ( M = 20.01 years, SD = 1.69 years; 52% male). MAIN OUTCOME MEASURES: The SCAT-5 symptom evaluation scale was used to assess baseline symptoms. The Generalized Anxiety Disorder Index-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to assess symptoms of anxiety and depression, respectively. RESULTS: Endorsement of SCAT-5 symptoms of feeling anxious, sadness, irritability, and feeling more emotional had the strongest correlations with the GAD-7 ( r' s > 0.400; P' s < 0.001). Sadness, trouble falling asleep, concentration problems, feeling slowed down, anxious, irritability, mental fog, fatigue, and memory problems had the highest correlations with the PHQ-9 ( r' s >0 .400; P' s < 0.001). The Emotional subscale from the SCAT-5 predicted mild to severe anxiety on the GAD-7 ( P < 0.001). The Sleep, Cognitive, and Emotional subscales predicted mild to severe depression on the PHQ-9 ( P' s < 0.05). CONCLUSIONS: These findings provide better delineation of symptoms endorsed on the SCAT-5 symptoms that aid in identification of athletes with symptoms of anxiety or depression who may be at risk for developing a clinical disorder or experiencing persistent symptoms after a concussion.

Adjusting to life after pediatric stroke: A qualitative study.

AIM: To examine adjustment after stroke in adolescence from the perspective of affected young people. METHOD: Fourteen participants (10 female) aged 13 to 25 years with a history of ischemic or hemorrhagic stroke in adolescence participated in one-on-one semi-structured interviews at the Hospital for Sick Children, Toronto, Canada. Interviews were audio-recorded and transcribed verbatim. Two independent coders conducted a reflexive thematic analysis. RESULTS: Five themes were identified as representative of adjustment after stroke: (1) 'Processing the story'; (2) 'Loss and challenges'; (3) 'I've changed'; (4) 'Keys to recovery'; and (5) 'Adjustment and acceptance'. INTERPRETATION: This qualitative study provides medical professionals with a personal, patient-driven lens through which to better understand the challenges of adjusting to life after pediatric stroke. Findings highlight the need to provide mental health support to patients to assist them in processing their stroke and adapting to long-lasting sequelae. WHAT THIS PAPER ADDS: Processing the onset event is a key component of adjustment to stroke. Feelings of anxiety, sadness, frustration, and self-consciousness impede adjustment to stroke. Young people may feel overwhelmed academically owing to neurocognitive deficits. Sequelae may rid young people of hobbies and passions, and alter plans for the future. To adjust to stroke, survivors draw on resilience, patience, determination, and social support.

Acute Effects of Concussion in Adolescent Athletes With High Preseason Anxiety.

OBJECTIVE: To examine associations between pre-existing anxiety symptoms, and symptoms and cognitive functioning acutely following a suspected concussion. DESIGN: Nested case-control study. SETTING: High schools in Maine, USA. PARTICIPANTS: Participants were identified from a dataset of 46 920 student athletes ages 13 to 18 who received baseline preseason testing. A subset of 4732 underwent testing following a suspected concussion. Of those, 517 were assessed within 72 hours after their suspected concussion and met other inclusion criteria. Nineteen injured athletes endorsed anxiety-like symptoms on the Post-Concussion Symptom Scale (PCSS) during baseline testing and were placed in the high anxiety group. Each athlete was matched to 2 injured athletes who did not endorse high levels of anxiety-like symptoms (N = 57). MAIN OUTCOME MEASURES: Immediate Post-Concussion Assessment and Cognitive Testing cognitive composite scores, PCSS total score, and symptom endorsement. RESULTS: Cognitive composite scores were similar between groups across testing times ( = 0.004-0.032). The high anxiety group endorsed a greater number of symptoms than the low anxiety group ( = 0.452) and rated symptoms as more severe ( = 0.555) across testing times. Using a modified symptom score that excluded anxiety-like symptoms, a mixed analysis of variance indicated a group by injury interaction ( = 0.079); the high anxiety group reported greater increases in overall symptom severity following injury. CONCLUSIONS: Adolescent athletes who have an anxious profile at baseline are likely to experience greater symptom burden following injury. Consideration of pre-injury anxiety may inform clinical concussion management by tailoring intervention strategies (eg, incorporating mental health treatments) to facilitate concussion recovery.

Influence of Anxiety on Baseline Cognitive Testing and Symptom Reporting in Adolescent Student Athletes.

Anxiety symptoms are commonly endorsed by student athletes. This study examined the possible influence of anxiety on baseline cognitive testing and symptom reporting in a large sample of adolescent student athletes. Participants were 37,945 adolescent student athletes from the state of Maine who completed baseline testing using ImPACT®. ImPACT includes an evaluation of cognitive functioning and a questionnaire assessing the presence and severity of common post-concussion symptoms. Participants were divided into high and low anxiety groups based on endorsement of anxiety-like symptoms. Student athletes in the high anxiety group were more likely to be girls and to have a greater lifetime history of treatment for mental health problems and headaches (ps < 0.001). The high anxiety group scored slightly lower on cognitive tests (Cohen ds = 0.15-0.26) and reported a much greater amount of baseline pre-season symptoms (Cohen d = 3.38). More than eight of 10 youth in the high anxiety group (82.7%) met International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) symptom criteria for at least a mild form of the postconcussional syndrome compared with less than two of 10 (18.4%) in the low anxiety group. Students in the high anxiety group had slightly lower scores on neurocognitive testing, but the differences were not practically meaningful; however, they endorsed dramatically more physical, cognitive, and emotional symptoms. Anxiety can mimic the ICD-10 postconcussional syndrome in adolescent student athletes at baseline, when they have not been injured.

Academic outcome in pediatric ischemic stroke.

An important cause of acquired brain injury in children, pediatric ischemic stroke can cause sequelae across a wide range of cognitive domains, including verbal reasoning and processing speed. As a result, survivors are especially vulnerable to academic difficulties and face unique challenges compared to their peers. Despite this knowledge, pediatric stroke remains an understudied neurological condition, and its impact on school functioning poorly understood. The present clinical study addressed academic outcome in this population using a multifaceted approach. Patients were recruited for participation from the Children's Stroke Program at the Hospital for Sick Children in Toronto, Canada. A battery of standardized neuropsychological tests was administered, and additional data was collected through parent-rated measures and review of recent academic report cards. Compared to peers, youth with stroke exhibited deficits in processing speed, verbal reasoning, and core academic skills spanning reading, reading comprehension, writing, and math. Lesion laterality did not affect cognitive and academic scores. Youth with a combined cortical-subcortical lesion scored lower on a test of nonverbal reasoning compared to youth with either cortical or subcortical lesions. Compared to healthy peers, the pediatric stroke group was more likely to report requiring extra help at school, accommodations, individual education plans, and assistive technology. They were also more likely to be diagnosed with a learning disability, but not Attention Deficit/Hyperactivity Disorder. Nonverbal reasoning skills, school grades, and school-related quality of life were comparable between groups. The present study contributed to a more nuanced understanding of the impact of pediatric stroke on academic outcome.

A Qualitative Exploration of the Experiences of Children and Adolescents with Tourette Syndrome.

OBJECTIVE: The purpose of this qualitative study was to explore the experiences of youth with Tourette Syndrome (TS). METHOD: Thirteen participants with TS were recruited from a large tertiary care hospital to complete semi-structured interviews and two questionnaires pertaining to demographic information and tic severity. Thematic analysis was utilized to systematically analyze the data. RESULTS: Three main themes were identified: 1) beliefs about TS; 2) TS related distress and impairment; and, 3) coping with TS. CONCLUSION: The findings from this study suggest that most participants were aware of their tics but unaware of the cause of tics/TS. The interviews also highlighted that, for most participants, TS caused emotional, social, physical, and/or occupational impairment. Despite their distress, participants provided several suggestions for coping with TS and for supporting those who are diagnosed with this condition.

OBJECTIF: Cette étude qualitative visait à explorer les expériences des adolescents souffrant du syndrome de Gilles de La Tourette (SGT). MÉTHODE: Treize participants souffrant du SGT ont été recrutés dans un grand hôpital de soins tertiaires pour répondre à des entrevues semi-structurées et à deux questionnaires portant sur les données démographiques et la gravité des tics. Une analyse thématique a servi à analyser systématiquement les données. RÉSULTATS: Trois thèmes principaux se sont dégagés: 1) les croyances sur le SGT; 2) la détresse et la déficience liées au SGT, 3) l'adaptation au SGT. CONCLUSION: Les résultats de cette étude suggèrent que la plupart des participants étaient conscients de leurs tics mais pas de la cause des tics et du SGT. Les entrevues ont aussi révélé que pour la plupart des participants, le SGT causait une déficience émotionnelle, sociale, physique, et/ou professionnelle. Malgré leur détresse, les participants ont fourni plusieurs suggestions pour s'adapter au SGT et soutenir ceux qui reçoivent un diagnostic de cette affection.

Transcultural Factors in Hypnotizability Scales: Limits and Prospects.

Hypnotic suggestibility--loosely termed hypnotizability--is difficult to assess across cultures. Investigators often use translated research instruments to guide their inquiry in disparate geographic locations. Present-day hypnosis researchers rely heavily on two primary scales that are more than half a century old: the Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C) (Weitzenhoffer & Hilgard, 1959) and the Harvard Group Scale of Hypnotic Susceptibility: Form A (HGSHS:A) (Shor & Orne, 1962). Scholars typically translate these scales to measure hypnotizability transculturally. This approach, however, operates under the specious assumption that the concept of hypnotizability is largely monolithic or universal across cultures. Whereas translations likely conserve the linguistic content, they may arguably imply different cultural meanings and historical subtexts. Whereas social scientists acknowledge the importance of qualitative and phenomenological accounts in the study of altered consciousness, including suggestibility, researchers interested in hypnotizability consider the impact of findings from anthropology and ethnography too little. Clinicians and scholars of hypnosis would stand to benefit from incorporating the insights afforded by transcultural research in the overarching investigation of a concept as nuanced as hypnotizability.