Altered resting-state functional connectivity within the developing social brain after pediatric traumatic brain injury.

Traumatic brain injury (TBI) in childhood and adolescence can interrupt expected development, compromise the integrity of the social brain network (SBN) and impact social skills. Yet, no study has investigated functional alterations of the SBN following pediatric TBI. This study explored functional connectivity within the SBN following TBI in two independent adolescent samples. First, 14 adolescents with mild complex, moderate or severe TBI and 16 typically developing controls (TDC) underwent resting-state functional magnetic resonance imaging 12-24 months post-injury. Region of interest analyses were conducted to compare the groups' functional connectivity using selected SBN seeds. Then, replicative analysis was performed in an independent sample of adolescents with similar characteristics (9 TBI, 9 TDC). Results were adjusted for age, sex, socioeconomic status and total gray matter volume, and corrected for multiple comparisons. Significant between-group differences were detected for functional connectivity in the dorsomedial prefrontal cortex and left fusiform gyrus, and between the left fusiform gyrus and left superior frontal gyrus, indicating positive functional connectivity for the TBI group (negative for TDC). The replication study revealed group differences in the same direction between the left superior frontal gyrus and right fusiform gyrus. This study indicates that pediatric TBI may alter functional connectivity of the social brain. Frontal-fusiform connectivity has previously been shown to support affect recognition and changes in the function of this network could relate to more effortful processing and broad social impairments.

Impact of Moderate Exercise on Post-concussive Symptoms and Cognitive Function after Concussion in Children and Adolescents Compared to Healthy Controls.

Resolution of post-concussive symptoms (PCS) is a marker of recovery. However, it is unclear whether subtle impairments re-emerge in the context of increased demands. This study examined the effect of strenuous exercise on clinical symptoms and cognitive efficiency in children and adolescents after PCS resolution following concussion. We recruited concussed children and adolescents (n=30) on presentation to an Emergency Department (ED), and compared them to community-sourced non-injured controls (n=30), matched for age, and cognitive function. At Day 2 post symptom resolution, concussed participants (and controls) completed an exercise protocol, and pre- and post exercise assessments of PCS and computer-based cognitive efficiency. Findings demonstrated that, compared to controls, participants with recent concussion showed an overall reduction in PCS post-exercise (p=0.048), less impact of exercise on PCS than controls (p=0.021), and faster reaction times on computer-based cognitive tasks, even where cognitive demands were high (ps<0.05). These results provide preliminary support for the use of moderate exercise for the reduction of concussion post-symptom, as suggested in recent clinical guidelines.

Cognitive and physical symptoms of concussive injury in children: a detailed longitudinal recovery study.

BACKGROUND: Recovery from concussion sustained in childhood and adolescence is poorly understood. We explored patterns of recovery for neurocognition and postconcussive symptoms following concussion in children and adolescents. METHODS: Using a prospective, longitudinal design, we collected baseline data on 728 children and adolescents aged 10-17 years. 10 participants sustained a concussive injury (n=10) in the 12 months following baseline testing and they were reviewed at day 5, 10 and 30 postconcussion. Assessments included the CogSport for Kids computerised test battery to evaluate neurocognitive function and self-report, and parent measures of postconcussive symptoms. At day 30, parents also completed measures rating their child's quality of life and executive functions. RESULTS: Children and adolescents displayed a gradual reduction in postconcussive symptoms over the 30 days following injury. At day 5, 87% of participants were reporting physical and cognitive symptoms, with a generalised reduction in all symptoms by day 10 (40% of participants). On the computerised measure, reaction time was slower after concussion, but returned to baseline levels by day 30. At day 30, 10% of participants demonstrated ongoing postconcussive symptoms. Number of previous concussions was related to speed of symptom resolution. CONCLUSIONS: At 5 days postconcussion, the majority of children and adolescents experienced debilitating postconcussive symptoms. However, by 30 days postinjury, 90% demonstrated recovery to normal for both neurocognition and postconcussive symptoms.

Deep phenotyping of socio-emotional skills in children with typical development, neurodevelopmental disorders, and mental health conditions: Evidence from the PEERS.

OBJECTIVE: Socio-emotional skills, including social competence and social cognition, form the basis for robust relationships and wellbeing. Despite their importance, these skills are poorly defined and measured, particularly in children with developmental vulnerabilities. As a consequence, targets for effective management and treatment remain unclear. We aimed to i) phenotype social competence and social cognition in typically developing children (TDC) and in children with neurodevelopmental or mental health disorders (clinical groups) and ii) establish the relationships between these child-direct measures and parent ratings of social competence and behavior. METHOD: Using a multi-site, cross-sectional study design, we recruited 513 TDC and 136 children with neurodevelopmental (autism spectrum disorder [ASD], attention deficit hyperactivity disorder [ADHD]) or mental health (Anxiety Disorder [ANX]) diagnoses (age range 5-15 years). We administered the Paediatric Evaluation of Emotions, Relationships and Socialisation (PEERS) to children, and parents completed standardised questionnaires rating children's socio-emotional function. RESULTS: Standardised parent questionnaires revealed a global pattern of everyday socio-emotional impairment that was common to all clinical groups, while PEERS identified disorder-specific socio-cognitive profiles for children with ASD, ADHD and ANX. Compared to TDCs, children with ASD demonstrated global socio-cognitive impairment. Children with ADHD were impulsive, demonstrating difficulties managing speed accuracy trade-offs. Children with ANX exhibited slowed social decision-making, but otherwise intact skills. CONCLUSIONS: Standardized parent questionnaires of child socio-emotional function reveal differences between children with typical and atypical development, but do not yield disorder-specific, socio-emotional profiles. In contrast, findings from the PEERS objective assessment suggest that that ASD, ADHD and ANX are associated with distinct socio-cognitive phenotypes, to more accurately guide and target management and treatment of impaired social competence.

Aggression after paediatric traumatic brain injury: a theoretical approach.

PRIMARY OBJECTIVE: To examine aggression in adolescent males with and without traumatic brain injury (TBI). DESIGN: Quasi-experimental, matched-participants design. METHODS: Thirty-nine adolescents were examined, including a TBI group (n = 11) and a matched, uninjured comparison group (n = 28). Participants with TBI were injured an average of 8.3 years (SD = 4.2 years) prior. Participants and parents completed the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL), both measures of global psychopathology. In addition, the theoretically-driven Reactive and Proactive Aggression Questionnaire (RPQ) and the Form of Aggression Scale (FAS) were completed. MAIN OUTCOMES AND RESULTS: When compared using the YSR and CBCL, no group differences were detected. In contrast, using the self-report RPQ, participants with TBI reported more reactive and proactive aggression than non-injured peers. Using the FAS, participants with TBI reported engaging in aggression out of frustration and not to dominate or acquire objects. CONCLUSION: Aggressive behaviours are a long-term outcome after paediatric TBI. Measures of global psychopathology do not permit detailed examination of specific behaviour problems such as aggression, which may provide inaccurate data from which to derive incidence rates. In contrast, theoretically-driven measures can provide greater insight into post-TBI aggression with important treatment implications.

Protocol for a prospective, school-based standardisation study of a digital social skills assessment tool for children: The Paediatric Evaluation of Emotions, Relationships, and Socialisation (PEERS) study.

BACKGROUND: Humans are by nature a social species, with much of human experience spent in social interaction. Unsurprisingly, social functioning is crucial to well-being and quality of life across the lifespan. While early intervention for social problems appears promising, our ability to identify the specific impairments underlying their social problems (eg, social communication) is restricted by a dearth of accurate, ecologically valid and comprehensive child-direct assessment tools. Current tools are largely limited to parent and teacher ratings scales, which may identify social dysfunction, but not its underlying cause, or adult-based experimental tools, which lack age-appropriate norms. The present study describes the development and standardisation of Paediatric Evaluation of Emotions, Relationships, and Socialisation (PEERS®), an iPad-based social skills assessment tool. METHODS: The PEERS project is a cross-sectional study involving two groups: (1) a normative group, recruited from early childhood, primary and secondary schools across metropolitan and regional Victoria, Australia; and (2) a clinical group, ascertained from outpatient services at The Royal Children's Hospital Melbourne (RCH). The project aims to establish normative data for PEERS®, a novel and comprehensive app-delivered child-direct measure of social skills for children and youth. The project involves recruiting and assessing 1000 children aged 4.0-17.11 years. Assessments consist of an intellectual screen, PEERS® subtests, and PEERS-Q, a self-report questionnaire of social skills. Parents and teachers also complete questionnaires relating to participants' social skills. Main analyses will comprise regression-based continuous norming, factor analysis and psychometric analysis of PEERS® and PEERS-Q. ETHICS AND DISSEMINATION: Ethics approval has been obtained through the RCH Human Research Ethics Committee (34046), the Victorian Government Department of Education and Early Childhood Development (002318), and Catholic Education Melbourne (2166). Findings will be disseminated through international conferences and peer-reviewed journals. Following standardisation of PEERS®, the tool will be made commercially available.

Impact of Exercise on Clinical Symptom Report and Neurocognition after Concussion in Children and Adolescents.

Recovery from concussion in childhood is poorly understood, despite its importance in decisions regarding return to normal activity. Resolution of post-concussive symptoms (PCS) is widely employed as a marker of recovery in clinical practice; however, it is unclear whether subtle impairments persist only to re-emerge in the context of increased physical or cognitive demands. This study aimed to examine the effect of strenuous exercise on clinical symptom report and neurocognition in children and adolescents after PCS resolution after concussion. We recruited children and adolescents with concussion (n = 30) on presentation to an Emergency Department (ED). At Day 2 and Day 10 post-self-reported symptom resolution, participants completed a strenuous exercise protocol, and pre- and post-exercise assessment of PCS and neurocognition. Results demonstrated an overall reduction in PCS from Day 2 to Day 10 post-symptom resolution, with no evidence of symptom increase after strenuous exercise at either time point. Neurocognitive performance was linked to task complexity: on less cognitively demanding tasks, processing speed was slower post-exercise and, unexpectedly, slower on Day 10 than Day 2, while for more demanding tasks (new learning), Day 2 exercise resulted in faster responses, but Day 10 processing speed post-exercise was slower. In summary, we found the expected recovery pattern for PCS, regardless of exercise, while for neurocognition, recovery was dependent on the degree of cognitive demand, and there was an unexpected reduction in performance from Day 2 to Day 10. Findings provide some suggestion that premature return to normal activities (e.g., school) may slow neurocognitive recovery.

Developmental Trajectory of Information-Processing Skills in Children: Computer-Based Assessment.

There are significant merits to a comprehensive cognitive assessment, but they are also time-consuming, costly, and susceptible to practice effects and may not detect change in the context of medical interventions or minor brain disruptions. Brief computer-based assessments focused on "fluid" cognitive domains (e.g., information-processing skills), which are vulnerable to disruption as a result of a brain injury, may provide an alternative assessment option. This study sought to: (a) examine the utility of a well-established, adult-based computerized tool, CogSport for Kids (CogState), for evaluating information-processing skills in children and adolescents; and (b) to report normative data for healthy children and adolescents. The study was a cross-sectional, community-based observational study of typically developing children aged 9 to 17 years old (N = 832). Participants completed the CogSport for Kids test battery, which includes six brief computerized tasks that assess cognitive functions including processing speed, attention, and working memory. Results showed an improvement with age for response speed and accuracy. The greatest change occurred between 9 and 12 years with performance stabilizing at 15 years. This brief screening tool is appropriate for clinical and research use in children aged 9 years and older and may be used to track cognitive development from childhood into adulthood and to identify children who deviate from normal expectations.

Apologies following an adverse medical event: The importance of focusing on the consumer's needs.

OBJECTIVE: The lack of a theoretical framework limits educators' ability to train health practitioners how to disclose, and apologise for adverse medical events. The multidimensional theory of apology proposes apologies consist of one or more components which can either be self-focused (focused on the apologiser's needs) or other-focused (focused on the needs of the consumer). We investigated whether the inclusion of other-focused elements in an apology enhanced its impact in a health setting. METHODS: 251 participants responded to a video-recording of an actor portraying a surgeon apologising to a patient for an adverse event. In one condition the apology was exclusively self-focused and in the other it was both self and other-focused. RESULTS: The self-focused apology was viewed more positively than negatively, but the apology that included additional other-focused elements elicited a more favourable reaction; it was seen as more sincere and as denoting more sorriness. CONCLUSION AND PRACTICE IMPLICATIONS: Practitioners can enhance the impact of their apologies by including other-focused elements, that is, demonstrate they understand the impact the event had on the consumers, express remorse for causing harm, and offer, or take action, to address the intangible harm caused.

The Forms of Bullying Scale (FBS): validity and reliability estimates for a measure of bullying victimization and perpetration in adolescence.

The study of bullying behavior and its consequences for young people depends on valid and reliable measurement of bullying victimization and perpetration. Although numerous self-report bullying-related measures have been developed, robust evidence of their psychometric properties is scant, and several limitations inhibit their applicability. The Forms of Bullying Scale (FBS), with versions to measure bullying victimization (FBS-V) and perpetration (FBS-P), was developed on the basis of existing instruments, for use with 12- to 15-year-old adolescents to economically, yet comprehensively measure both bullying perpetration and victimization. Measurement properties were estimated. Scale validity was tested using data from 2 independent studies of 3,496 Grade 8 and 783 Grade 8-10 students, respectively. Construct validity of scores on the FBS was shown in confirmatory factor analysis. The factor structure was not invariant across gender. Strong associations between the FBS-V and FBS-P and separate single-item bullying items demonstrated adequate concurrent validity. Correlations, in directions as expected with social-emotional outcomes (i.e., depression, anxiety, conduct problems, and peer support), provided robust evidence of convergent and discriminant validity. Responses to the FBS items were found to be valid and concurrently reliable measures of self-reported frequency of bullying victimization and perpetration, as well as being useful to measure involvement in the different forms of bullying behaviors. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Bullying in school and cyberspace: Associations with depressive symptoms in Swiss and Australian adolescents.

BACKGROUND: Cyber-bullying (i.e., bullying via electronic means) has emerged as a new form of bullying that presents unique challenges to those victimised. Recent studies have demonstrated that there is a significant conceptual and practical overlap between both types of bullying such that most young people who are cyber-bullied also tend to be bullied by more traditional methods. Despite the overlap between traditional and cyber forms of bullying, it remains unclear if being a victim of cyber-bullying has the same negative consequences as being a victim of traditional bullying. METHOD: The current study investigated associations between cyber versus traditional bullying and depressive symptoms in 374 and 1320 students from Switzerland and Australia respectively (52% female; Age: M = 13.8, SD = 1.0). All participants completed a bullying questionnaire (assessing perpetration and victimisation of traditional and cyber forms of bullying behaviour) in addition to scales on depressive symptoms. RESULTS: Across both samples, traditional victims and bully-victims reported more depressive symptoms than bullies and non-involved children. Importantly, victims of cyber-bullying reported significantly higher levels of depressive symptoms, even when controlling for the involvement in traditional bullying/victimisation. CONCLUSIONS: Overall, cyber-victimisation emerged as an additional risk factor for depressive symptoms in adolescents involved in bullying.