Emotion labeling and socio-emotional outcomes 18 months after early childhood traumatic brain injury.

A growing body of literature has documented evidence for emotion labeling (EL) deficits after traumatic brain injury (TBI); however, long-term effects of TBI on EL abilities, particularly among young children, are unclear. We investigated EL abilities and socio-emotional outcomes in 32 children with moderate-severe TBI, 23 with complicated-mild TBI, and 82 children with orthopedic injuries (OI), shortly after injury and at 18 months post-injury. All children were between 3:0 and 6:11 years of age at the time of injury. Repeated measures analyses indicated that all groups showed improved EL performance between acute and 18-month assessments, but that the moderate-severe TBI group improved at a slower rate than the OI group, so that the two groups showed significantly different performance at 18 months. Emotion labeling ability did not significantly contribute to the prediction of socio-emotional outcomes after controlling for pre-injury functioning. These results provide preliminary evidence of emerging EL deficits after early childhood TBI that are related to injury severity but that do not predict social and behavioral outcomes.

Neural correlates of interference control in adolescents with traumatic brain injury: functional magnetic resonance imaging study of the counting stroop task.

Difficulty in inhibition or cognitive control is a common and significant sequela of pediatric traumatic brain injury (TBI). The present study used functional MRI to examine one specific inhibitory function, interference control, in 11 adolescents, aged 12-16 years, (mean age, 15.7 years) with TBI who were at least 1 year postinjury and 11 age-matched typically developing control participants (TC) (mean age, 15.2 years). Participants completed a Counting Stroop task with 2 main conditions: (1) a neutral condition requiring the counting of animal words and (2) an interference condition in which mismatched number words were counted. Both TBI and TC adolescents activated similar networks of brain regions relevant to interference control, but the TBI group showed higher levels of activation relative to the TC group in multiple brain areas within this network, including predominantly right frontal and parietal regions. Findings of greater activation of the relevant neural network in the TBI group are consistent with recent fMRI findings using other interference control paradigms with individuals with a history of TBI.

Cognitive development after traumatic brain injury in young children.

The primary aims of this study were to examine post-injury cognitive development in young children with traumatic brain injury (TBI) and to investigate the role of the proximal family environment in predicting cognitive outcomes. Age at injury was 3-6 years, and TBI was classified as severe (n = 23), moderate (n = 21), and complicated mild (n = 43). A comparison group of children who sustained orthopedic injuries (OI, n = 117) was also recruited. Child cognitive assessments were administered at a post-acute baseline evaluation and repeated at 6, 12, and 18 months post-injury. Assessment of the family environment consisted of baseline measures of learning support and stimulation in the home and of parenting characteristics observed during videotaped parent-child interactions. Relative to the OI group, children with severe TBI group had generalized cognitive deficiencies and those with less severe TBI had weaknesses in visual memory and executive function. Although deficits persisted or emerged across follow-up, more optimal family environments were associated with higher scores for all injury groups. The findings confirm other reports of poor recovery of cognitive skills following early childhood TBI and suggest environmental influences on outcomes.

Brief report: Description of feasibility and satisfaction findings from an innovative online family problem-solving intervention for adolescents following traumatic brain injury.

OBJECTIVE: To describe feasibility and satisfaction findings from an innovative online family problem-solving intervention for adolescents with traumatic brain injury (TBI). METHODS: Nine adolescents who sustained a moderate to severe TBI in the previous 24 months and their families participated in a novel, online, manualized treatment program (Teen Online Problem Solving, TOPS) consisting of 10 web-based sessions providing information and interactive exercises on cognitive, social, and behavioral skills typically affected by TBI. Web-based sessions were followed by synchronous video conferences with a therapist to review target skills and apply the problem-solving process to family goals. RESULTS: All teens and consenting parents completed at least 10 sessions. The website and videoconferences received moderate to high ratings on helpfulness and ease of use. Parents and teens reported increased knowledge regarding targeted knowledge and skills. CONCLUSIONS: Findings support the acceptability of TOPS for adolescent TBI.

Late proton magnetic resonance spectroscopy following traumatic brain injury during early childhood: relationship with neurobehavioral outcomes.

We sought to extend previous research that demonstrates reduced neurometabolite concentrations during the chronic phase of pediatric traumatic brain injury (TBI) in children injured during early childhood. We hypothesized that young children with TBI in the chronic phase post-injury would have lower N-acetyl aspartate (NAA) metabolite concentrations in gray and white matter in comparison to controls. We also hypothesized that metabolite levels would be correlated with acute TBI severity and neurobehavioral skills. Ten children with a history of TBI between the ages of 3 and 6 years were compared to an age, gender, and race-matched group of 10 children with a history of an orthopedic injury (OI). Children completed neurobehavioral testing at 12 months post-injury. Proton magnetic resonance (MR) spectroscopy was completed at least 12 months post-injury when the children were 6-9 years old. Groups were compared on metabolite concentrations in the medial frontal gray matter and left frontal white matter. Metabolite levels were correlated with Glasgow Coma Scale (GCS) scores and neurobehavioral functioning. There was a trend for lower NAA concentrations in the medial frontal gray matter for the TBI group. Late NAA and Cr levels in the medial frontal gray matter and NAA levels in the left frontal white matter were strongly positively correlated with initial GCS score. Metabolite levels were correlated with some neurobehavioral measures differentially for children with TBI or OI. Some neurometabolite levels differed between the TBI and OI groups more than 1 year post-injury and were related to injury severity, as well as some neurobehavioral outcomes following TBI during early childhood.

Traumatic brain injury in young children: postacute effects on cognitive and school readiness skills.

Previous studies have documented weaknesses in cognitive ability and early academic readiness in young children with traumatic brain injury (TBI). However, few of these studies have rigorously controlled for demographic characteristics, examined the effects of TBI severity on a wide range of skills, or explored moderating influences of environmental factors on outcomes. To meet these objectives, each of three groups of children with TBI (20 with severe, 64 with moderate, and 15 with mild) were compared with a group of 117 children with orthopedic injuries (OI group). The children were hospitalized for their injuries between 3 and 6 years of age and were assessed an average of 1 1/2 months post injury. Analysis revealed generalized weaknesses in cognitive and school readiness skills in the severe TBI group and less pervasive effects of moderate TBI. Indices of TBI severity predicted outcomes within the TBI sample and environmental factors moderated the effects of TBI on some measures. The findings document adverse effects of TBI in early childhood on postacute cognitive and school readiness skills and indicate that these effects are related to both injury severity and the family environment.

Long-term neural processing of attention following early childhood traumatic brain injury: fMRI and neurobehavioral outcomes.

Attentional deficits are common and significant sequelae of pediatric traumatic brain injury (TBI). However, little is known about how the underlying neural processes that support different components of attention are affected. The present study examined brain activation patterns using fMRI in a group of young children who sustained a TBI in early childhood (n = 5; mean age = 9.4), and a group of age-matched control children with orthopedic injuries (OI) (n = 8) during a continuous performance task (CPT). Four children in the TBI group had moderate injuries, and one had a severe injury. Performance on the CPT task did not differ between groups. Both TBI and OI children activated similar networks of brain regions relevant to sustained attention processing, but the TBI group demonstrated several areas of significantly greater activation relative to controls, including frontal and parietal regions. These findings of over-activation of the relevant attention network in the TBI group contrast with those obtained in imaging studies of Attention-Deficit/Hyperactivity Disorder where under-activation of the attention network has been documented. This study provides evidence that young children's brains function differently following a traumatic brain injury, and that these differences persist for years after the injury.

Preliminary efficacy of a Web-based family problem-solving treatment program for adolescents with traumatic brain injury.

OBJECTIVE: Preliminary report of the efficacy of a Web-based treatment program to improve adolescent and family psychosocial functioning following traumatic brain injury (TBI). PARTICIPANTS: Families of 9 adolescents with TBI (2 severe and 7 moderate) injured less than 24 months ago participated in this study. INTERVENTION: A Web-based family treatment program designed to enhance family problem solving and adjustment, as well as reduce adolescent behavioral and social problems that are common sequelae of moderate-to-severe TBI was used as intervention. The program consisted of 10 core sessions and up to 4 supplemental sessions, each consisting of self-guided Web exercises followed by a videoconference therapy session. RESULTS: Significant improvements were found in parent-reported adolescent internalizing behaviors, self-reported adolescent depressive symptoms, parental depression, and parent-adolescent conflict. Effect sizes were in the medium-to-high range for these same contrasts. Exploratory analyses suggested that providing audio with the Web site may enhance some outcomes. CONCLUSIONS: This study provides preliminary evidence of the feasibility and efficacy of family-centered online intervention for improving adolescent and family adaptation following pediatric TBI.

Parent report of stereotyped behaviors, social interaction, and developmental disturbances in individuals with Angelman syndrome.

Research examining autistic symptoms in Angelman syndrome (AS) is limited. The goal of this study was to further characterize the nature of stereotyped behaviors, social interaction deficits, and developmental disturbances in individuals with AS. Parents of 248 individuals between the ages of 3 and 22 completed a survey of autistic symptomatology by mail, the Gilliam Autism Rating Scale. Results confirmed a high degree of developmental delay and limited expressive language skills. In terms of stereotyped behaviors and social interaction, areas of convergence and divergence between AS and behaviors typically associated with autism spectrum disorders are described. The relationship between child characteristics (age, gender, seizure disorder, genetic subtype) and autistic symptomatology are discussed.

Neural substrate differences in language networks and associated language-related behavioral impairments in children with TBI: a preliminary fMRI investigation.

The present study examined whether functional MRI (fMRI) can identify changes in the neural substrates of language in young children following traumatic brain injury (TBI). Eight children with TBI (F/M=3/5, age (Mean +/- SD)=7.98 +/- 1 years, range = 6-9 years) and a comparison group of nine children with orthopedic injuries (OI) (F/M=4/5, age (Mean +/- SD)=7.4 +/- 1 years, range=6-9 years) participated in an fMRI study of covert verb generation (VG). Results revealed significantly different BOLD signal activation in perisylvian language areas between the groups, after accounting for potential confounders such as verbal fluency and executive function. We also found significant associations between the BOLD signal activation and performance on language-specific neuropsychological tests (NEPSY verbal fluency score, Verbal IQ) and Glasgow Coma Scale (GCS) score. This study suggests that children with TBI have significantly different brain activation patterns in language circuitry compared to children with orthopedic injuries. Although we found clear differences in brain activation between the two groups, conventional MR images showed no evidence of structural abnormalities in five of eight children with TBI. Our study demonstrates the feasibility and potential utility of fMRI as a means of quantifying changes associated with language deficits in future pediatric TBI studies.

Structural language, pragmatic communication, behavior, and social competence in children adopted internationally: A pilot study.

The objectives of this study were to examine the association of structural language and pragmatic communication with behavior problems and social competence in girls adopted internationally. Participants included girls between 6-12 years of age who were internationally adopted from China (n = 32) and Eastern-Europe (n = 25) and a control group of never-adopted girls (n = 25). Children completed the Wechsler Abbreviated Scale of Intelligence. Parents completed the Child Communication Checklist- second edition, the Child Behavior Checklist, and the Home and Community Social Behavior Scales. Compared to the controls, parents in the Eastern European group reported more problems with social competence, externalizing behaviors, structural language, and pragmatic communication. The Chinese group evidenced more internalizing problems. Using generalized linear regression, interaction terms were examined to determine if the associations of pragmatic communication and structural language with behavior problems and social competence varied across groups. Controlling for general intellectual functioning, poorer pragmatic communication was associated with more externalizing problems and poorer social competence. In the Chinese group, poorer pragmatic communication was associated with more internalizing problems. Post-adoption weaknesses in pragmatic communication are associated with behavior problems and social competence. Internationally adopted children may benefit from interventions that target pragmatic communication.

The family environment predicts long-term academic achievement and classroom behavior following traumatic brain injury in early childhood.

OBJECTIVE: This study examined how the family environment predicts long-term academic and behavioral functioning in school following traumatic brain injury (TBI) in early childhood. METHOD: Using a concurrent cohort, prospective design, 15 children with severe TBI, 39 with moderate TBI, and 70 with orthopedic injury (OI) who were injured when they were 3-7 years of age were compared on tests of academic achievement and parent and teacher ratings of school performance and behavior on average 6.83 years postinjury. Soon after injury and at the longer term follow-up, families completed measures of parental psychological distress, family functioning, and quality of the home environment. Hierarchical linear regression analyses examined group differences in academic outcomes and their associations with measures of the early and later family environment. RESULTS: The severe TBI group, but not the moderate TBI group, performed worse than did the OI group on all achievement tests, parent ratings of academic performance, and teacher ratings of internalizing problems. Higher quality early and late home environments predicted stronger academic skills and better classroom behavior for children with both TBI and OI. The early family environment more consistently predicted academic achievement, whereas the later family environment more consistently predicted classroom functioning. The quality of the home environment predicted academic outcomes more strongly than did parental psychological distress or family functioning. CONCLUSION: TBI in early childhood has long-term consequences for academic achievement and school performance and behavior. Higher quality early and later home environments predict better school outcomes for both children with TBI and children with OI. (PsycINFO Database Record

Predictors of Long-Term Victimization After Early Pediatric Traumatic Brain Injury.

OBJECTIVE: Pediatric traumatic brain injuries (TBIs) adversely affect long-term functional and social outcomes. Limited research suggests children with TBI are more likely to be victimized by peers than noninjured children. Deficits in social information processing (SIP), cognitive ability, and executive functioning (EF) may contribute to increased victimization risk. This study examined rates of peer victimization/bullying in children with early TBI compared with children with orthopedic injuries (OIs) and the role of processing speed, executive function (EF), and SIP as mediators of the association of TBI and peer victimization. METHOD: Children ages 10 to 14 years who sustained a complicated mild/moderate or severe TBI (N = 58) or OI (N = 72) during early childhood (ages 3-7 yr) and their parents participated in a longitudinal prospective follow-up 6.8 years postinjury. SIP, EF and processing speed, and peer victimization were assessed. RESULTS: Parents of children with severe TBI reported greater rates of peer victimization than parents of children with OIs. Children with severe TBI demonstrated greater EF deficits than children with complicated mild/moderate TBI or OI and poorer processing speed than children with OI. No significant indirect relationships were found between groups and any outcome variables to indicate mediation. CONCLUSION: Based on parent report, children with severe TBI have higher risk of peer victimization than those with less severe injuries. In addition, children with severe TBI have more impaired EF and cognitive ability than counterparts with less severe TBI. Further research is needed to explore predictors of long-term victimization after early TBI to create interventions aimed at providing social, emotional, and behavioral skill building for victimized youth.

Sensory processing patterns in persons with Angelman syndrome.

OBJECTIVE: Research examining sensory processing patterns in persons with Angelman syndrome is nonexistent despite anecdotal evidence and clinical diagnostic criteria that may reflect these features. The goal of this study was to better characterize sensory processing patterns in persons with Angelman syndrome. METHOD: Parents of 340 persons with Angelman syndrome between 3 and 22 years of age completed a standardized measure of sensory processing, the Sensory Experiences Questionnaire. RESULTS: Results confirmed a high degree and variety of sensory processing abnormalities in persons with Angelman syndrome. These problems were most prominent in the areas of hypo-responsiveness to tactile and vestibular input, consistent with reports of sensory seeking behaviors in this population. Sensory processing deficits were not related to gender, seizure disorder, or genetic subtype. However, some behaviors were correlated with age. CONCLUSION: This study provides the first systematic description of sensory processing abnormalities in a large sample of persons with Angelman syndrome. Considerations for enhancing occupational performance and social participation in this population through occupational therapy interventions are discussed.

Sleep in individuals with Angelman syndrome: parent perceptions of patterns and problems.

The diagnostic criteria for Angelman syndrome includes sleep disturbance as an associated characteristic. There are, however, few researchers who have examined sleep problems in this population. Our goal in this study was to better characterize the sleep patterns and problems in individuals with Angelman syndrome. Parents of 339 individuals between the ages of 3 and 22 completed a previously validated sleep questionnaire. Results confirmed that a variety of sleep problems exist in a significant portion of individuals with Angelman syndrome, most prominently in the areas of sleep initiation, sleep duration, reliance on sleep facilitators, being awakened by loud noises, and being disoriented when aroused. Developmental trends, syndrome specificity of findings, clinical implications, and directions for future research are discussed.

Intelligence, Attention, and Behavioral Outcomes in Internationally Adopted Girls with a History of Institutionalization.

OBJECTIVE: The aim of this study was to investigate the association of neurocognitive functioning with internalizing and externalizing problems and school and social competence in children adopted internationally. METHOD: Participants included girls between the ages of 6-12 years who were internationally adopted from China (n = 32) or Eastern Europe (n = 25) and a control group of never-adopted girls (n = 25). Children completed the Vocabulary and Matrix Reasoning subtests from the Wechsler Abbreviated Scale of Intelligence and the Score! and Sky Search subtests from the Test of Everyday Attention for Children. Parents completed the Child Behavior Checklist and the Home and Community Social Behavior Scales. RESULTS: Compared to the controls, the Eastern European group evidenced significantly more problems with externalizing behaviors and school and social competence and poorer performance on measures of verbal intelligence, perceptual reasoning, and auditory attention. More internalizing problems were reported in the Chinese group compared to the controls. Using generalized linear regression, interaction terms were examined to determine whether the associations of neurocognitive functioning with behavior varied across groups. Eastern European group status was associated with more externalizing problems and poorer school and social competence, irrespective of neurocognitive test performance. In the Chinese group, poorer auditory attention was associated with more problems with social competence. CONCLUSIONS: Neurocognitive functioning may be related to behavior in children adopted internationally. Knowledge about neurocognitive functioning may further our understanding of the impact of early institutionalization on post-adoption behavior.

Supratentorial tuber location and autism in tuberous sclerosis complex.

The high rate of autism in tuberous sclerosis complex provides an opportunity to study the pathogenesis of autism. This study investigated the relationship between a DSM-IV diagnosis of autism and tuber location in a sample of 50 individuals with tuberous sclerosis complex. Chi-square analyses revealed no differences between individuals with autism (n = 15) and those without autism (n = 35) on the occurrence of tubers in the right or left frontal, occipital, parietal, or temporal regions. There were no differences between the two groups in the occurrence of tubers in subcortical or cortical regions. In the largest sample to date, these results fail to support the hypothesis that supratentorial tuber location is a marker for autism.

Emerging narrative discourse skills 18 months after traumatic brain injury in early childhood.

This study examined the longer term effect of traumatic brain injury (TBI), approximately 18 months post-injury, on emerging narrative discourse skills of 85 children with orthopaedic injury (OI), 43 children with moderate TBI, and 19 children with severe TBI who were between 3 years and 6 years 11 months at injury. Children with TBI performed worse than children with OI on most discourse indices. Children with severe TBI were less proficient than children with moderate TBI at identifying unimportant story information. Age and pragmatic skills were predictors of discourse performance.

Neural correlates of risky decision making in adolescents with and without traumatic brain injury using the balloon analog risk task.

We studied risky decision making (RDM) in 8 healthy adolescents (TC) and 11 adolescents with mild to moderate traumatic brain injuries (TBI) using the Balloon Analog Risk Task (BART) and functional magnetic resonance imaging (fMRI). Participants inflated simulated balloons (with more points awarded to bigger balloons), which might burst at any time. Increasing brain activation levels were associated with increasing balloon size in a largely bilateral network, including cerebellar, inferior parietal, limbic, and frontal areas. Both groups performed similarly and activated similar networks.

Executive functions and social competence in young children 6 months following traumatic brain injury.

OBJECTIVE: This study examined the impact of traumatic brain injury (TBI) in young children on executive functions and social competence, and particularly on the role of executive functions as a predictor of social competence. METHOD: Data were drawn from a prospective, longitudinal study. Participants were children between the ages of 3 years 0 months and 6 years 11 months at time of injury. The initial sample included 23 with severe TBI, 64 with moderate TBI, and 119 with orthopedic injuries (OI). All participants were assessed at 3 and 6 months postinjury. Executive functions were assessed using neuropsychological tests (Delayed Alternation task and Shape School) and parent ratings on the Behavior Rating Inventory of Executive Function and Child Behavior Questionnaire. Parents rated children's social competence on the Adaptive Behavior Assessment System, Preschool and Kindergarten Behavior Scales, and Home and Community Social Behavior Scales. RESULTS: Children with severe TBI displayed more negative outcomes than children with OI on neuropsychological tests, ratings of executive functions, and ratings of social competence (η² ranged from .03 to .11). Neuropsychological tests of executive functions had significant but weak relationships with behavioral ratings of executive functions (ΔR² ranged from .06 to .08). Behavioral ratings of executive functions were strongly related to social competence (ΔR² ranged from .32 to .42), although shared rater and method variance likely contributed to these associations. CONCLUSIONS: Severe TBI in young children negatively impacts executive functions and social competence. Executive functions may be an important determinant of social competence following TBI.