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Yumul JN, McKinlay A, Anderson V, Catroppa C. Behaviour outcomes three months after mild TBI in preschool children. Neuropsychol Rehabil 2024; 34:600-618. [PMID: 37354534 DOI: 10.1080/09602011.2023.2224030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/02/2023] [Indexed: 06/26/2023]
Abstract
This study examined parents' report of behaviour in preschoolers after a mild traumatic brain injury (mTBI), compared the proportion of preschoolers with elevated behaviour ratings between the mTBI and limb injury (LI) groups, and explored injury, premorbid child, and parent variables that may be associated with parents' report of behaviour at three months post-injury. Children aged 2-5 years with a mTBI (n = 13) or mild LI (n = 6) were recruited from the emergency department. Behaviour was assessed using the Child Behaviour Checklist. Preliminary findings showed that post-injury behaviour ratings remained in the normal range. The mTBI group had higher scores than the LI group at three months post-injury in terms of sleep; however, this may have been pre-existing. Two children with mTBI received borderline-clinically significant ratings on diagnostic-level anxiety problems at the three-month follow-up, while none of the limb-injured controls obtained elevated behaviour ratings. Parent-rated post-injury behaviour was significantly associated with premorbid child functioning and parental stress, which needs to be explored in greater detail using larger preschool mTBI samples.
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Affiliation(s)
- Joy Noelle Yumul
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Audrey McKinlay
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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2
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Rigney G, Jo J, Williams K, Terry DP, Zuckerman SL. Parental Factors Associated With Recovery After Mild Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2023; 40:2015-2036. [PMID: 37212287 DOI: 10.1089/neu.2023.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
While parental factors have been shown to potentially influence recovery after mild traumatic brain injury (mTBI) in children, both the strength and direction of the relationships remain unclear. We performed a systematic review regarding the association between parental factors and recovery after mTBI. PubMed, CINHL, Embase, PsychINFO, Web of Science, ProQuest, Cochrane Central, and Cochrane databases were queried for articles published between September 1, 1970, and September 10, 2022, reporting any parental factor and its association with recovery after mTBI in children younger than 18 years old. The review included both quantitative and qualitative studies published in English. Regarding the directionality of the association, only studies that assessed the effects of parental factors on recovery after mTBI were included. Study quality was assessed using a five-domain scale created by the Cochrane Handbook and the Agency for Healthcare Research and Quality. The study was prospectively registered with PROSPERO (CRD42022361609). Of 2050 studies queried, 40 met inclusion criteria, and 38 of 40 studies used quantitative outcome measures. Across 38 studies, 24 unique parental factors and 20 different measures of recovery were identified. The most common parental factors studied were socioeconomic status/income (SES; n = 16 studies), parental stress/distress (n = 11), parental level of education (n = 9), pre-injury family functioning (n = 8), and parental anxiety (n = 6). Among all associations between parental factors and recovery reported, having a family history of a neurologic disease (i.e., migraine, epilepsy, neurodegenerative disease; 5/6 significant associations reported, 83%), parental stress/distress (9/11, 82%), parental anxiety (4/6, 67%), parental level of education (5/9, 56%), and SES/income (11/19, 57.9%) were shown to have the strongest evidence reporting significant associations with recovery, while a family history of psychiatric disease (3/6, 50%) and pre-injury family functioning (4/9, 44%) showed mixed results. Evidence regarding other parental factors including parental sex, race/ethnicity, insurance status, parental history of concussion, family litigation status, family adjustment levels, and family psychosocial adversity were limited, as studies investigating such factors were few. The current review highlights literature describing several parental factors that significantly influence recovery from mTBI. It will likely be useful for future studies to incorporate parental SES, education, stress/distress, anxiety, quality of parent-child relationships, and parenting style when examining modifying factors in recovery after mTBI. Future studies should also consider how parental factors may serve as potential interventions or policy levers to optimize sport concussion-related policy and return-to-play guidelines.
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Affiliation(s)
- Grant Rigney
- Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob Jo
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristen Williams
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas P Terry
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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3
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Djukic S, Phillips NL, Lah S. Sleep outcomes in pediatric mild traumatic brain injury: a systematic review and meta-analysis of prevalence and contributing factors. Brain Inj 2022; 36:1289-1322. [PMID: 36413091 DOI: 10.1080/02699052.2022.2140198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim was to determine the prevalence of disturbed sleep in children who sustained mild traumatic brain injury (mTBI). METHODS We conducted electronic searches of three databases MEDLINE, PsychINFO and EMBASE against pre-determined inclusion/exclusion criteria. We used the Newcastle-Ottawa Scale to assess the risk of bias. RESULTS Forty-four articles met the inclusion criteria. The risk of bias was mainly rated as moderate to high. Meta-analysis revealed that prevalence of sleep disturbances decreased as the time since injury increased: 51%, 40% and 9% within 1 week, between 1 week and 1 month, and between 1 and 3 months, respectively, but increased to 21% after 3 months. The sleep symptom drowsiness followed a similar temporal pattern. Other sleep symptoms of hypersomnia (sleeping more than usual) and insomnia (trouble falling asleep and sleeping less than usual) remained stable over time. The prevalence of sleep disturbances in children with mTBI was higher than in the general population. Pre-injury sleep and older age at injury were related to worse sleep outcomes. CONCLUSIONS Sleep disturbances are highly prevalent in the acute phase post-mTBI. Given that disturbed sleep can impact daily functioning and recovery, routine screening and management of sleep disturbances in children who sustain mTBI is important.
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Affiliation(s)
- Suzana Djukic
- School of Psychology, The University of Sydney, Sydney, Australia
| | | | - Suncica Lah
- School of Psychology, The University of Sydney, Sydney, Australia
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4
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Quality of life 6 and 18 months after mild traumatic brain injury in early childhood: An exploratory study of the role of genetic, environmental, injury, and child factors. Brain Res 2020; 1748:147061. [DOI: 10.1016/j.brainres.2020.147061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/18/2022]
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5
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Tuerk C, Anderson V, Bernier A, Beauchamp MH. Social competence in early childhood: An empirical validation of the SOCIAL model. J Neuropsychol 2020; 15:477-499. [DOI: 10.1111/jnp.12230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/01/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Carola Tuerk
- Department of Psychology University of Montreal Montreal Quebec Canada
| | - Vicki Anderson
- Murdoch Children’s Research Institute The Royal Children’s Hospital Parkville Victoria Australia
- Melbourne School of Psychological Science and Department of Pediatrics University of Melbourne Melbourne Victoria Australia
| | - Annie Bernier
- Department of Psychology University of Montreal Montreal Quebec Canada
| | - Miriam H. Beauchamp
- Department of Psychology University of Montreal Montreal Quebec Canada
- Sainte‐Justine Hospital Research Center Montreal Quebec Canada
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Beauchamp MH, Dégeilh F, Yeates K, Gagnon I, Tang K, Gravel J, Stang A, Burstein B, Bernier A, Lebel C, El Jalbout R, Lupien S, de Beaumont L, Zemek R, Dehaes M, Deschênes S. Kids' Outcomes And Long-term Abilities (KOALA): protocol for a prospective, longitudinal cohort study of mild traumatic brain injury in children 6 months to 6 years of age. BMJ Open 2020; 10:e040603. [PMID: 33077571 PMCID: PMC7574946 DOI: 10.1136/bmjopen-2020-040603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Mild traumatic brain injury (mTBI) is highly prevalent, especially in children under 6 years. However, little research focuses on the consequences of mTBI early in development. The objective of the Kids' Outcomes And Long-term Abilities (KOALA) study is to document the impact of early mTBI on children's motor, cognitive, social and behavioural functioning, as well as on quality of life, stress, sleep and brain integrity. METHODS AND ANALYSES KOALA is a prospective, multicentre, longitudinal cohort study of children aged 6 months to 6 years at the time of injury/recruitment. Children who sustain mTBI (n=150) or an orthopaedic injury (n=75) will be recruited from three paediatric emergency departments (PEDs), and compared with typically developing children (community controls, n=75). A comprehensive battery of prognostic and outcome measures will be collected in the PED, at 10 days, 1, 3 and 12 months postinjury. Biological measures, including measures of brain structure and function (magnetic resonance imaging, MRI), stress (hair cortisol), sleep (actigraphy) and genetics (saliva), will complement direct testing of function using developmental and neuropsychological measures and parent questionnaires. Group comparisons and predictive models will test the a priori hypotheses that, compared with children from the community or with orthopaedic injuries, children with mTBI will (1) display more postconcussive symptoms and exhibit poorer motor, cognitive, social and behavioural functioning; (2) show evidence of altered brain structure and function, poorer sleep and higher levels of stress hormones. A combination of child, injury, socioenvironmental and psychobiological factors are expected to predict behaviour and quality of life at 1, 3 and 12 months postinjury. ETHICS AND DISSEMINATION The KOALA study is approved by the Sainte-Justine University Hospital, McGill University Health Centre and University of Calgary Conjoint Health Research Ethics Boards. Parents of participants will provide written consent. Dissemination will occur through peer-reviewed journals and an integrated knowledge translation plan.
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Affiliation(s)
- Miriam H Beauchamp
- Psychology, Université de Montréal, Montreal, Quebec, Canada
- Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Fanny Dégeilh
- Psychology, Université de Montréal, Montreal, Quebec, Canada
- Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
- Psychiatry, LMU München, Munchen, Bayern, Germany
| | - Keith Yeates
- Psychology, University of Calgary, Calgary, Alberta, Canada
- Research Institute, Alberta Children's Hospital, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Trauma, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Ken Tang
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jocelyn Gravel
- Pediatric Emergency Medicine, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Antonia Stang
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Brett Burstein
- Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Annie Bernier
- Psychology, Université de Montreal, Montreal, Quebec, Canada
| | - Catherine Lebel
- Research Institute, Alberta Children's Hospital, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Radiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Sonia Lupien
- Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | | | - Roger Zemek
- Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Mathieu Dehaes
- Psychology, Université de Montréal, Montreal, Quebec, Canada
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Botchway EN, Godfrey C, Ryan NP, Hearps S, Nicholas CL, Anderson VA, Catroppa C. Sleep Disturbances in Young Adults with Childhood Traumatic Brain Injury: Relationship with Fatigue, Depression, and Quality of Life. Brain Inj 2020; 34:1579-1589. [PMID: 33054410 DOI: 10.1080/02699052.2020.1832704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study assessed the consequences of childhood traumatic brain injury (TBI) on sleep, fatigue, depression, and quality of life (QoL) outcomes and explored the relationships between these variables at 20 years following childhood TBI. PARTICIPANTS We followed up 54 young adults with mild, moderate, and severe TBI, and 13 typically developing control (TDC) participants, recruited at the time of TBI. METHODS Sleep was assessed with the Pittsburgh Sleep Quality Index and actigraphy. RESULTS At 20 years postinjury, results showed no significant difference between whole TBI group and TDC participants on subjective sleep quality; however, the moderate TBI group reported significantly poorer subjective sleep quality compared to those with severe TBI. Poorer subjective sleep was associated with increased symptoms of fatigue, depression, and poorer perceptions of General Health in the TBI group. Actigraphic sleep efficiency, fatigue, depression, and QoL outcomes were not significantly different between TBI and TDC or among TBI severity groups. CONCLUSIONS These preliminary findings underscore associations between subjective sleep disturbance, fatigue, depression, and QoL in this TBI sample, and mostly comparable outcomes in sleep, fatigue, depression, and QoL between the TBI and TDC groups. Further research is required to clarify these findings.
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Affiliation(s)
- Edith N Botchway
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne , Melbourne, Australia
| | - Celia Godfrey
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne , Melbourne, Australia
| | - Nicholas P Ryan
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne , Melbourne, Australia.,Cognitive Neuroscience Unit, Deakin University , Geelong, Victoria, Australia
| | - Stephen Hearps
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia
| | - Christian L Nicholas
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Melbourne School of Psychological Sciences, University of Melbourne , Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health , Heidelberg, Victoria, Australia
| | - Vicki A Anderson
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne , Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne , Melbourne, Australia
| | - Cathy Catroppa
- Clinical Science, Murdoch Children's Research Institute , Parkville, Victoria, Australsia.,Department of Psychology, Royal Children's Hospital , Parkville, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne , Melbourne, Australia
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Gagner C, Tuerk C, De Beaumont L, Bernier A, Beauchamp MH. Brain-Derived Neurotrophic Factor Val66Met Polymorphism and Internalizing Behaviors after Early Mild Traumatic Brain Injury. J Neurotrauma 2020; 38:102-110. [PMID: 32605421 DOI: 10.1089/neu.2019.6936] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pediatric traumatic brain injury (TBI) can lead to adverse emotional, social, and behavioral consequences. However, outcome is difficult to predict due to significant individual variability, likely reflecting a complex interaction between injury- and child-related variables. Among these variables are genetically determined individual differences, which can modulate TBI outcome through their influence on neuroplasticity mechanisms. In this study, we examined the effect of Val66Met, a common polymorphism of the brain-derived neurotrophic factor gene known to be involved in neuroplasticity mechanisms, on behavioral symptoms of mild TBI (mTBI) sustained in early childhood. This work is part of a prospective, longitudinal cohort study of early TBI. The current sample consisted of 145 children between ages 18 and 60 months assigned to one of three participant groups: mild TBI, orthopedic injury, or typically developing children. Participants provided a saliva sample to detect the presence of the Val66Met polymorphism, and the Child Behavior Checklist was used to document the presence of behavioral symptoms at 6- and 18-months post-injury. Contrary to our initial hypothesis, at 6 months post-injury, non-carriers of the Val66Met polymorphism in the mTBI group presented significantly more internalizing symptoms (e.g., anxiety/depression and somatic complaints) than Val66Met carriers, who were similar to orthopedically injured and typically developing children. However, at 18 months post-injury, all children with mTBI presented more internalizing symptoms, independent of genotype. The results of the study provide evidence for a protective effect of the Val66Met polymorphism on internalizing behavior symptoms 6 months after early childhood mTBI.
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Affiliation(s)
- Charlotte Gagner
- Department of Psychology, University of Montreal, Montréal, Québec, Canada.,Sainte-Justine Hospital Research Center, Montréal, Québec, Canada
| | - Carola Tuerk
- Department of Psychology, University of Montreal, Montréal, Québec, Canada
| | - Louis De Beaumont
- Hôpital du Sacré-Coeur de Montréal Research Center, Montréal, Québec, Canada.,Department of Surgery, University of Montreal, Montréal, Québec, Canada
| | - Annie Bernier
- Department of Psychology, University of Montreal, Montréal, Québec, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montréal, Québec, Canada.,Sainte-Justine Hospital Research Center, Montréal, Québec, Canada
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9
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Sarmiento K, Gioia GA, Kirkwood MW, Wade SL, Yeates KO. A commentary for neuropsychologists on CDC's guideline on the diagnosis and management of mild traumatic brain injury among children. Clin Neuropsychol 2020; 34:259-277. [PMID: 31530221 PMCID: PMC7039321 DOI: 10.1080/13854046.2019.1660806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/28/2019] [Accepted: 08/18/2019] [Indexed: 12/27/2022]
Abstract
Objective: In 2018, the Centers for Disease Control Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. This commentary summarizes the key recommendations in the CDC Pediatric mTBI Guideline most relevant for neuropsychologists and discusses research gaps and topics that should receive attention in future iterations of the Guideline.Method: We described the methods used to develop the Guideline, which included a comprehensive Systematic Review. We also distilled and presented key practice strategies reflected in Guideline.Results: To optimize care of pediatric patients with mTBI, neuropsychologists should: use validated, age-appropriate symptom scales, assess evidence-based risk factors for prolonged recovery, provide patients with instructions on return to activity customized to their symptoms, and counsel patients to return gradually to nonsports activities after a short period of rest. Future iterations of the Guideline should encompass a review and guidance on care of patients with psychiatric and psychological difficulties, as well as the potential use of imaging to assess patients with persistent symptoms. Expanded research on mTBI among girls, children age 8 and under, and effective treatments for pediatric mTBI will be beneficial to inform care practices.Conclusions: Recommendations in the CDC Pediatric mTBI Guideline highlight multiple opportunities for neuropsychologists to take action to improve the care of young patients with mTBI and to advance research in the field. Multiple resources and tools are available to support implementation of these recommendations into clinical practice.
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Affiliation(s)
- Kelly Sarmiento
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gerard A. Gioia
- Division of Pediatric Neuropsychology, Children’s National Health System, George Washington University School of Medicine, Washington, DC, USA
| | - Michael W. Kirkwood
- Department of Physical Medicine and Rehabilitation, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Shari L. Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Keith O. Yeates
- Departments of Psychology and Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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10
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Gagner C, Dégeilh F, Bernier A, Beauchamp MH. Persistent Changes in Child Behavior After Early Mild Traumatic Brain Injury. J Pediatr Psychol 2020; 45:50-60. [PMID: 31584662 DOI: 10.1093/jpepsy/jsz071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/16/2019] [Accepted: 08/16/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To document longitudinal changes in internalizing and externalizing behavioral symptoms after mild traumatic brain injury (mTBI) sustained in early childhood (i.e., between 18 and 60 months of age). METHODS Participants (N = 226) were recruited to one of three groups: children with mTBI, typically developing children and orthopedic injured children. The Child Behavior Checklist was used to document the presence of internalizing and externalizing behaviors at 6, 18, and 30 months postinjury. Linear mixed-model analyses were used to examine group effects on the trajectory of internalizing and externalizing behavioral manifestations over 30 months postinjury. RESULTS Children who sustain mTBI during the preschool period have higher rates of internalizing and externalizing behavioral symptoms at the initial assessment time point and these symptoms persist up to 30 months postinjury. Moreover, results indicate that for up to 18 months postinjury, significantly more children with mTBI present behavioral difficulties that may require some form of clinical attention (i.e., scores in the borderline or clinical range), than do their orthopedically injured and noninjured peers. CONCLUSIONS Sustaining mTBI early in life may lead to long-lasting behavioral changes in young children (i.e., at least 30 months). These changes are likely the product of a complex interplay between neurological and non-neurological factors, both contributing to generating and maintaining behavioral difficulties.
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Affiliation(s)
- Charlotte Gagner
- Department of Psychology, University of Montreal, Quebec, Canada.,Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Fanny Dégeilh
- Department of Psychology, University of Montreal, Quebec, Canada.,Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Annie Bernier
- Department of Psychology, University of Montreal, Quebec, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Quebec, Canada.,Sainte-Justine Research Center, Montreal, Quebec, Canada
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11
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A Systematic Review of Sleep-Wake Disturbances in Childhood Traumatic Brain Injury: Relationship with Fatigue, Depression, and Quality of Life. J Head Trauma Rehabil 2019; 34:241-256. [DOI: 10.1097/htr.0000000000000446] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Botchway EN, Godfrey C, Nicholas CL, Hearps S, Anderson V, Catroppa C. Objective sleep outcomes 20 years after traumatic brain injury in childhood. Disabil Rehabil 2019; 42:2393-2401. [PMID: 30945574 DOI: 10.1080/09638288.2019.1578422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To assess objective sleep outcomes and correlates in young adults with a history of childhood traumatic brain injury.Materials and methods: Participants included 45 young adults who sustained brain injury in childhood (mild = 12, moderate = 22, and severe = 11) and 13 typically developing control participants. Sleep was assessed with actigraphy and sleep diaries recorded over 14 consecutive days. Rates of good sleep (sleep efficiency ≥ 85%) and poor sleep (sleep efficiency < 85%) were also evaluated.Results: At 20-years postinjury, participants with traumatic brain injury and controls presented with similar outcomes across the objective sleep parameters (all p > 0.050) and rates of poor sleepers were also similar between these groups (p = 0.735): 67% and 77%, respectively. However, moderate and severe traumatic brain injury and female sex were associated with longer sleep duration.Conclusions: These findings provide preliminary insights into objective sleep outcome and associated factors in the very-long-term after childhood brain injuries. They also indicate the need to monitor sleep outcomes in young adults with and without traumatic brain injury.Implication for rehabilitationSustaining traumatic brain injury in childhood can impact on several functional domains including sleep.Sleep disturbances, particularly insomnia-related symptoms, are common in this population, with evidence of poor outcomes reported until adolescence postinjury, while outcomes beyond adolescence remain unexplored.In this first investigation of objective sleep outcomes in young adults with a history of childhood traumatic brain injury, we showed that insomnia-related symptoms are highly prevalent in both young adults with traumatic brain injury (67%) and healthy controls (77%).These findings suggest the need to routinely evaluate and treat sleep problem in young adults in general, irrespective of history of childhood traumatic brain injury.
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Affiliation(s)
- Edith N Botchway
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Celia Godfrey
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Christian L Nicholas
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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13
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Botchway EN, Godfrey C, Anderson V, Nicholas CL, Catroppa C. Outcomes of Subjective Sleep–Wake Disturbances Twenty Years after Traumatic Brain Injury in Childhood. J Neurotrauma 2019; 36:669-678. [DOI: 10.1089/neu.2018.5743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Edith N. Botchway
- Murdoch Children's Research Institute, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Celia Godfrey
- Murdoch Children's Research Institute, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Christian L. Nicholas
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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Lalonde G, Bernier A, Beaudoin C, Gravel J, Beauchamp MH. Factors contributing to parent-child interaction quality following mild traumatic brain injury in early childhood. J Neuropsychol 2019; 14:98-120. [PMID: 30779296 DOI: 10.1111/jnp.12179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 11/24/2018] [Indexed: 01/18/2023]
Abstract
There is emerging evidence that parent-child interactions are affected by early childhood traumatic brain injury (TBI). These findings are of functional importance when considering the high prevalence of TBI in early childhood alongside evidence that young children exposed to positive relationships with their parents early in life exhibit better social functioning concurrently and longitudinally. Given that the overall quality of parent-child interactions is the result of both parent and child emotional and behavioural dispositions, it remains unclear which parental or child-related factors contribute to the quality of interactions post-TBI. The aim of this study was to investigate the factors that contribute to the quality of parent-child interactions following early childhood TBI. The sample included 68 children (18-60 months at recruitment) with accidental, uncomplicated mild TBI (mTBI). The quality of parent-child interactions was assessed 6 months post-injury using the Mutually Responsive Orientation scale, an observational measure of the dyadic quality of parent-child exchanges. Potential contributing factors were assessed among parental factors (e.g., age, socioeconomic status, family burden, parental stress, marital satisfaction) and child-related factors (e.g., age, sex, symptoms, fatigue, adaptive/behavioural skills). Socioeconomic status, child post-concussive symptoms, and child sleep problems were found to be significant independent contributing factors to parent-child interactions six months post-injury. This study provides the first evidence that both parental and child factors relate to the quality of parent-child interactions following mTBI, thus contributing to a better understanding of the scope and complexity of factors that play a role in childrens' recovery.
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Affiliation(s)
- Gabrielle Lalonde
- Ste-Justine Research Center, Montreal, Quebec, Canada.,Department of Psychology, University of Montreal, Quebec, Canada
| | - Annie Bernier
- Department of Psychology, University of Montreal, Quebec, Canada
| | - Cindy Beaudoin
- Ste-Justine Research Center, Montreal, Quebec, Canada.,Department of Psychology, University of Montreal, Quebec, Canada
| | | | - Miriam H Beauchamp
- Ste-Justine Research Center, Montreal, Quebec, Canada.,Department of Psychology, University of Montreal, Quebec, Canada
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Executive Functions and Their Relation to Sleep Following Mild Traumatic Brain Injury in Preschoolers. J Int Neuropsychol Soc 2018; 24:769-780. [PMID: 30113277 DOI: 10.1017/s1355617718000401] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Traumatic brain injury (TBI) sustained during childhood is known to impact children's executive functioning. However, few studies have focused specifically on executive functioning after preschool TBI. TBI has also been associated with sleep disturbances, which are known to impair executive functions in healthy children. The aim of this study was to investigate executive functions in preschoolers with mild TBI, and to determine the role of sleep in the links between TBI and executive functioning. METHODS The sample was drawn from a longitudinal study and included 167 children, aged 18 to 60 months, divided into 2 groups: children with accidental mild TBI (n=84) and typically developing children (n=83). Children were assessed 6 months post-injury on executive function measures (inhibition and cognitive flexibility) and sleep measures (actigraphy data and parental rating of sleep problems). RESULTS The two groups did not differ in their executive abilities. However, relative to controls, children with mild TBI and shorter nighttime sleep duration or increased sleep problems exhibited poorer executive functions. CONCLUSIONS These results support a "double hazard" effect, whereby the combination of sleep disturbances and mild TBI results in poorer executive functions. The findings highlight the importance of assessing and monitoring the quality of sleep even after mild head injuries. Poor sleep may place children at risk for increased cognitive difficulties. (JINS, 2018, 24, 769-780).
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