The diagnosis of ADHD in children and adolescents with epilepsy: a scoping review.

Attention-deficit hyperactivity disorder (ADHD) is often diagnosed in children and adolescents with epilepsy, but clear clinical guidelines on how to make this diagnosis are still lacking. Without these guidelines, there is no consensus between specialists on how to proceed when assessing children with epilepsy for ADHD, which can negatively impact the quality of care being offered to this population. As a first step toward gaining more specific clinical guidelines, this scoping review was aimed at documenting the tools and procedures used to diagnose ADHD in children and adolescents with epilepsy over time and at determining whether the diagnoses were made in accordance with clinical guidelines and recommendations. The literature search was conducted using PsycINFO, PubMed, and CINAHL. Studies were included if conducted with children and adolescents aged between 4 and 18 years with epilepsy being evaluated for ADHD. Studies were clustered according to their publication date and the reported diagnostic procedures were identified. Forty-nine out of 3854 records were included. Results highlight discrepancies between how ADHD was diagnosed in reviewed studies and clinical guidelines or recommendations. Indeed, most studies did not use a multi-method and multi-informant approach when diagnosing ADHD in children with epilepsy, with no improvement over time. Future studies aimed at diagnosing ADHD in children and adolescents should ensure that they are following clinical guidelines and recommendations, in addition to adapting their diagnostic procedures to the presence of any neurological comorbidities, such as epilepsy.

Psychosocial Factors Associated With Time to Recovery After Concussion in Adolescent Ice Hockey Players.

OBJECTIVE: To investigate the association between psychosocial factors and physician clearance to return to play (RTP) in youth ice hockey players after sport-related concussion. DESIGN: Prospective cohort study, Safe to Play (2013-2018). SETTING: Youth hockey leagues in Alberta and British Columbia, Canada. PARTICIPANTS: Three hundred fifty-three ice hockey players (aged 11-18 years) who sustained a total of 397 physician-diagnosed concussions. INDEPENDENT VARIABLES: Psychosocial variables. MAIN OUTCOME MEASURES: Players and parents completed psychosocial questionnaires preinjury. Players with a suspected concussion were referred for a study physician visit, during which they completed the Sport Concussion Assessment Tool (SCAT3/SCAT5) and single question ratings of distress and expectations of recovery. Time to recovery (TTR) was measured as days between concussion and physician clearance to RTP. Accelerated failure time models estimated the association of psychosocial factors with TTR, summarized with time ratios (TRs). Covariates included age, sex, body checking policy, days from concussion to the initial physician visit, and symptom severity at the initial physician visit. RESULTS: Self-report of increased peer-related problems on the Strengths and Difficulties Questionnaire (TR, 1.10 [95% CI, 1.02-1.19]), higher ratings of distress about concussion outcomes by participants (TR, 1.06 [95% CI, 1.01-1.11]) and parents (TR, 1.05 [95% CI, 1.01-1.09]), and higher parent ratings of distress about their child's well-being at the time of injury (TR, 1.06 [95% CI, 1.02-1.09]) were associated with longer recovery. CONCLUSIONS: Greater pre-existing peer-related problems and acute distress about concussion outcomes and youth well-being predicted longer TTR. Treatment targeting these psychosocial factors after concussion may promote recovery.

Psychopathology and mind wandering in young university students.

Mind wandering has often been studied in relation to psychopathology. However, debates remain as to whether sluggish cognitive tempo, recently termed cognitive disengagement syndrome (CDS), and ADHD symptoms could be unique predictors of mind wandering. Therefore, this study was aimed at documenting the associations between CDS, ADHD symptoms and mind wandering while controlling for age, sex, internalized symptoms, and sleep. A sample consisting of university students (N = 60; aged between 17 and 32 years; 65% female) completed measures of CDS, ADHD symptoms, internalized functioning and insomnia. Mind wandering was also assessed using the 5-item Mind Wandering Questionnaire (MWQ) and thought sampling during a reading task. Multiple regression analyses show that while younger age and inattention were significant predictors of greater levels of self-reported mind wandering on the MWQ, sex, CDS, hyperactivity/impulsivity, internalized symptoms, and sleep were not. In addition, no variables were able to significantly predict spontaneous and deliberate mind wandering as assessed by thought sampling. These findings raise important questions regarding the equivalence between measures of state-level and trait-level mind wandering. The associations between ADHD, CDS and mind wandering in young adults are still unclear, but our findings highlight critical methodological considerations for future studies that might further our understanding of the relationship between task-unrelated thought and psychopathology.

Community Social Paediatrics Approach, an Innovative Healthcare Intervention: Implementation Fidelity in Atlantic Canada.

The Community Social Paediatrics approach (CSPA) is a comprehensive and personalized approach to care that is becoming more widely used throughout Canada. However, data on its implementation fidelity remain scarce. The purpose of this research was to assess the implementation fidelity of a CSPA established in 2017 in Canada. Data were collected through focus group interviews with the CSPA team using an implementation fidelity grid based on the Dr. Julien Foundation standard accreditation criteria. Results showed that on one hand, administrative and financial management and governance were among those domains with lower ratings. On the other hand, assessment/orientation and follow-up/support had high levels of fidelity of implementation. This research helps to better understand which factors are contributing to varying levels of fidelity of implementation. To reach an increased level of fidelity of implementation, it is recommended that adequate resources be in place.

Symptoms of depression and anxiety increased marginally from before to during the COVID-19 pandemic among young adults in Canada.

We documented changes in depressive and anxiety symptoms from before to during the COVID-19 pandemic among young adults and investigated whether changes differed across participant characteristics. Data were available in an investigation of 1294 grade 7 students recruited in 1999-2000. For this analysis, we used data collected pre-pandemically in 2017-20 (mean (SD) age = 30.6 (1.0)) and during the pandemic in 2020-21 (mean (SD) age = 33.6 (0.6)). 673 participants with data in both cycles were retained for analysis. Symptoms were measured using the Major Depression Inventory (MDI) and the Generalized Anxiety Disorder-7 (GAD-7) scale. Standardized mean differences (SMD) of changes in MDI and GAD-7 values between cycles were calculated across participant characteristics. On average, MDI scores increased by 2.1 (95%CI 1.4, 2.8) points during the pandemic from mean 10.5; GAD-7 scores increased by 1.2 (0.8, 1.5) points from mean 4.7. The SMD was 0.24 (0.14, 0.33) for MDI, and 0.24 (0.13, 0.34) for GAD-7. No differences in MDI change scores were observed across participant characteristics. Differences in GAD-7 change scores were observed by mood/anxiety disorder (SMD - 0.31 (- 0.58, - 0.05)), household income (0.24 (0.02, 48)), living with young children (- 0.56 (- 1.23,- 0.05)), and adherence to public health recommendations 0.58 (0.19, 1.03)). Increases in depressive and anxiety symptoms were observed 10-16 months into the COVID-19 pandemic among adults age 32-36.

Parental Knowledge, Self-confidence, and Usability Evaluation of a Web-Based Infographic for Pediatric Concussion: Multimethod Study.

BACKGROUND: Concussions, which are known as mild traumatic brain injuries, are complex injuries caused by direct or indirect blows to the head and are increasingly being recognized as a significant public health concern for children and their families. Previous research has identified few studies examining the efficacy of educational interventions on parental concussion knowledge. The aim of this research was to actively work together with children who have experienced a concussion and their parents to develop, refine, and evaluate the usability of a web-based infographic for pediatric concussion. OBJECTIVE: The objective of this study was to report on the usability of the infographic, parental knowledge, and self-confidence in pediatric concussion knowledge before and after exposure to the infographic. METHODS: A multiphase, multimethod research design using patient engagement techniques was used to develop a web-based infographic. For this phase of the research (usability, knowledge, and confidence evaluation), parents who could communicate in English were recruited via social media platforms and invited to complete web-based questionnaires. Electronic preintervention and postintervention questionnaires were administered to parents to assess changes to concussion knowledge and confidence after viewing the infographic. A usability questionnaire with 11 items was also completed. RESULTS: A web-based, infographic was developed. The infographic is intended for parents and children and incorporates information that parents and children identified as both wants and needs about concussion alongside the best available research evidence on pediatric concussion. A total of 31 surveys were completed by parents. The mean scores for each item on the usability surveys ranged from 8.03 (SD 1.70) to 9.26 (SD 1.09) on a 10-point Likert scale, indicating that the usability components of the infographic were largely positive. There was no statistically significant difference between preintervention and postintervention knowledge scores (Z=-0.593; P=.55; both preintervention and postintervention knowledge scores had a median of 9 out of 10). In contrast, there was a statistically significant difference between preintervention (mean 3.9/5, SD 0.56) and postintervention (mean 4.4/5, SD 0.44) confidence in knowledge scores (t30=-5.083; P<.001). CONCLUSIONS: Our results demonstrate that parents positively rated a web-based, infographic for pediatric concussion. In addition, although there was no statistically significant difference overall in parents' knowledge scores before and after viewing the infographic, their confidence in their knowledge did significantly increase. These results suggest that using a web-based infographic as a knowledge translation intervention may be useful in increasing parents' confidence in managing their child's concussion.

Perceptions of Symptom Duration are Associated With Emotional Distress and Functioning in Adolescents With Protracted Concussion Recovery.

Adolescents with persisting post-concussive symptoms often report high levels of emotional distress, which can impact their daily functioning. The associations between modifiable factors, such as perceptions of recovery, and emotional distress have not been investigated in this age group. OBJECTIVE: To evaluate perceptions about recovery duration (e.g., "my symptoms will last a long time", "my symptoms will be permanent rather than temporary") and its associations with emotional distress and functioning in children and adolescents with a slower post-concussive recovery. METHODS: Participants (N = 49, 69% girls, 11-17 years old, M = 15.8 years old, SD = 1.8) were recruited from a concussion clinic on average 7.7 months after injury (SD = 2.5). Measures included the Illness Perception Questionnaire Revised (perceived duration of symptoms only) to evaluate recovery expectations, the Health and Behavior Inventory (self and parent reports) to evaluate current post-concussive symptoms (cognitive and somatic symptoms), the emotional distress subscale of the Strengths and Difficulties Questionnaire (SDQ-self-report), and the emotional functioning subscale of the Pediatric Quality of Life Questionnaire (PedsQL-self-report). RESULTS: Regression analyses (linear models with all covariates entered at once) suggested that greater expectations for symptom persistence were significantly associated with higher emotional distress on both SDQ and PedsQL subscales, after controlling for post-concussive symptom severity and other confounds. Emotional distress/functioning was not associated with perceptions of symptom duration reported by parents, severity of post-concussive symptoms (self- and parent reports), age, number of concussions, time since injury, or a history of mental health concern or diagnosis (parent-reported). CONCLUSIONS: This study suggests that pessimistic attitudes for recovery duration may be more strongly associated with emotional distress than current post-concussive symptom severity or a history of mental health concern or diagnosis.

Psychoeducational Interventions and Postconcussive Recovery in Children and Adolescents: A Rapid Systematic Review.

OBJECTIVE: The purpose of this rapid systematic review was to identify and synthesize results of empirical studies that have examined psychoeducational interventions provided to children and adolescents aged 5-19 recovering from a concussion and their families. METHODS: This study followed the PRISMA guidelines adjusted for a rapid systematic review. We searched three databases (EMBASE, PsycInfo and MEDLINE) with key terms for concussion (or mild traumatic brain injury - mTBI), the intervention (psychoeducation, instructions, and reassurance) and the target population (children and adolescents aged 5 to 19). Our search strategy generated 2225 unique records and seven were included. We performed a quality appraisal on the included studies using the Mixed Methods Appraisal Tool (MMAT). RESULTS: Results indicated that psychoeducational interventions had satisfactory feasibility results. Caregivers generally found the intervention to be useful to determine return to play (n=2) and understand consequences following a concussion (n=1). However, results from studies on post-concussive symptom improvement (n=4) and post-intervention concussion knowledge (n=2) showed variability and mixed findings. Methodological quality was low for most studies. CONCLUSIONS: This present review shows that there are very few published studies on psychoeducational interventions offered to children, adolescents, and families for the post-concussion management. Current evidence suggests that those interventions are useful in guiding caregivers during their child's recovery. However, the impact of psychoeducational interventions on post-concussive recovery seems to be less clear.

"You Can't Fix Your Brain": Exploring concussion experiences of children and parents.

PURPOSE: To explore the experiences, information needs and preferences of children who have had a concussion and their parents who have cared for them. DESIGN: Qualitative description. METHODS: Semi-structured qualitative interviews were conducted via Zoom with children who have had a concussion between ages 5 and 16 years and parents who have cared for a child with a concussion. Interviews were audio-recorded and transcribed. RESULTS: Fourteen interviews were conducted with children and parents who have experiences with concussion. Four major themes were identified: (1) mechanism of injury and concussion symptoms experienced by children, (2) parent concerns, emotions, and health care experience with child's concussion, (3) concussions affect more than just your head and, (4) health information seeking, and preferences of parents and children related to concussion. Children and their parents have unique experiences, information needs and preferences regarding concussion. PRACTICE IMPLICATIONS: This information offers valuable insights about developing resources about childhood concussion that parents and children will find useful and relevant. This research has direct relevance to healthcare professionals who may encounter children with concussion in their daily practice so they can ensure the needs of children and families are being met. Our findings will be used to create the content for an innovative knowledge translation tool about pediatric concussion.

Demographic and Clinical Presentations of Youth using Enhanced Mental Health Services in Six Indigenous Communities from the ACCESS Open Minds Network.

OBJECTIVE: In many Indigenous communities, youth mental health services are inadequate. Six Indigenous communities participating in the ACCESS Open Minds (AOM) network implemented strategies to transform their youth mental health services. This report documents the demographic and clinical presentations of youth accessing AOM services at these Indigenous sites. METHODS: Four First Nations and two Inuit communities contributed to this study. Youth presenting for mental health services responded to a customized sociodemographic questionnaire and presenting concerns checklist, and scales assessing distress, self-rated health and mental health, and suicidal thoughts and behaviors. RESULTS: Combined data from the First Nations sites indicated that youth across the range of 11-29 years accessed services. More girls/women than boys/men accessed services; 17% identified as LBGTQ+. Most (83%) youth indicated having access to at least one reliable adult and getting along well with the people living with them. Twenty-five percent of youth reported difficulty meeting basic expenses. Kessler (K10) distress scores indicated that half likely had a moderate mental health problem and a fourth had severe problems. Fifty-five percent of youth rated their mental health as fair or poor, while 50% reported suicidal thoughts in the last month. Anxiety, stress, depression and sleep issues were the most common presenting problems. Fifty-one percent of youth either accessed services themselves or were referred by family members. AOM was the first mental health service accessed that year for 68% of youth. CONCLUSIONS: This report is the first to present a demographic and clinical portrait of youth presenting at mental health services in multiple Indigenous settings in Canada. It illustrates the acceptability and feasibility of transforming youth mental health services using core principles tailored to meet communities' unique needs, resources, and cultures, and evaluating these using a common protocol. Data obtained can be valuable in evaluating services and guiding future service design. Trial registration name and number at Clinicaltrials.gov: ACCESS Open Minds/ACCESS Esprits ouverts, ISRCTN23349893.

Functional magnetic resonance imaging study of working memory several years after pediatric concussion.

PRIMARY OBJECTIVE: The neurophysiological effects of pediatric concussion several years after injury remain inadequately characterized. The objective of this study was to determine if a history of concussion was associated with BOLD response differences during an n-back working memory task in youth. RESEARCH DESIGN: Observational, cross-sectional. METHODS AND PROCEDURES: Participants include 52 children and adolescents (M = 15.1 years, 95%CI = 14.4-15.8, range = 9-19) with past concussion (n = 33) or orthopedic injury (OI; n = 19). Mean time since injury was 2.5 years (95%CI = 2.0-3.0). Measures included postconcussion symptom ratings, neuropsychological testing, and blood-oxygen-dependent-level (BOLD) functional magnetic resonance imaging (fMRI) during an n-back working memory task. MAIN OUTCOMES AND RESULTS: Groups did not differ on accuracy or speed during the three n-back conditions. They also did not differ in BOLD signal change for the 1- vs. 0-back or 2- vs. 0-back contrasts (controlling for task performance). CONCLUSIONS: This study does not support group differences in BOLD response during an n-back working memory task in youth who are on average 2.5 years post-concussion. The findings are encouraging from the perspective of understanding recovery after pediatric concussion.

Microstructure of the Corpus Callosum Long after Pediatric Concussion.

OBJECTIVE: The long-term effects of pediatric concussion on white matter microstructure are poorly understood. This study investigated long-term changes in white matter diffusion properties of the corpus callosum in youth several years after concussion. METHODS: Participants were 8-19 years old with a history of concussion (n = 36) or orthopedic injury (OI) (n = 21). Mean time since injury for the sample was 2.6 years (SD = 1.6). Participants underwent diffusion magnetic resonance imaging, completed cognitive testing, and rated their post-concussion symptoms. Measures of diffusivity (fractional anisotropy, mean, axial, and radial diffusivity) were extracted from white matter tracts in the genu, body, and splenium regions of the corpus callosum. The genu and splenium tracts were further subdivided into 21 equally spaced regions along the tract and diffusion values were extracted from each of these smaller regions. RESULTS: White matter tracts in the genu, body, and splenium did not differ in diffusivity properties between youth with a history of concussion and those with a history of OI. No significant group differences were found in subdivisions of the genu and splenium after correcting for multiple comparisons. Diffusion metrics did not significantly correlate with symptom reports or cognitive performance. CONCLUSIONS: These findings suggest that at approximately 2.5 years post-injury, youth with prior concussion do not have differences in their corpus callosum microstructure compared to youth with OI. Although these results are promising from the perspective of long-term recovery, further research utilizing longitudinal study designs is needed to confirm the long-term effects of pediatric concussion on white matter microstructure.

How Perceptions Impact Recovery from Concussion in Childhood and Adolescence: a Systematic Review.

Perceptions about the causes and consequences of concussion, and individual representations and interpretations of these factors, can influence the post-concussive recovery process. The goal of this project was to synthesize evidence on perceptions related to concussions as experienced by children, adolescents, and parents, and to evaluate how these perceptions impact post-concussive recovery in physical, behavioural, cognitive, and psychological domains. We undertook a systematic review based on the Cochrane Handbook, conducting a comprehensive search of six databases and Google Scholar. Duplicate, independent screening was employed and the quality of studies was assessed using the Mixed Methods Appraisal Tool (MMAT). A total of 1552 unique records were identified, and six records (5 scientific articles and 1 thesis, published between 1990 and 2018; N = 26 to 412, age range from 2 to 18 years) were included. Perceptions about concussions were assessed differently between studies, with a range in types of measures and respondents. Some evidence suggested that perceptions could negatively impact concussion recovery, mostly post-concussive symptoms. However, results were not consistent between studies and the methodological quality was variable (and often low). There is limited evidence of the impact of perceptions of children, adolescents, and their parents on concussion recovery. Priorities for future research investigating concussion recovery should include recruiting representative samples, accounting for potential confounders, and measuring perceptions in children, adolescents and parents using validated measures. Higher quality studies are needed to better understand the role of perceptions in concussion recovery and to inform clinical care.

Headache long after pediatric concussion: presence, intensity, interference, and association with cognition.

Objective: Document headache presence, intensity, and interference after concussion(s), as well as examine its association with cognition.Participants: Participants 8-19 years of age were assessed on average 34 months (SD = 21.5) after an orthopedic injury (OI, n = 29), single concussion (n = 21), or multiple concussions (n = 15).Measures: Headache intensity was rated using the Headache Rating Scale and headache interference was rated using the Post-Concussion Symptom Inventory (PCSI). Cognition was rated using the PCSI and measured using CNS Vital Signs.Results: Type of injury did not differ significantly in headache presence or intensity. However, there was a dose-response relationship found for children's ratings of headache interference, which was rated highest among children with multiple concussions, intermediate among those with single concussion, and lowest among children with OI. Both headache intensity and interference ratings correlated significantly with self and parent ratings of cognition on the PCSI, but not with cognitive test performance.Conclusions: Youth with single or multiple concussions report greater headache interference - but not higher headache intensity - compared to youth without concussion. Although higher headache intensity and interference were associated with more self-reported cognitive symptoms, headaches did not correlate with cognitive test performance.

A Pilot Randomized Controlled Trial of Cognitive-Behavioral Therapy for Insomnia in Adolescents With Persistent Postconcussion Symptoms.

OBJECTIVE: Cognitive-behavioral therapy for insomnia (CBT-I) is an effective insomnia treatment but has yet to be applied to adolescents with sleep disruption following concussion. This pilot study evaluated CBT-I to improve insomnia in adolescents with protracted concussion recovery. SETTING: Tertiary pediatric hospital. PARTICIPANTS: Participants (N = 24) were 12 to 18 years old (M = 15.0, SD = 1.4), 15.1 weeks (SD = 9.2) postinjury, and presenting with sleep disruption and persistent postconcussion symptoms. DESIGN: A single-blind, parallel-group randomized controlled trial (RCT) design comparing 6 weeks of CBT-I and a treatment-as-usual control group. Outcomes were measured before treatment, at treatment completion, and 4 weeks after completion. MAIN MEASURES: Primary outcome was Insomnia Severity Index. Secondary outcomes included Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes about Sleep Scale, 7-night sleep diary, PROMIS Depression, PROMIS Anxiety, and Health and Behavior Inventory. RESULTS: Adolescents who received CBT-I demonstrated large and clinically significant improvements in insomnia ratings at posttreatment that were maintained at follow-up. They also reported improved sleep quality, fewer dysfunctional beliefs about sleep, better sleep efficiency, shorter sleep-onset latency, and longer sleep time compared with those with treatment as usual. There was also a modest reduction in postconcussion symptoms. CONCLUSION: In this pilot RCT, 6 weeks of CBT-I produced significant improvement in sleep in adolescents with persistent postconcussion symptoms. A larger trial is warranted.

Factor structure of the CNS Vital Signs computerized cognitive battery in youth with neurological diagnoses.

Computerized cognitive batteries, such as CNS Vital Signs (CNSVS), can provide valuable information in clinical and research settings. However, psychometric properties, especially in children and adolescents, remain relatively understudied. The aim of this study was to investigate the factor structure of CNSVS in children and adolescents with neurological diagnoses. Participants with neurological diagnoses (N = 280) age 7-19 years were assessed as part of their clinical care at a tertiary hospital. All participants received the full CNSVS computerized cognitive battery, which contains seven subtests designed to measure attention, executive functioning, psychomotor speed, and memory. Principal components analyses were used to examine factor structure. Scores from CNSVS subtests loaded onto a three-component solution and accounted for 46% of the variance. The three components were deemed to best represent (1) speed, (2) memory, and (3) inhibition, with subtest scores loading differently than the original 11 primary and secondary domain scores would have suggested. Although the CNSVS program generates numerous primary and secondary domain scores, a three-component solution represents a more parsimonious approach to interpreting performance on the CNSVS in youth with neurological diagnoses. Confirmation of this factor solution in other samples is warranted.

Evaluating anxiety and depression symptoms in children and adolescents with prior mild traumatic brain injury: Agreement between methods and respondents.

Psychological functioning can be adversely impacted after a mild traumatic brain injury (mTBI) and may be a potential target for intervention. Despite the use of symptom ratings or structured diagnostic interview to assess long-term anxiety and depression symptoms in children and adolescents post-injury, no known studies have considered the agreement between different assessment methods and between respondents. The objectives of this study were to investigate the agreement between symptom ratings and structured diagnostic interview and between children and parents' symptom reporting. Participants (N = 33; 9-18 years old) were recruited from the Emergency Department and assessed on average 22.8 months (SD = 5.6) after their mTBI. Anxiety and depression symptoms were evaluated via subscales of a questionnaire (Behavior Assessment System for Children) and parts of a computerized structured diagnostic interview (generalized anxiety disorder and major depressive episode; Diagnostic Interview Schedule for Children - C-DISC-IV) administered individually to children and their parents. Results showed that the inter-method agreement to identify high levels of anxiety and depression was moderate to perfect in children while it was lower in parents. Although a similar percentage of participants with elevated anxiety or depression were identified by both children and parents, the agreement between youth and parents was variable, ranging from poor to good for anxiety and poor to moderate for depression. These results highlight the importance of collecting youth and parents' reports of anxiety and depression symptoms and considering potential discrepancies between informants' answers.

Cerebral blood flow in children and adolescents several years after concussion.

OBJECTIVES: The long-term effects of concussion in youth remain poorly understood. The objective of this study was to determine the association between history of concussion and cerebral blood flow (CBF) in youth. METHODS: A total of 53 children and adolescents with a history of concussion (n = 37) or orthopaedic injury (OI; n = 16) were considered. Measures included pseudo-continuous arterial spin labelling magnetic resonance imaging to quantify CBF, post-concussion symptoms, psychological symptoms, and cognitive testing. RESULTS: Participants (mean age: 14.4 years, 95% CI = 13.8-15.4, range = 8-19) were on average 2.7 years (95% CI = 2.2-3.1) post-injury. Youth with a history of concussion had higher parent-reported physical, cognitive, anxiety, and depression symptoms than children with OI, but the groups did not differ on self-reported symptoms (post-concussive or psychological) or cognitive testing. Global CBF did not differ between groups. Regional CBF analyses suggested that youth with a history of concussion had hypoperfusion in posterior and inferior regions and hyperperfusion in anterior/frontal/temporal regions as compared to those with OI. However, neither global nor regional CBF were significantly associated with demographics, pre-injury functioning, number of concussions, time since injury, post-concussive symptoms, psychological symptoms, or cognitive abilities. CONCLUSIONS: Youth with a history of concussion demonstrate differences in regional CBF (not global CBF), but without clear clinical expression.

Predicting Psychological Distress after Pediatric Concussion.

A significant proportion of children and adolescents report psychological distress following concussion, but little is known about the predictors of these problems. The purpose of this study was to examine predictive factors of psychological distress following pediatric concussion. It was hypothesized that the presence of pre-injury psychological distress would be the strongest predictor of psychological distress post-concussion, with other demographic and acute injury factors adding incrementally to prediction. This is a prospective, multi-center cohort. Children and adolescents (6-17 years old; n = 311) who sustained a concussion and were assessed through four pediatric emergency departments. Participants were reassessed at 4-weeks (n = 275) and 12-weeks (n = 190) post-injury. Emergency department (ED) assessment documented injury mechanism, acute symptomatology, acute cognitive functioning, and pre-injury functioning. Psychological distress at 4- and 12-weeks follow-up was categorized as present if one or more psychological scores from the parent-completed measures (Child Behavior Checklist, Strengths and Difficulties Questionnaire) exceeded established cutoffs. The presence of psychological distress at each follow-up was predicted using multi-variable logistic regressions. Psychological distress was reported in 23% of youth at both 4- and 12-weeks post-concussion. A pre-injury diagnosis of anxiety and acutely forgetting recent information were significant predictors of psychological distress at 4 weeks, whereas worse acute orientation assessment in the ED predicted psychological distress at 12 weeks. Nearly one of four youth experienced psychological distress after concussion. Clinicians in acute care settings should screen for the factors (pre-injury anxiety, acute mental status) associated with post-injury psychological distress and consider proactively referring patients for further assistance.