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Gunther OE, Garneau M, Geoffroy MC, Martin-Storey A, Latimer E, Déry M, Temcheff CE. Comparison of concordance and predictive validity of head injuries from parental reports and medical records. Brain Inj 2024:1-7. [PMID: 39041545 DOI: 10.1080/02699052.2024.2381046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/12/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVE To examine agreement between parental reports of head injury and evidence of head injury in medical records and to compare these two measures in predicting early conduct disorder (CD). DESIGN AND SETTING Parent survey data was compared with records of child head injury from the National Health Services Register (Régie de l'assurance maladie du Québec, RAMQ) administrative database. PARTICIPANTS Children (N = 685) ages 6-9 with and without CD. There were 147 children with RAMQ recorded head injury and 39 children with parent-reported head injury. MAIN MEASURES Indication of one or more head injury before 6 years of age as reported by parents and/or as noted in medical data. Early CD (present by age 9) according to parents and/or teachers. RESULTS Results indicated poor agreement between the two forms of reporting κ = .161 (95% CI, .083 to .239), p < 0.001. Medical data significantly predicted the presence of CD in children, with a RAMQ coded head injury suggesting a child was 1.88 times more likely to have CD. Parent reports of head injuries did not significantly predict CD. Conclusion: Medical data should be prioritized in research addressing pediatric head injury, given that parent reports may fail to capture incidence of injury and therefore may be less predictive of other known correlates of head injury.
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Affiliation(s)
- Olivia E Gunther
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Mathilde Garneau
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Claude Geoffroy
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Alexa Martin-Storey
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Eric Latimer
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Michèle Déry
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Caroline E Temcheff
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
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2
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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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3
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Slykerman RF, Clasby BE, Chong J, Edward K, Milne BJ, Temperton H, Thabrew H, Bowden N. Case identification of non-traumatic brain injury in youth using linked population data. BMC Neurol 2024; 24:82. [PMID: 38429681 PMCID: PMC10908152 DOI: 10.1186/s12883-024-03575-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Population-level administrative data provides a cost-effective means of monitoring health outcomes and service needs of clinical populations. This study aimed to present a method for case identification of non-traumatic brain injury in population-level data and to examine the association with sociodemographic factors. METHODS An estimated resident population of youth aged 0-24 years was constructed using population-level datasets within the New Zealand Integrated Data Infrastructure. A clinical consensus committee reviewed the International Classification of Diseases Ninth and Tenth Editions codes and Read codes for inclusion in a case definition. Cases were those with at least one non-traumatic brain injury code present in the five years up until 30 June 2018 in one of four databases in the Integrated Data Infrastructure. Rates of non-traumatic brain injury were examined, both including and excluding birth injury codes and across age, sex, ethnicity, and socioeconomic deprivation groups. RESULTS Of the 1 579 089 youth aged 0-24 years on 30 June 2018, 8154 (0.52%) were identified as having one of the brain injury codes in the five-years to 30 June 2018. Rates of non-traumatic brain injury were higher in males, children aged 0-4 years, Māori and Pacific young people, and youth living with high levels of social deprivation. CONCLUSION This study presents a comprehensive method for case identification of non-traumatic brain injury using national population-level administrative data.
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Affiliation(s)
- Rebecca F Slykerman
- Department of Psychological Medicine, Te Ara Hāro, University of Auckland, Building 507, 22-30 Park Avenue, Auckland, Grafton, 1023, New Zealand.
| | - Betony E Clasby
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Jimmy Chong
- Paediatric Rehabilitation Service, Te Whatu Ora, Te Toka Tumai, Auckland, New Zealand
| | - Kathryn Edward
- Paediatric Rehabilitation Service, Te Whatu Ora, Te Toka Tumai, Auckland, New Zealand
| | - Barry J Milne
- Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | - Helen Temperton
- Paediatric Rehabilitation Service, Te Whatu Ora, Te Toka Tumai, Auckland, New Zealand
| | - Hiran Thabrew
- Department of Psychological Medicine, Te Ara Hāro, University of Auckland, Building 507, 22-30 Park Avenue, Auckland, Grafton, 1023, New Zealand
| | - Nicholas Bowden
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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4
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Linden MA, McKinlay A, Hawley C, Aaro-Jonsson C, Kristiansen I, Meyer-Heim A, Ewing-Cobbs L, Wicks B, Beauchamp MH, Prasad R. Further recommendations of the International Paediatric Brain Injury Society (IPBIS) for the post-acute rehabilitation of children with acquired brain injury. Brain Inj 2024; 38:151-159. [PMID: 38329039 DOI: 10.1080/02699052.2024.2309252] [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: 08/11/2022] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Paediatric acquired brain injury is a life-long condition which impacts on all facets of the individual's lived experience. The existing evidence base continues to expand and new fields of enquiry are established as clinicians and researchers uncover the extent of these impacts. PRIMARY OBJECTIVE To add to recommendations described in the International Paediatric Brain Injury Society's 2016 paper on post-acute care for children with acquired brain injury and highlight new areas of enquiry. REVIEW OF INFORMATION Recommendations were made based on the opinions of a group of experienced international clinicians and researchers who are current or past members of the board of directors of the International Paediatric Brain Injury Society. The importance of each recommendation was agreed upon by means of group consensus. OUTCOMES This update gives new consideration to areas of study including injuries which occur in pre-school children, young people in the military, medical referral, young offenders and the use of technology in rehabilitation.
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Affiliation(s)
- Mark A Linden
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Carol Hawley
- Warwick Medical School - Mental Health and Wellbeing, University of Warwick, UK
| | | | - Ingela Kristiansen
- Department of Pediatric Neurology, Uppsala University Hospital, Uppsala, Sweden
| | - Andreas Meyer-Heim
- Rehabilitation Centre, University Children's Hospital Zürich, Zurich, Switzerland
| | - Linda Ewing-Cobbs
- Department of Pediatrics, UTHealth Houston, McGovern Medical School, USA
| | | | - Miriam H Beauchamp
- Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Rajendra Prasad
- Department of Neurosurgery, Indraprastha Apollo Hospitals, New Delhi, India
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5
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Stewart SL, Withers A, Graham AA, Poss JW, Donnelly N. Examining the Biopsychosocial Factors Related to Lifetime History of Concussion in Children and Youth. Child Psychiatry Hum Dev 2024; 55:36-47. [PMID: 35729361 DOI: 10.1007/s10578-022-01384-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/03/2022]
Abstract
This study investigated the prevalence of lifetime concussions, related psychosocial problems, and post-concussion recovery rates in a clinical sample of children and youth. Participants were 24,186 children and youth (M = 11.9 years, SD = 3.5) who completed an interRAI Child and Youth Mental Health Assessment at mental health agencies across Ontario, Canada. In addition to the expected physiological correlates, results found concussions to be more prevalent in children and youth with attention deficit hyperactivity disorders, anxiety disorders, disruptive behaviour disorders, mood disorders, and those involved in self-harm, harm to others, destructive aggression, and internalizing and externalizing symptoms. The results of this study add to our understanding of children and youth's experiences with concussions. Clinical implications and recommendations are discussed to maximize the effectiveness of evidence-based interventions related to concussion recovery.
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Affiliation(s)
- Shannon L Stewart
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON, N6G 1G7, Canada
| | - Abigail Withers
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON, N6G 1G7, Canada.
| | - Alana A Graham
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON, N6G 1G7, Canada
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G5, Canada
| | - Nicholas Donnelly
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON, N6G 1G7, Canada
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6
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Bemanalizadeh M, Yazdi M, Yaghini O, Kelishadi R. A meta-analysis on the effect of telemedicine on the management of attention deficit and hyperactivity disorder in children and adolescents. J Telemed Telecare 2024; 30:31-43. [PMID: 34633251 DOI: 10.1177/1357633x211045186] [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: 11/16/2022]
Abstract
INTRODUCTION This study aims to report the effect sizes of telemedicine treatments on the symptom domains of paediatric ADHD. METHODS In this systematic review and meta-analysis, electronic databases, i.e. PubMed, Scopus, Web of Science and Embase, were searched for articles published up to December 2020. The inclusion criteria were as follows: children or adolescents diagnosed for ADHD or other hyperkinetic disorders; randomized controlled trials (RCTs); efficacy established with parents and teachers or self-rating scales at least for one of the following domains: inattention, cognitive function, hyperactivity, hyperactivity/impulsivity or oppositional behaviours. The risk of bias was assessed using the Cochrane risk of bias tool for RCTs. RESULTS From 310 records reduced to 228 after removing duplicates, overall 12 studies were fulfilled our inclusion criteria. They consisted of 708 participants (358 with telemedicine intervention and 350 controls). The telemedicine interventions varied from computerized training programmes with phone calls to videoconferencing programmes, virtual reality classrooms or games. The most applicable method consisted of computerized training programmes with phone calls. Pooling results of all studies with available data on each subscale showed a significant effect of telemedicine on inattention/cognitive function (standardized mean difference (SMD) = 0.26, 95% CI: 0.16, 0.36), hyperactivity/impulsivity (SMD = 0.29, 95% CI: 0.06, 0.52), and oppositional behaviours (SMD = 0.72, 95% CI: 0.24, 1.20) subscales in ADHD. Almost all studies had an overall unclear risk of bias. The source of outcome assessment (parents, teachers or self-report questionnaire) was addressed as a potential confounding factor. In almost all symptom domains, the satisfaction from the treatment was higher in parents than in teachers. CONCLUSIONS The clinical effects of telemedicine on the treatment of ADHD showed a small effect size for inattention/cognitive function, hyperactivity/impulsivity and oppositional behaviours.
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Affiliation(s)
- Maryam Bemanalizadeh
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Science, Iran
| | - Maryam Yazdi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Science, Iran
| | - Omid Yaghini
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Science, Iran
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Science, Iran
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Iran
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7
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Dupont D, Larivière-Bastien D, Caron JG, Beaudoin C, Gravel J, Gagnon I, Burstein B, Beaudin M, Rose SC, Yeates KO, Beauchamp MH. "What If?": Caregivers' Experiences Following Early Childhood Concussion. J Pediatr Psychol 2023; 48:971-981. [PMID: 37579243 DOI: 10.1093/jpepsy/jsad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVE Little is known about the symptoms, signs, and management guidelines for children under the age of 6 years after they sustain a concussion. Caregivers of such young children may have unique concerns and encounter different challenges from those of school-age children given the distinctive developmental characteristics of the early childhood period. This study aimed to explore the experience of caregivers through semistructured interviews to inform clinical practice. METHODS Fifty caregivers of children aged 6 months to 5.99 years were interviewed 3 months postinjury for this qualitative study to document their experience in relation to their child's accident, recovery, and healthcare provisions. RESULTS Four main themes were identified: (1) visible changes associated with caregiver concerns, (2) a roller-coaster of emotions after the injury, (3) healthcare providers' role in addressing the need for reassurance, and (4) the need for better information after the injury. CONCLUSION The findings provide critical insight into the unique experiences and information needs of caregivers of young children who sustain concussion. The challenges identified can inform healthcare professionals regarding the needs of caregivers after early concussion and contribute to building a knowledge base for the development of age-appropriate anticipatory guidance for caregiver mental health and child recovery.
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Affiliation(s)
- Dominique Dupont
- Department of Psychology, University of Montreal, Canada
- CHU Sainte-Justine Research Center, Canada
| | - Danaë Larivière-Bastien
- Department of Psychology, University of Montreal, Canada
- CHU Sainte-Justine Research Center, Canada
| | - Jeffrey G Caron
- School of Kinesiology and Physical Activity Sciences, University of Montreal, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Canada
| | - Cindy Beaudoin
- Department of Psychology, University of Montreal, Canada
| | | | - Isabelle Gagnon
- Montreal Children's Hospital, McGill University Health Centre, Canada
- School of Physical and Occupational Therapy, McGill University, Canada
| | - Brett Burstein
- Montreal Children's Hospital, McGill University Health Centre, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Myriam Beaudin
- Department of Psychology, University of Quebec in Montreal, Canada
| | - Sean C Rose
- Department of Neurology, Nationwide Children's Hospital, USA
| | - Keith O Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, Canada
- Hotchkiss Brain Institute, University of Calgary, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Canada
- CHU Sainte-Justine Research Center, Canada
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8
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Esterov D, Hines E, Neumann AA, Mara KC, Weaver AL. The Association of Adverse Childhood Experiences with Long-term Mood and Anxiety Disorders After Childhood Traumatic Brain Injury: A Population-based Case-Control Study. Arch Phys Med Rehabil 2023; 104:2075-2083. [PMID: 37467935 PMCID: PMC10792097 DOI: 10.1016/j.apmr.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/31/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To assess the association between ACEs and the development of psychiatric disorders by age 25 among individuals who sustained TBI prior to age 10. DESIGN Population-based case-control study. SETTING Olmsted County, Minnesota. PARTICIPANTS 566 individuals (N=566) who sustained a TBI prior to age 10 were identified and classified using a validated TBI classification system. Among these individuals, cases with a subsequent mood or anxiety disorder prior to age 25 were identified through clinical diagnostic codes and manual record review. For each case, a 1:1 matched control was randomly selected from individuals with a pediatric TBI who did not have a mood/anxiety disorder prior to the matched case's mood/anxiety disorder. INTERVENTIONS Not applicable MAIN OUTCOME MEASURES: Development of a mood/anxiety disorder. RESULTS Among the 114 matched pairs of individuals with a TBI prior to age 10, a subsequent mood/anxiety diagnosis was significantly associated with a history of 10 of 14 ACE categories and with having an ACE score ≥1 (odds ratio 5.17; 95% confidence interval 2.78-9.59). CONCLUSIONS This is the first population-based study to the authors' knowledge showing that among children who sustained a TBI prior to age 10, those who experienced ACEs are at increased risk of developing a mood or anxiety disorder.
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Affiliation(s)
- Dmitry Esterov
- Department of Physical Medicine and Rehabilitation Mayo Clinic, Rochester MN.
| | - Emily Hines
- Department of Physical Medicine and Rehabilitation Mayo Clinic, Rochester MN
| | - Alyssa A Neumann
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Kristin C Mara
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Amy L Weaver
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Ewing-Cobbs L, Danna CV, Tolar TD, Granger D, Cox CS, Prasad MR. Stress Reactivity After Pediatric Traumatic Brain Injury: Relation With Behavioral Adjustment. J Neurotrauma 2023; 40:1436-1450. [PMID: 36424831 PMCID: PMC10312200 DOI: 10.1089/neu.2022.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Traumatic injury is linked increasingly to alterations in both stress response systems and psychological health. We investigated reactivity of salivary analytes of the hypothalamic-pituitary-adrenal axis (cortisol) and autonomic nervous system (salivary alpha amylase, sAA) during a psychosocial stress procedure in relation to psychological health outcomes. In a prospective cohort design, stress reactivity of children ages 8 to 15 years hospitalized for traumatic brain injury (TBI; n = 74) or extracranial injury (EI; n = 35) was compared with healthy controls (n = 51) 7 months after injury. Area under the curve increase (AUCinc) assessed pre-stressor to post-stressor cortisol and sAA values. Multi-variable general linear models evaluated demographic, family functioning, group, cortisol, and sAA AUCinc, and their interactions in relation to concurrent child and parent ratings of emotion regulation and internalizing and externalizing problems. Although AUCinc values were similar across groups, their relations with outcomes varied by group. Higher stress reactivity is typically associated with fewer adjustment problems. Relative to controls, greater sAA reactivity was associated with greater emotion dysregulation after TBI. In contrast, the relation of sAA reactivity with internalizing and generalized anxiety scores was flatter for both TBI and EI groups. The flattened and/or reversed direction of sAA reactivity with psychological health outcomes after TBI, and to a lesser degree EI, suggests autonomic nervous system dysregulation. Across groups, sAA reactivity interacted with sex on several psychological health outcomes with greater dysregulation in girls than in boys. Our findings highlight altered sAA, but not cortisol reactivity, as a potential mechanism of biological vulnerability associated with poorer adjustment after TBI.
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Affiliation(s)
- Linda Ewing-Cobbs
- Children's Learning Institute and Department of Pediatrics, McGovern School of Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Christina V. Danna
- Children's Learning Institute and Department of Pediatrics, McGovern School of Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | | | - Douglas Granger
- Institute for Interdisciplinary Salivary Bioscience, University of California, Irvine, Irvine, California, and Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Charles S. Cox
- Department of Pediatric Surgery, McGovern School of Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Mary R. Prasad
- McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Ware JB, Sandsmark DK. Imaging Approach to Concussion. Neuroimaging Clin N Am 2023; 33:261-269. [PMID: 36965944 DOI: 10.1016/j.nic.2023.01.002] [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: 02/20/2023]
Abstract
The acute and long-term neurobiological sequelae of concussion (mild traumatic brain injury [mTBI]) and sub-concussive head trauma have become increasingly apparent in recent decades in part due to neuroimaging research. Although imaging has an established role in the clinical management of mTBI for the identification of intracranial lesions warranting urgent interventions, MR imaging is increasingly employed for the detection of post-traumatic sequelae which carry important prognostic significance. As neuroimaging research continues to elucidate the pathophysiology of TBI underlying prolonged recovery and the development of persistent post-concussive symptoms, there is a strong motivation to translate these techniques into clinical use for improved diagnosis and therapeutic monitoring.
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Affiliation(s)
- Jeffrey B Ware
- Department of Radiology, Neuroradiology Division, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Danielle K Sandsmark
- Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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11
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Esterov D, Witkowski J, McCall DM, Weaver AL, Brown AW. Long-Term Risk for Mood and Anxiety Disorders After Pediatric Traumatic Brain Injury: A Population-Based, Birth Cohort Analysis. J Head Trauma Rehabil 2023; 38:E212-E222. [PMID: 36731039 PMCID: PMC10413284 DOI: 10.1097/htr.0000000000000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine whether exposure to traumatic brain injury (TBI) before 10 years of age is associated with development of a mood or anxiety disorder by 25 years of age, and whether sex or injury severity influences this risk. SETTING Olmsted County, Minnesota. PARTICIPANTS A total of 5518 persons born from January 1, 1976, through December 31, 1982. DESIGN Population-based, birth cohort study. Children sustaining TBI before 10 years of age (index date) were confirmed by manual record review and classified by injury severity using the Mayo Classification System. Each TBI case was age- and sex-matched to 2 referents from the same birth cohort without a history of TBI at the index date. Cox proportional hazards models were fit to compare the risk of a subsequent clinically diagnosed mood or anxiety disorder by 25 years of age between TBI cases and referents. Separate analysis was performed stratified by sex and injury severity. MAIN MEASURES Incidence of mood and anxiety disorders determined through clinical diagnostic codes and manual record review. RESULTS The study included 562 children (238 females [42.3%] and 324 males [57.7%]) with TBI before 10 years of age (mean [SD] age at TBI: 4.7 [2.8] years). At least 1 mood or anxiety disorder was diagnosed for 115 persons with TBI and 215 referents. No statistically significant association existed between childhood TBI status and anxiety disorder (adjusted hazard ratio [aHR], 1.01 [95% confidence interval (CI), 0.71-1.43]; P = .97) or mood disorder (aHR, 1.16 [95% CI, 0.92-1.47]; P = .21). However, females who sustained TBI had a significantly increased risk of a subsequently diagnosed mood disorder compared with age-matched female referents (aHR, 1.40 [95% CI, 1.04-1.89]; P = .03). CONCLUSIONS This study suggests that isolated TBI before 10 years of age is not significantly associated with an increased risk of anxiety or mood disorder by 25 years of age, though females may be at an increased risk.
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Affiliation(s)
- Dmitry Esterov
- Department of Physical Medicine and Rehabilitation (Drs Esterov and Brown), Division of Clinical Trials and Biostatistics (Ms Weaver), Mayo Clinic, Rochester, Minnesota; and Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (Drs Witkowski and McCall). Dr Witkowski is now with the Department of Physical Medicine and Rehabilitation, Northwestern Medicine, Wheaton, Illinois. Dr McCall is now with the Gundersen Health System, La Crosse, Wisconsin
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12
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Adams Nejatbakhsh N, Dawson D, Hutchison M, Selby P. Association between pediatric TBI and mental health and substance use disorders: A scoping review. Brain Inj 2023; 37:525-533. [PMID: 36871963 DOI: 10.1080/02699052.2023.2184871] [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: 03/07/2023]
Abstract
BACKGROUND The relationship between pediatric Traumatic Brain Injury (TBI) and long-term mental health and substance use disorders is not well known, resulting in inadequate prevention and management strategies. The aim of this scoping review is to review the evidence on pediatric TBI and the development of mental health disorders and substance use later in life and to identify gaps in the literature to inform future research. METHODS We searched multiple databases for original articles published between September 2002 and September 2022 on TBI-related mental health and/or substance use disorders in children and youth. Two independent reviewers performed the screening using Arksey and O'Malley and Levac et al.'s scoping review framework. RESULTS A total of six papers are included in this scoping review. Studies included are comprised of cross-sectional and prospective longitudinal cohort studies. DISCUSSION A correlation between pediatric TBI and development of certain mental health disorders and substance use is suggested, although much of the current evidence is mixed and does not account for confounding variables. Future studies should aim to closely examine these links and identify modifiers that can influence these relationships.
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Affiliation(s)
- Nasrin Adams Nejatbakhsh
- Addiction Medicine, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Canada
| | - Danielle Dawson
- Addiction Medicine, Centre for Addiction and Mental Health, Toronto, Canada
| | | | - Peter Selby
- Addiction Medicine, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Canada.,Psychiatry, University of Toronto, Toronto, Canada.,Dalla Lana School of Medicine, University of Toronto, 155 College St, Toronto, Canada
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13
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Chiariello R, McCarthy C, Glaeser BL, Shah AS, Budde MD, Stemper BD, Olsen CM. Chronicity of repeated blast traumatic brain injury associated increase in oxycodone seeking in rats. Behav Brain Res 2023; 438:114181. [PMID: 36330906 PMCID: PMC9993345 DOI: 10.1016/j.bbr.2022.114181] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
Numerous epidemiological studies have found co-morbidity between non-severe traumatic brain injury (TBI) and substance misuse in both civilian and military populations. Preclinical studies have also identified this relationship for some misused substances. We have previously demonstrated that repeated blast traumatic brain injury (rbTBI) increased oxycodone seeking without increasing oxycodone self-administration, suggesting that the neurological sequelae of traumatic brain injury can elevate opioid misuse liability. Here, we determined the chronicity of this effect by testing different durations of time between injury and oxycodone self-administration and durations of abstinence. We found that the subchronic (four weeks), but not the acute (three days) or chronic (four months) duration between injury and oxycodone self-administration was associated with increased drug seeking and re-acquisition of self-administration following a 10-day abstinence. Examination of other abstinence durations (two days, four weeks, or four months) revealed no effect of rbTBI on drug seeking at any of the abstinence durations tested. Together, these data indicate that there is a window of vulnerability after TBI when oxycodone self-administration is associated with elevated drug seeking and relapse-related behaviors.
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Affiliation(s)
- Rachel Chiariello
- Department of Neurosurgery, Medical College of Wisconsin, United States; Clement J. Zablocki Veterans Affairs Medical Center, United States
| | - Cassandra McCarthy
- Department of Neurosurgery, Medical College of Wisconsin, United States; Clement J. Zablocki Veterans Affairs Medical Center, United States
| | - Breanna L Glaeser
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, United States; Neuroscience Research Center, Medical College of Wisconsin, United States
| | - Alok S Shah
- Department of Neurosurgery, Medical College of Wisconsin, United States; Clement J. Zablocki Veterans Affairs Medical Center, United States
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, United States; Clement J. Zablocki Veterans Affairs Medical Center, United States; Neuroscience Research Center, Medical College of Wisconsin, United States
| | - Brian D Stemper
- Clement J. Zablocki Veterans Affairs Medical Center, United States; Neuroscience Research Center, Medical College of Wisconsin, United States; Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, United States
| | - Christopher M Olsen
- Department of Neurosurgery, Medical College of Wisconsin, United States; Department of Pharmacology and Toxicology, Medical College of Wisconsin, United States; Neuroscience Research Center, Medical College of Wisconsin, United States.
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14
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Pullen JC, Wolfson DI, Totten DJ, Jeckell AS, Bonfield CM, Zuckerman SL, Yengo-Kahn AM. Attention-Deficit Hyperactivity Disorder and Learning Disabilities Modify Recovery and Sport Behavior Following Sport-Related Concussion. Clin Pediatr (Phila) 2023; 62:121-131. [PMID: 35883273 DOI: 10.1177/00099228221113787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Limited evidence exists concerning how a diagnosis of attention-deficit hyperactivity disorder and/or learning disabilities (ADHD/LD) modifies recovery and behavior following sport-related concussion (SRC). To understand how ADHD/LD modifies the post-SRC experience, we conducted a retrospective cohort study of concussed young athletes through phone interviews with patients and guardians. Outcomes included time until symptom resolution (SR) and return-to-learn (RTL), plus subjective changes in post-SRC activity and sports behavior. Multivariate Cox and logistic regression was performed, adjusting for biopsychosocial characteristics. The ADHD/LD diagnosis was independently associated with worse outcomes, including lower likelihood to achieve SR (hazard ratio [HR] = 0.62, 95% confidence interval [CI] = [0.41-0.94]; P = .02) and RTL (HR = 0.55, 95% CI = [0.36-0.83]; P < .01) at any time following injury, and increased odds of changing sport behavior after concussion (odds ratio [OR] = 3.26, 95% CI = [1.26-8.42], P = .02), often to a safer style of play (62.5% vs 39.6%; P = .02) or retiring from the sport (37.5% vs 18.5%; P = .02). These results provide further evidence of the unique needs for athletes with ADHD/LD following SRC.
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Affiliation(s)
- Jesse C Pullen
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel I Wolfson
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Douglas J Totten
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Aaron S Jeckell
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher M Bonfield
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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15
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Catroppa C, Sood NT, Morrison E, Kenardy J, Lah S, McKinlay A, Ryan N, Crowe L, Soo C, Godfrey C, Anderson V. The Australian and New Zealand brain injury lifespan cohort protocol: Leveraging common data elements to characterise longitudinal outcome and recovery. BMJ Open 2023; 13:e067712. [PMID: 36657763 PMCID: PMC9853218 DOI: 10.1136/bmjopen-2022-067712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Cognitive, behavioural, academic, mental health and social impairments are common following paediatric traumatic brain injury (TBI). However, studies are often reliant on small samples of children drawn from narrow age bands, and employ highly variable methodologies, which make it challenging to generalise existing research findings and understand the lifetime history of TBI. METHOD AND ANALYSIS This study will synthesise common data sets from national (Victoria, New South Wales, Queensland) and international (New Zealand) collaborators, such that common data elements from multiple cohorts recruited from these four sites will be extracted and harmonised. Participant-level harmonised data will then be pooled to create a single integrated data set of participants including common cognitive, social, academic and mental health outcome variables. The large sample size (n=1816), consisting of participants with mild, moderate and severe TBI, will provide statistical power to answer important questions that cannot be addressed by small, individual cohorts. Complex statistical modelling, such as generalised estimation equation, multilevel and latent growth models, will be conducted. ETHICS AND DISSEMINATION Ethics approval was granted by the Human Research Ethics Committee (HREC) of the Royal Children's Hospital (RCH), Melbourne (HREC Reference Number 2019.168). The approved study protocol will be used for all study-related procedures. Findings will be translated into clinical practice, inform policy decisions, guide the appropriate allocation of limited healthcare resources and support the implementation of individualised care.
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Affiliation(s)
- Cathy Catroppa
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Nikita Tuli Sood
- Brain and Mind, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Elle Morrison
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Justin Kenardy
- The University of Queensland, Saint Lucia Campus, Saint Lucia, Queensland, Australia
| | - Suncica Lah
- The University of Sydney, Sydney, New South Wales, Australia
| | | | - Nicholas Ryan
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Louise Crowe
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Cheryl Soo
- Applied Medical Research, Ingham Institute, Liverpool, New South Wales, Australia
| | - Celia Godfrey
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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16
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Huynh LK, Gagner C, Bernier A, Beauchamp MH. Discrepancies between mother and father ratings of child behavior after early mild traumatic brain injury. Child Neuropsychol 2023; 29:56-75. [PMID: 35451343 DOI: 10.1080/09297049.2022.2066074] [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: 10/18/2022]
Abstract
Mild traumatic brain injuries (mTBI) are highly prevalent during early childhood and can lead to behavioral difficulties. Parent report questionnaires are widely used to assess children's behavior, but they are subject to parental bias. The aim of this study was to investigate parental discrepancies in internalized and externalized behavior ratings of children who sustain mTBI in early childhood (i.e., between 18 and 60 months) and to determine if parenting stress or family burden related to the injury contribute to parental discrepancies. Mothers and fathers of 85 children with mTBI, 58 orthopedic injured (OI), and 82 typically developing children (TDC) completed the Child Behavior Checklist 6 months after the injury. The primary caregiver completed the Parental Distress subscale of the Parenting Stress Index and the Family Burden of Injury Interview. Mothers reported more internalized and externalized behavior problems than fathers in the mTBI group. No group difference was found in the OI or TDC groups. Neither parenting stress nor family burden related to the injury predicted discrepancies in behavior ratings. Mothers' and fathers' perceptions of behavior after their young child sustains mTBI appear to differ, suggesting that both parents' views are useful in understanding outcome. This difference was not found in either of the comparison groups indicating that factors related to mTBI may underlie the rating discrepancies.
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Affiliation(s)
- Lara-Kim Huynh
- Department of Psychology, University of Montreal, Montreal, Canada
| | - Charlotte Gagner
- Department of Psychology, University of Montreal, Montreal, Canada
| | - Annie Bernier
- Department of Psychology, University of Montreal, Montreal, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Canada.,Sainte-Justine Hospital Research Center, Montreal, Canada
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17
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Wales L. Conceptual framework of the recovery of self-awareness following a severe traumatic brain injury in childhood. Brain Inj 2022; 37:655-661. [PMID: 36527373 DOI: 10.1080/02699052.2022.2158233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Self-awareness following a TBI in childhood is an under-represented area of research in the pediatric literature. The issue is well described in the adult literature but the theories and practice recommendations in this body of literature are not easily transferable to pediatric neurorehabilitation. Children and young people sustain a TBI at a time when the brain is yet to fully develop. This paper outlines a conceptual framework that incorporates and adapts knowledge from the adult and pediatric literature of self-awareness. METHODS The content and the structure of the framework is constructed from clinical experience, existing literature and the findings from an empirical study. FINDINGS A conceptual framework is presented with 3 key components: self-awareness knowledge, self-awareness in context, self-awareness for the future. The components are explained and the relationship between the concepts is highlighted. CONCLUSION The framework provides a common language for clinicians and academics to explore the concepts that impact self-awareness during recovery. The framework captures the dynamic developmental and recovery trajectory of self-awareness following a TBI in childhood.
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Affiliation(s)
- Lorna Wales
- Research team, The Children’s Trust, Tadworth, Tadworth, UK
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18
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Brown AW, Esterov D, Zielinski MD, Weaver AL, Mara KC, Ferrara MJ, Immermann JM, Moir C. Incidence and risk of attention-deficit/hyperactivity disorder and learning disability by adulthood after traumatic brain injury in childhood: a population-based birth cohort study. Child Neuropsychol 2022:1-17. [DOI: 10.1080/09297049.2022.2136645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Allen W. Brown
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Amy L. Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Kristin C. Mara
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Michael J. Ferrara
- Surgical Medical Acute Care Research Program, Mayo Clinic, Rochester, MN, USA
| | - Joseph M. Immermann
- Surgical Medical Acute Care Research Program, Mayo Clinic, Rochester, MN, USA
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19
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Back to School: Academic Functioning and Educational Needs among Youth with Acquired Brain Injury. CHILDREN 2022; 9:children9091321. [PMID: 36138630 PMCID: PMC9497748 DOI: 10.3390/children9091321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022]
Abstract
Youth with a history of traumatic or non-traumatic acquired brain injury are at increased risk for long-lasting cognitive, emotional, behavioral, social, and physical sequelae post-injury. Such sequelae have great potential to negatively impact this population’s academic functioning. Consistently, poorer academic achievement and elevated need for educational supports have been well-documented among youth with a history of acquired brain injury. The current paper reviews the literature on neuropsychological, psychiatric, and academic outcomes of pediatric acquired brain injury. A discussion of special education law as it applies to this patient population, ongoing limitations within the field, and a proposal of solutions are also included.
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20
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Weil ZM, White B, Whitehead B, Karelina K. The role of the stress system in recovery after traumatic brain injury: A tribute to Bruce S. McEwen. Neurobiol Stress 2022; 19:100467. [PMID: 35720260 PMCID: PMC9201063 DOI: 10.1016/j.ynstr.2022.100467] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022] Open
Abstract
Traumatic brain injury (TBI) represents a major public health concern. Although the majority of individuals that suffer mild-moderate TBI recover relatively quickly, a substantial subset of individuals experiences prolonged and debilitating symptoms. An exacerbated response to physiological and psychological stressors after TBI may mediate poor functional recovery. Individuals with TBI can suffer from poor stress tolerance, impairments in the ability to evaluate stressors, and poor initiation (and cessation) of neuroendocrine stress responses, all of which can exacerbate TBI-mediated dysfunction. Here, we pay tribute to the pioneering neuroendocrinologist Dr. Bruce McEwen by discussing the ways in which his work on stress physiology and allostatic loading impacts the TBI patient population both before and after their injuries. Specifically, we will discuss the modulatory role of hypothalamic-pituitary-adrenal axis responses immediately after TBI and later in recovery. We will also consider the impact of stressors and stress responses in promoting post-concussive syndrome and post-traumatic stress disorders, two common sequelae of TBI. Finally, we will explore the role of early life stressors, prior to brain injuries, as modulators of injury outcomes.
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21
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Ziminski D, Szlyk HS, Baiden P, Okine L, Onyeaka HK, Muoghalu C, Cavazos-Rehg P. Sports- and physical activity-related concussion and mental health among adolescents: Findings from the 2017 and 2019 Youth Risk Behavior Survey. Psychiatry Res 2022; 312:114542. [PMID: 35461119 PMCID: PMC9531575 DOI: 10.1016/j.psychres.2022.114542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/28/2022]
Abstract
This study examined the association between self-reported sports- or physical activity-related concussion and symptoms of depression and suicidal behaviors (suicidal ideation, having a suicide plan, and suicide attempts). This study used data from the 2017 and 2019 Youth Risk Behavior Survey (YRBS), a biennial, school-based, nationally representative survey of U.S. students in grade levels 9 to 12 (N = 14,496). Multivariate logistical regression models assessed the association between self-reported sports-or physical activity-related concussions and suicidal behaviors among students, controlling for a range of demographic and psychosocial variables. Altogether, 13.6% of students reported a sports-or physical activity related concussion in the past 12 months. Among youth, sports-or physical activity related concussions were significantly associated with greater odds of symptoms of depression, suicidal ideation, making a suicide plan, and suicide attempts compared to other youth who did not experience sports- or physical activity-related concussion. Findings highlight increased risk for adverse mental health outcomes among students with sports-or physical activity related concussions. Providing resources for students to engage in physical activity and sports teams may help prevent the onset of depression and suicidal behaviors; however, resources must also be available to monitor any concussions related to these activities to provide support for student emotional well-being.
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Affiliation(s)
- Devon Ziminski
- Rutgers, The State University of New Jersey, School of Social Work, 120 Albany St, New Brunswick, NJ 08901
| | - Hannah S. Szlyk
- Rutgers, The State University of New Jersey, School of Social Work, 120 Albany St, New Brunswick, NJ 08901,Corresponding author: Dr. Hannah S. Szlyk, PhD, LCSW Social Work, Rutgers University: Rutgers The State University of New Jersey, 390 George Street, Rm. 807, New Brunswick, NJ 08901, United States, (H.S. Szlyk)
| | - Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX, 76019
| | - Lucinda Okine
- University of Southern California, USC Suzanne Dworak-Peck School of Social Work, 669 W 34th St. Los Angeles, CA 90089
| | - Henry K. Onyeaka
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital/McLean Hospital, Boston, MA, USA, 02115
| | - Chioma Muoghalu
- Plains Regional Medical Center, Clovis, New Mexico, NM 88101,Duke University School of Medicine, Master of Management in Clinical Informatics, NC 27710
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
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22
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Esterov D, Witkowski J, McCall DM, Wi CI, Weaver AL, Brown AW. Risk factors for development of long-term mood and anxiety disorder after pediatric traumatic brain injury: a population-based, birth cohort analysis. Brain Inj 2022; 36:722-732. [PMID: 35604956 PMCID: PMC10364060 DOI: 10.1080/02699052.2022.2077987] [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: 11/02/2022]
Abstract
OBJECTIVES The objective of this study was to identify characteristics associated with an increased risk of anxiety and mood disorder prior to 25 years of age, in children who sustained a traumatic brain injury (TBI) prior to age 10. METHODS This population-based study identified 562 TBI cases from a 1976-1982 birth cohort in Olmsted County, Minnesota. TBI cases were manually confirmed and classified by injury severity. Separate Cox proportional hazards regression models were fit to estimate the association of TBI and secondary non-TBI related characteristics with the risk of a subsequent clinically determined anxiety or mood disorder. Multivariable-adjusted population attributable risk (PAR) estimates were calculated for TBI characteristics. RESULTS Older age at initial TBI and extracranial injury at time of initial TBI were significantly associated with an increased risk of anxiety (adjusted HR [95% CI]: 1.33 [1.16, 1.52] per 1-year increase and 2.41 [1.26, 4.59]), respectively. Older age at initial TBI was significantly associated with an increased risk of a mood disorder (adjusted HR 1.17 [1.08-1.27]). CONCLUSION In individuals sustaining a TBI prior to age 10, age at injury greater than 5 years old was the largest contributor to development of a mood or anxiety disorder.
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Affiliation(s)
- Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Julie Witkowski
- Mayo Clinic, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Dana M McCall
- Mayo Clinic, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Amy L Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Allen W Brown
- Department of Physical Medicine and Rehabilitation, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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23
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Lowet DS, Vaida F, Hesselink JR, Levin HS, Ewing-Cobbs L, Schachar RJ, Chapman SB, Bigler ED, Wilde EA, Saunders AE, Yang TT, Tymofiyeva O, Max JE. Novel Oppositional Defiant Disorder 12 Months After Traumatic Brain Injury in Children and Adolescents. J Neuropsychiatry Clin Neurosci 2022; 34:149-157. [PMID: 35040660 DOI: 10.1176/appi.neuropsych.21060149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The investigators examined the factors predictive of novel oppositional defiant disorder in the 6-12 months following traumatic brain injury (TBI). METHODS Children ages 5-14 years old who experienced a TBI were recruited from consecutive admissions to five hospitals. Participants were evaluated soon after injury (baseline) for preinjury characteristics, including psychiatric disorders, adaptive function, family function, psychosocial adversity, family psychiatric history, socioeconomic status, and injury severity, to develop a biopsychosocial predictive model for development of novel oppositional defiant disorder. MRI analyses were conducted to examine potential brain lesions. Psychiatric outcome, including that of novel oppositional defiant disorder, was assessed 12 months after injury. RESULTS Although 177 children were recruited for the study, 120 children without preinjury oppositional defiant disorder, conduct disorder, or disruptive behavior disorder not otherwise specified (DBD NOS) returned for the 12-month assessment. Of these 120 children, seven (5.8%) exhibited novel oppositional defiant disorder, and none developed conduct disorder or DBD NOS in the 6-12 months postinjury. Novel oppositional defiant disorder was significantly associated with lower socioeconomic status, higher psychosocial adversity, and lower preinjury adaptive functioning. CONCLUSIONS These results demonstrate that novel oppositional defiant disorder following TBI selectively and negatively affects an identifiable group of children. Both proximal (preinjury adaptive function) and distal (socioeconomic status and psychosocial adversity) psychosocial variables significantly increase risk for this outcome.
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Affiliation(s)
- Daniel S Lowet
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Florin Vaida
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - John R Hesselink
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Harvey S Levin
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Linda Ewing-Cobbs
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Russell J Schachar
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Sandra B Chapman
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Erin D Bigler
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Elisabeth A Wilde
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Ann E Saunders
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Tony T Yang
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Olga Tymofiyeva
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Jeffrey E Max
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
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Olsen CM, Corrigan JD. Does Traumatic Brain Injury Cause Risky Substance Use or Substance Use Disorder? Biol Psychiatry 2022; 91:421-437. [PMID: 34561027 PMCID: PMC8776913 DOI: 10.1016/j.biopsych.2021.07.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/07/2021] [Accepted: 07/12/2021] [Indexed: 01/22/2023]
Abstract
There is a high co-occurrence of risky substance use among adults with traumatic brain injury (TBI), although it is unknown if the neurologic sequelae of TBI can promote this behavior. We propose that to conclude that TBI can cause risky substance use, it must be determined that TBI precedes risky substance use, that confounders with the potential to increase the likelihood of both TBI and risky substance use must be ruled out, and that there must be a plausible mechanism of action. In this review, we address these factors by providing an overview of key clinical and preclinical studies and list plausible mechanisms by which TBI could increase risky substance use. Human and animal studies have identified an association between TBI and risky substance use, although the strength of this association varies. Factors that may limit detection of this relationship include differential variability due to substance, sex, age of injury, and confounders that may influence the likelihood of both TBI and risky substance use. We propose possible mechanisms by which TBI could increase substance use that include damage-associated neuroplasticity, chronic changes in neuroimmune signaling, and TBI-associated alterations in brain networks.
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Affiliation(s)
- Christopher M Olsen
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, Wisconsin; Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - John D Corrigan
- Department of Physical Medicine & Rehabilitation, Wexner Medical Center, The Ohio State University, Columbus, Ohio
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25
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What About the Little Ones? Systematic Review of Cognitive and Behavioral Outcomes Following Early TBI. Neuropsychol Rev 2022; 32:906-936. [PMID: 34994947 DOI: 10.1007/s11065-021-09517-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 06/07/2021] [Indexed: 10/19/2022]
Abstract
There is increasing empirical focus on the effects of early traumatic brain injuries (TBI; i.e., before the age of six years) on child development, but this literature has never been synthetized comprehensively. This systematic review aimed to document the cognitive, academic, behavioral, socio-affective, and adaptive consequences of early TBI. Four databases (Medline, PsycNET, CINAHL, PubMed) were systematically searched from 1990 to 2019 using key terms pertaining to TBI and early childhood. Of 12, 153 articles identified in the initial search, 43 were included. Children who sustain early TBI are at-risk for a range of difficulties, which are generally worse when injury is sustained at a younger age, injury severity is moderate to severe, and injury mechanisms are non-accidental. Early childhood is a sensitive period for the emergence and development of new skills and behaviors, and brain disruption during this time is not benign. Research, clinical management, intervention, and prevention efforts should be further developed with consideration of the unique characteristics of the early childhood period.
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26
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Nemkova S. Modern approaches to the diagnostics and treatment of the consequences of traumatic brain injury in children and adolescents. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:20-29. [DOI: 10.17116/jnevro202212206120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Stojanovski S, Scratch SE, Dunkley BT, Schachar R, Wheeler AL. A Systematic Scoping Review of New Attention Problems Following Traumatic Brain Injury in Children. Front Neurol 2021; 12:751736. [PMID: 34858314 PMCID: PMC8631327 DOI: 10.3389/fneur.2021.751736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: To summarize existing knowledge about the characteristics of attention problems secondary to traumatic brain injuries (TBI) of all severities in children. Methods: Computerized databases PubMed and PsychINFO and gray literature sources were used to identify relevant studies. Search terms were selected to identify original research examining new ADHD diagnosis or attention problems after TBI in children. Studies were included if they investigated any severity of TBI, assessed attention or ADHD after brain injury, investigated children as a primary or sub-analysis, and controlled for or excluded participants with preinjury ADHD or attention problems. Results: Thirty-nine studies were included in the review. Studies examined the prevalence of and risk factors for new attention problems and ADHD following TBI in children as well as behavioral and neuropsychological factors associated with these attention problems. Studies report a wide range of prevalence rates of new ADHD diagnosis or attention problems after TBI. Evidence indicates that more severe injury, injury in early childhood, or preinjury adaptive functioning problems, increases the risk for new ADHD and attention problems after TBI and both sexes appear to be equally vulnerable. Further, literature suggests that cases of new ADHD often co-occurs with neuropsychiatric impairment in other domains. Identified gaps in our understanding of new attention problems and ADHD include if mild TBI, the most common type of injury, increases risk and what brain abnormalities are associated with the emergence of these problems. Conclusion: This scoping review describes existing studies of new attention problems and ADHD following TBI in children and highlights important risk factors and comorbidities. Important future research directions are identified that will inform the extent of this outcome across TBI severities, its neural basis and points of intervention to minimize its impact.
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Affiliation(s)
- Sonja Stojanovski
- SickKids Research Institute, Program in Neuroscience and Mental Health, Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, ON, Canada.,Physiology Department, University of Toronto, Toronto, ON, Canada
| | - Shannon E Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Benjamin T Dunkley
- SickKids Research Institute, Program in Neuroscience and Mental Health, Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Russell Schachar
- SickKids Research Institute, Program in Neuroscience and Mental Health, Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, ON, Canada.,Psychiatry Department, University of Toronto, Toronto, ON, Canada
| | - Anne L Wheeler
- SickKids Research Institute, Program in Neuroscience and Mental Health, Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, ON, Canada.,Physiology Department, University of Toronto, Toronto, ON, Canada
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28
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Iverson GL, Kelshaw PM, Cook NE, Caswell SV. Middle School Children With Attention-Deficit/Hyperactivity Disorder Have a Greater Concussion History. Clin J Sport Med 2021; 31:438-441. [PMID: 32032165 DOI: 10.1097/jsm.0000000000000773] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/31/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Examine lifetime history of concussions in middle school student athletes who have attention-deficit/hyperactivity disorder (ADHD). DESIGN Cross-sectional study. SETTING Nine middle schools in Virginia, USA. PARTICIPANTS A sample of 1037 middle school students (ages 11-14 years, M = 12.6, SD = 0.93; 45.8% girls) underwent baseline/preseason assessments during the 2017 to 2018 academic year and self-reported their health history, including whether or not they had been diagnosed with ADHD. Athletes were divided into 2 groups, those with ADHD (n = 71; 6.8%) and control subjects (n = 966). INDEPENDENT VARIABLES Self-reported diagnosis of ADHD and self-identified sex. MAIN OUTCOME MEASURES Self-reported concussion history. RESULTS In the total sample, boys were more likely to report a previous history of concussion than girls [χ2(1) = 10.81, P = 0.001; odds ratio (OR) = 1.92; 95% confidence interval (CI), 1.30-2.85]. The rate of previous concussion in children with ADHD (23.9%) was twice the rate of previous concussion among children without ADHD (11.4%) [χ2(1) = 9.70, P = 0.002; OR = 2.45; 95% CI, 1.37-4.38]. Approximately 1 in 4 boys with ADHD (24.5%) and 1 in 5 girls with ADHD (22.2%) reported having sustained one or more previous concussions. CONCLUSIONS Attention-deficit/hyperactivity disorder is associated with a greater prevalence of previous concussion in middle school children. Further research is needed to understand the risk of sustaining concussion for young athletes with ADHD, as well as short- and long-term outcomes of concussion among young athletes with ADHD.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and Spaulding Research Institute, and MassGeneral Hospital for Children Sport Concussion Program, Boston, Massachusetts
| | - Patricia M Kelshaw
- College of Education and Human Development, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia; and
| | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and Spaulding Research Institute, and MassGeneral Hospital for Children Sport Concussion Program, Boston, Massachusetts
| | - Shane V Caswell
- Athletic Training Education Program, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia
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29
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Jones KM, Starkey N, Barker-Collo S, Ameratunga S, Theadom A, Pocock K, Borotkanics R, Feigin VL. Parent and Teacher-Reported Child Outcomes Seven Years After Mild Traumatic Brain Injury: A Nested Case Control Study. Front Neurol 2021; 12:683661. [PMID: 34367050 PMCID: PMC8342814 DOI: 10.3389/fneur.2021.683661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Increasing evidence suggests potential lifetime effects following mild traumatic brain injury (TBI) in childhood. Few studies have examined medium-term outcomes among hospitalized and non-hospitalized samples. Study aims were to describe children's behavioral and emotional adjustment, executive function (EF), quality of life, and participation at 7-years following mild TBI using parents' and teachers' reports. Methods: Nested case control study of 86 children (68% male, mean age at assessment = 11.27 years; range 7–17 years) who sustained a mild TBI 7-years previously, identified from a prospective, population-based study. They were compared to 69 children free from TBI (61% male, mean age at assessment = 11.12 years; range 5–17 years). In addition to parent-reported socio-demographic details, parents (mild TBI n = 86, non-TBI n = 69) completed age-appropriate standardized questionnaires about children's health-related quality of life, behavioral and emotional adjustment, EF, and social participation. Parents own mood was assessed using the Hospital Anxiety and Depression Scale. Teachers (mild TBI n = 53, non-TBI n = 42) completed questionnaires about children's behavioral and emotional adjustment, and EF. Results: Parent reports showed median group-level scores for cases were statistically significantly greater than controls for emotional symptoms, conduct problems, hyperactivity/inattention, total behavioral difficulties, inhibitory control, shifting, planning/organizing, and Global Executive Composite (total) EF difficulties (p-values 0.001–0.029). Parent reports of child quality of life and social participation were similar, as were teacher reports of child behavioral and emotional adjustment, and EF (p > 0.05). When examining clinical cut-offs, compared to controls, cases had a higher risk of parent-reported total EF difficulties (odds ratio = 3.00) and, to a lesser extent, total behavior problems (odds ratio = 2.51). Conclusions: As a group, children with a history of mild TBI may be at elevated risk for clinically significant everyday EF difficulties in the medium-term compared to non-TBI controls, as judged by their parents. Further multi-informant longitudinal research is required, following larger samples. Aspects requiring particular attention include pre-injury characteristics, such as sleep disturbances and comorbidities (e.g., headaches), that may act as potential confounders influencing the association between mild TBI and child behavioral problems.
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Affiliation(s)
- Kelly M Jones
- School of Clinical Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Nicola Starkey
- Division of Arts, Law, Psychology & Social Sciences, School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Suzanne Barker-Collo
- Faculty of Science, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- Faculty of Science, School of Psychology, The University of Auckland, Auckland, New Zealand.,UCL Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Alice Theadom
- School of Clinical Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Katy Pocock
- School of Clinical Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Robert Borotkanics
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Valery L Feigin
- School of Clinical Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
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30
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Serpa RO, Ferguson L, Larson C, Bailard J, Cooke S, Greco T, Prins ML. Pathophysiology of Pediatric Traumatic Brain Injury. Front Neurol 2021; 12:696510. [PMID: 34335452 PMCID: PMC8319243 DOI: 10.3389/fneur.2021.696510] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022] Open
Abstract
The national incidence of traumatic brain injury (TBI) exceeds that of any other disease in the pediatric population. In the United States the Centers for Disease Control and Prevention (CDC) reports 697,347 annual TBIs in children ages 0–19 that result in emergency room visits, hospitalization or deaths. There is a bimodal distribution within the pediatric TBI population, with peaks in both toddlers and adolescents. Preclinical TBI research provides evidence for age differences in acute pathophysiology that likely contribute to long-term outcome differences between age groups. This review will examine the timecourse of acute pathophysiological processes during cerebral maturation, including calcium accumulation, glucose metabolism and cerebral blood flow. Consequences of pediatric TBI are complicated by the ongoing maturational changes allowing for substantial plasticity and windows of vulnerabilities. This review will also examine the timecourse of later outcomes after mild, repeat mild and more severe TBI to establish developmental windows of susceptibility and altered maturational trajectories. Research progress for pediatric TBI is critically important to reveal age-associated mechanisms and to determine knowledge gaps for future studies.
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Affiliation(s)
- Rebecka O Serpa
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lindsay Ferguson
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Cooper Larson
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Julie Bailard
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Samantha Cooke
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Tiffany Greco
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Mayumi L Prins
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
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31
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Ewing-Cobbs L, Montroy JJ, Clark AE, Holubkov R, Cox CS, Keenan HT. As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury. Front Neurol 2021; 12:687740. [PMID: 34290664 PMCID: PMC8287068 DOI: 10.3389/fneur.2021.687740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To model pre-injury child and family factors associated with the trajectory of internalizing and externalizing behavior problems across the first 3 years in children with pediatric traumatic brain injury (TBI) relative to children with orthopedic injuries (OI). Parent-reported emotional symptoms and conduct problems were expected to have unique and shared predictors. We hypothesized that TBI, female sex, greater pre-injury executive dysfunction, adjustment problems, lower income, and family dysfunction would be associated with less favorable outcomes. Methods: In a prospective longitudinal cohort study, we examined the level of behavior problems at 12 months after injury and rate of change from pre-injury to 12 months and from 12 to 36 months in children ages 4-15 years with mild to severe TBI relative to children with OI. A structural equation model framework incorporated injury characteristics, child demographic variables, as well as pre-injury child reserve and family attributes. Internalizing and externalizing behavior problems were indexed using the parent-rated Emotional Symptoms and Conduct Problems scales from the Strengths and Difficulties questionnaire. Results: The analysis cohort of 534 children [64% boys, M (SD) 8.8 (4.3) years of age] included 395 with mild to severe TBI and 139 with OI. Behavior ratings were higher after TBI than OI but did not differ by TBI severity. TBI, higher pre-injury executive dysfunction, and lower income predicted the level and trajectory of both Emotional Symptoms and Conduct Problems at 12 months. Female sex and poorer family functioning were vulnerability factors associated with greater increase and change in Emotional Symptoms by 12 months after injury; unique predictors of Conduct Problems included younger age and prior emotional/behavioral problems. Across the long-term follow-up from 12 to 36 months, Emotional Symptoms increased significantly and Conduct Problems stabilized. TBI was not a significant predictor of change during the chronic stage of recovery. Conclusions: After TBI, Emotional Symptoms and Conduct Problem scores were elevated, had different trajectories of change, increased or stayed elevated from 12 to 36 months after TBI, and did not return to pre-injury levels across the 3 year follow-up. These findings highlight the importance of addressing behavioral problems after TBI across an extended time frame.
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Affiliation(s)
- Linda Ewing-Cobbs
- Department of Pediatrics and Children's Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Janelle J. Montroy
- Department of Pediatrics and Children's Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Amy E. Clark
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Richard Holubkov
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Charles S. Cox
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Heather T. Keenan
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
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Gornall A, Takagi M, Morawakage T, Liu X, Anderson V. Mental health after paediatric concussion: a systematic review and meta-analysis. Br J Sports Med 2021; 55:1048-1058. [PMID: 33926965 DOI: 10.1136/bjsports-2020-103548] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis sought to rigorously examine mental health outcomes following paediatric concussion. To date, heterogeneous findings and methodologies have limited clinicians' and researchers' ability to meaningfully synthesise existing literature. In this context, there is a need to clarify mental health outcomes in a homogeneous sample, controlling for key methodological differences and applying a consistent definition of concussion across studies. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched Medline, Embase, PsycINFO, CINAHL, SportDiscus, Scopus and PubMed. ELIGIBILITY Peer-reviewed studies published between 1980 and June 2020 that prospectively examined mental health outcomes after paediatric concussion, defined as per the Berlin Consensus Statement on Concussion in Sport. RESULTS Sixty-nine articles characterising 60 unique samples met inclusion criteria, representing 89 114 children with concussion. Forty articles (33 studies) contributed to a random effects meta-analysis of internalising (withdrawal, anxiety, depression, post-traumatic stress), externalising (conduct problems, aggression, attention, hyperactivity) and total mental health difficulties across three time points post-injury (acute, persisting and chronic). Overall, children with concussion (n=6819) experienced significantly higher levels of internalising (g=0.41-0.46), externalising (g=0.25-0.46) and overall mental health difficulties compared with controls (g=0.18-0.49; n=56 271), with effects decreasing over time. SUMMARY/CONCLUSIONS Our review highlights that mental health is central to concussion recovery. Assessment, prevention and intervention of mental health status should be integrated into standard follow-up procedures. Further research is needed to clarify the mechanisms underlying observed relationships between mental health, post-concussion symptoms and other psychosocial factors. Results suggest that concussion may both precipitate and exacerbate mental health difficulties, thus impacting delayed recovery and psychosocial outcomes.
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Affiliation(s)
- Alice Gornall
- Psychological Sciences, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia.,Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Michael Takagi
- Psychological Sciences, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia.,Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Psychology, The University of Melbourne, Melbourne School of Psychological Sciences, Melbourne, Victoria, Australia
| | - Thilanka Morawakage
- Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Xiaomin Liu
- Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Vicki Anderson
- Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia .,Psychology, The University of Melbourne, Melbourne School of Psychological Sciences, Melbourne, Victoria, Australia.,Psychology Service, The Royal Children's Hospital, Mebourne, Victoria, Australia
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Lugo GJ, Beletanga M, Goldstein L, Rana M, Jonas R, Torres AR. Assessment and Treatment of Concussion in the Pediatric Population. Semin Neurol 2021; 41:132-146. [PMID: 33657625 DOI: 10.1055/s-0041-1725135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Traumatic brain injury (TBI) is common in children. The evaluation and management of children with TBI is based on the research performed in adults. There is a relative paucity of research in the literature involving children and many of the practice recommendations for this age are based on expert opinion in the absence of good research studies in both sports and non-sports-related injuries. The pediatric population is heterogeneous and the approach might be specific for infants, preschoolers, school age children, and adolescents. Children may also suffer from neurodevelopmental disabilities, making their evaluation even more challenging. Adult neurologists are often asked to see children due to increasing demands. This review will focus on specific issues related to TBI in children that might be useful to adult neurologists. Science, however, is evolving rapidly and physicians should make sure to remain up to date to offer evidence-based services to their patients.
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Affiliation(s)
- Giancarlo J Lugo
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Maria Beletanga
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Laura Goldstein
- Division of Child Psychiatry, Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
| | - Mandeep Rana
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Rinat Jonas
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Alcy R Torres
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Pediatric Brain Injury Program, Boston University School of Medicine, Boston, Massachusetts
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Waltzman D, Daugherty J, Sarmiento K, Proescholdbell S. Lifetime History of Traumatic Brain Injury With Loss of Consciousness and the Likelihood for Lifetime Depression and Risk Behaviors: 2017 BRFSS North Carolina. J Head Trauma Rehabil 2021; 36:E40-E49. [PMID: 32769836 PMCID: PMC7769859 DOI: 10.1097/htr.0000000000000603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Because of the growing concern about the potential effects of traumatic brain injuries (TBIs) on a child's developing brain and the potential impact of lifetime depression and risk behaviors associated with TBI, further exploration is warranted. SETTING AND PARTICIPANTS Data (N = 4917) from the 2017 North Carolina Behavioral Risk Factors Surveillance System (BRFSS). DESIGN Cross-sectional. MAIN MEASURES Examine whether a lifetime history of TBI with loss of consciousness (LOC) or having a history of TBI with LOC prior to 18 years of age was associated with a greater likelihood of lifetime depression, current binge drinking, and current cigarette and e-cigarette smoking. RESULTS Respondents with a history of TBI with LOC had 2.1 (95% CI, 1.6-2.8) times higher odds of lifetime depression and 1.7 to 1.8 (95% CI, 1.02-2.97) times higher odds of all risk behaviors than those without a lifetime history of TBI with LOC. There were no statistical differences between age of first TBI with LOC and lifetime depression, binge drinking, cigarette smoking, and e-cigarette use after controlling for key demographics. CONCLUSION These findings underscore the importance of increasing awareness among healthcare providers of the prevalence of lifetime depression and risk behaviors among individuals with a history of TBI and the need for improved screening and referrals to evidence-based services.
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Affiliation(s)
- Dana Waltzman
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Waltzman and Daugherty and Ms Sarmiento); and Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina (Mr Proescholdbell)
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35
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Bannon SM, Kumar RG, Bogner J, O'Neil-Pirozzi TM, Spielman L, Watson EM, Dams-O'Connor K. Reinjury After Moderate to Severe TBI: Rates and Risk Factors in the NIDILRR Traumatic Brain Injury Model Systems. J Head Trauma Rehabil 2021; 36:E50-E60. [PMID: 32769829 DOI: 10.1097/htr.0000000000000586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To compare characteristics of those who do and do not sustain subsequent traumatic brain injuries (TBIs) following index TBI and to identify reinjury risk factors. DESIGN Secondary data analysis of an ongoing longitudinal cohort study. SETTING TBI Model Systems Centers. PARTICIPANTS In total, 11 353 individuals aged 16+ years. MAIN OUTCOME MEASURES Ohio State University TBI Identification Method. RESULTS In total, 7.9% of individuals reported sustaining a TBI post-index TBI. Twenty percent of reinjuries occurred within a year of the index TBI. Reinjury risk followed an approximate U-shaped distribution such that risk was higher in the first year, declined 2 to 10 years postinjury, and then increased after 10 years. A multivariable Weibull model identified predictors of reinjury: younger (<29 years) and middle-aged and older (50+ years) age at index TBI relative to middle age, pre-index TBI, pre-index alcohol and illicit drug use, incarceration history, and less severe index TBI. CONCLUSIONS A subset of individuals who receive inpatient rehabilitation for TBI are at an increased risk for reinjury, and an injury-prone phenotype may be characterized by engagement in risk behaviors. Factors associated with reinjury risk may differ for younger versus middle-aged and older adults. Findings underscore the need for empirically informed risk stratification models to identify TBI survivors at risk for reinjury.
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Affiliation(s)
- Sarah M Bannon
- Department of Psychiatry, Massachusetts General Hospital (Ms Bannon), and Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital (Dr O'Neil-Pirozzi), Harvard Medical School, Boston, Massachusetts; Department of Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York (Drs Kumar, Spielman, Watson, and Dams-O'Connor); Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus (Dr Bogner); and Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts (Dr O'Neil-Pirozzi)
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36
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Biopsychosocial Factors Associated With Attention Problems in Children After Traumatic Brain Injury. Am J Phys Med Rehabil 2020; 100:215-228. [DOI: 10.1097/phm.0000000000001643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mckinlay A. Long‐Term Outcomes of Traumatic Brain Injury in Early Childhood. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12084] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Audrey Mckinlay
- Melbourne School of Psychological Sciences, University of Melbourne, Australia,
- University of Canterbury, Christchurch, New Zealand,
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TBI as a Risk Factor for Substance Use Behaviors: A Meta-analysis. Arch Phys Med Rehabil 2020; 102:1198-1209. [PMID: 33152264 DOI: 10.1016/j.apmr.2020.10.112] [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: 08/13/2019] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To quantify the relationship between substance use behaviors before and after traumatic brain injury (TBI), to identify populations that may benefit more from targeted interventions to reduce the effect of substance use on TBI recovery, and to establish areas for further study. DATA SOURCES Studies were identified via literature searches using MEDLINE, PsychInfo, PsychArticles, PubMed, and GoogleScholar (published before January 2019), as well as reference section reviews and forward searches. Searches were conducted using search terms for TBI and substance use behaviors. STUDY SELECTION Studies were included if they (1) contained both a measure of TBI and a measure of substance use behaviors; (2) reported an effect size representing the relationship between substance use behaviors before and after TBI, compared TBI vs non-TBI groups on substance use behaviors controlling for pre-TBI substance use, or compared groups with differing TBI severity on subsequent substance use behaviors controlling for pre-TBI substance use; (3) were written in English; and (4) were human subjects research. Studies examining effects of substance use intervention for people sustaining TBI were excluded from this study. DATA EXTRACTION Study variables included substance use behaviors, TBI severity, time since TBI, military status, age, race, and sex. DATA SYNTHESIS Substance use behaviors had a small but statistically significant decrease after moderate-severe TBI. After moderate-severe TBI, there was a statistically significant decline in both substance use (d=-0.29, P<.01) and negative substance use consequences (d=-0.67, P=.01). There was no significant change in substance use behaviors after mild TBI. CONCLUSIONS Substance use behaviors had a small decrease after moderate to severe TBI and no significant change after mild TBI. Study findings suggest the need for accurate assessment to identify those at greatest risk for problematic substance use behaviors after TBI.
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Chevignard M, Câmara-Costa H, Dellatolas G. Pediatric traumatic brain injury and abusive head trauma. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:451-484. [PMID: 32958191 DOI: 10.1016/b978-0-444-64150-2.00032-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Childhood traumatic brain injury (TBI) commonly occurs during brain development and can have direct, immediately observable neurologic, cognitive, and behavioral consequences. However, it can also disrupt subsequent brain development, and long-term outcomes are a combination of preinjury development and abilities, consequences of brain injury, as well as delayed impaired development of skills that were immature at the time of injury. There is a growing number of studies on mild TBI/sport-related concussions, describing initial symptoms and their evolution over time and providing guidelines for effective management of symptoms and return to activity/school/sports. Mild TBI usually does not lead to long-term cognitive or academic consequences, despite reports of behavioral/psychologic issues postinjury. Regarding moderate to severe TBI, injury to the brain is more severe, with evidence of a number of detrimental consequences in various domains. Patients can display neurologic impairments (e.g., motor deficits, signs of cerebellar disorder, posttraumatic epilepsy), medical problems (e.g., endocrine pituitary deficits, sleep-wake abnormalities), or sensory deficits (e.g., visual, olfactory deficits). The most commonly reported deficits are in the cognitive-behavioral field, which tend to be significantly disabling in the long-term, impacting the development of autonomy, socialization and academic achievement, participation, quality of life, and later, independence and ability to enter the workforce (e.g., intellectual deficits, slow processing speed, attention, memory, executive functions deficits, impulsivity, intolerance to frustration). A number of factors influence outcomes following pediatric TBI, including preinjury stage of development and abilities, brain injury severity, age at injury (with younger age at injury most often associated with worse outcomes), and a number of family/environment factors (e.g., parental education and occupation, family functioning, parenting style, warmth and responsiveness, access to rehabilitation and care). Interventions should identify and target these specific factors, given their major role in postinjury outcomes. Abusive head trauma (AHT) occurs in very young children (most often <6 months) and is a form of severe TBI, usually associated with delay before appropriate care is sought. Outcomes are systematically worse following AHT than following accidental TBI, even when controlling for age at injury and injury severity. Children with moderate to severe TBI and AHT usually require specific, coordinated, multidisciplinary, and long-term rehabilitation interventions and school adaptations, until transition to adult services. Interventions should be patient- and family-centered, focusing on specific goals, comprising education about TBI, and promoting optimal parenting, communication, and collaborative problem-solving.
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Affiliation(s)
- Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France; GRC 24, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France.
| | - Hugo Câmara-Costa
- GRC 24, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France; Centre d'Etudes en Santé des Populations, INSERM U1018, Paris, France
| | - Georges Dellatolas
- GRC 24, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France
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Abstract
OBJECTIVE To synthesize the literature and conduct a gap analysis on the association between attention-deficit/hyperactivity disorder (ADHD) and clinical outcome from sport-related concussion. METHOD The electronic search for this systematic review (PROSPERO ID: CRD42019128281) was conducted in February 2019 using terms related to concussion, sports/athletics, and predictors/modifiers of outcome to search the PubMed, PsycINFO, MEDLINE, CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus, and Web of Science databases. Eligible studies evaluated the association between ADHD and outcome from sport-related concussion. Of 4014 studies screened, 359 full-text articles were reviewed, with 14 studies ultimately included, involving 3623 participants (n = 359 [9.9%] with ADHD). RESULTS Study samples were primarily from specialty medical clinics (57.1%) and high school or college athletic groups (28.6%). Only 2 studies reported a statistically significant association between ADHD and worse clinical outcome. Of these, 1 included 13 participants with ADHD and the other included only 8 participants with ADHD. Only 1 previous study in this review was designed specifically to examine ADHD and prolonged concussion recovery, and that study did not report a statistically significant association. CONCLUSION There is not a clear association between ADHD and worse clinical outcome from concussion. However, eligible studies had limitations in research design, and nearly all studies were underpowered and evaluated the association between ADHD and concussion outcome as a secondary focus rather than the primary research question, precluding definitive conclusions. The association between ADHD and clinical outcomes remains unclear, and future research specifically examining ADHD and concussion recovery is needed.
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Biederman J, Fried R, DiSalvo M, Driscoll H, Green A, Biederman I, Woodworth KY, Faraone SV. A novel digital health intervention to improve patient engagement to stimulants in adult ADHD in the primary care setting: Preliminary findings from an open label study. Psychiatry Res 2020; 291:113158. [PMID: 32559669 DOI: 10.1016/j.psychres.2020.113158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022]
Abstract
AIMS We piloted the effectiveness and acceptability of a novel text messaging-based (SMS) digital health intervention aimed at addressing the previously documented poor rate of patient engagement in stimulant treatment in the primary care setting. METHODS 117 adults ages 18-55 from primary care and psychiatric practices who were prescribed a stimulant medication for ADHD treatment received the SMS intervention. Comparators were age-, race-, and sex-matched patients from the same health care organization's electronic medical record who had been prescribed stimulant medications over a similar time period. Using documented prescription records, we determined whether patients had timely prescription refills. RESULTS Ninety-six percent (N = 112) of participants completed our a priori metric of patient engagement consisting of 37 days of the SMS program. Eighty-one percent of participants refilled their index prescriptions in a timely manner compared to only 36% of patients receiving treatment as usual (OR=7.54, 95% CI: 4.46, 12.77; p<0.001). We found no significant interaction between prescribing source (non-psychiatry vs. psychiatry) and intervention group (SMS vs. treatment as usual). CONCLUSIONS These data suggest that an ADHD-centric, digital health intervention using text messaging significantly improves patient engagement in stimulant treatment in adults with ADHD.
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Affiliation(s)
- Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Ronna Fried
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Haley Driscoll
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Allison Green
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Itai Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - K Yvonne Woodworth
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
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Fried R, DiSalvo M, Kelberman C, Adler A, McCafferty D, Woodworth KY, Green A, Biederman I, Faraone SV, Biederman J. An innovative SMS intervention to improve adherence to stimulants in children with ADHD: Preliminary findings. J Psychopharmacol 2020; 34:883-890. [PMID: 32077768 DOI: 10.1177/0269881120908014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although large datasets document that stimulants decrease the risk for many adverse ADHD-associated outcomes, compliance with stimulants remains poor. AIMS This study examined the effectiveness of a novel ADHD-centric text messaging-based intervention aimed to improve adherence to stimulant medications in children with ADHD. METHODS Subjects were 87 children aged 6-12, who were prescribed a stimulant medication for ADHD treatment. Prescribers gave permission to contact their patients for participation in the study. Subjects were primarily from the primary care setting with a subsample of psychiatrically referred subjects for comparison. Age- and sex-matched comparators were identified (3:1) from the same pool of prescriber-approved subjects that did not participate. Timely prescription refills (within 37 days) were determined from prescription dates documented in patients' electronic medical record. RESULTS Eighty-five percent of SMS intervention patients refilled their prescriptions in a timely manner compared with 62% of patients receiving treatment as usual (OR = 3.46, 95% CI: 1.82, 6.58; p < 0.001). The number needed to treat statistic was computed as five, meaning for every five patients who receive the SMS intervention, we can keep one adherent to their stimulant treatment. CONCLUSIONS These preliminary findings support the potential utility of a readily accessible technology to improve the poor rate of adherence to stimulant treatment in children with ADHD. To the best of our knowledge, this study is the first digital health intervention aimed at improving adherence to stimulant medication for children with ADHD. These results support the need for further examination of this technology through more definitive randomized clinical trials.
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Affiliation(s)
- Ronna Fried
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Caroline Kelberman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Amos Adler
- MemoText Corporation, Toronto, ON, Canada
| | | | - K Yvonne Woodworth
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Allison Green
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Itai Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.,KG Jebsen Center for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Daugherty J, Waltzman D, Snedaker KP, Bouton J, Zhang X, Wang D. Concussion Experiences in New England Private Preparatory High School Students Who Played Sports or Recreational Activities. THE JOURNAL OF SCHOOL HEALTH 2020; 90:527-537. [PMID: 32369871 PMCID: PMC7393617 DOI: 10.1111/josh.12899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/03/2019] [Accepted: 01/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Sports- and recreation-related (SRR) activities are a major cause of adolescent concussions. Most adolescent SRR concussion research has been conducted among public school students. As private schools are qualitatively different from public schools (eg, location, socioeconomic status, sports played), this study explores the concussion experiences of a large group of private high school students. METHODS We surveyed 2047 New England private preparatory high school students who played sports or engaged in a recreational activity in 2018 about the sports they played, and their self-reported concussion experiences (eg, age at first concussion, if concussions were sports- or recreation-related). Descriptive, bivariate, and multivariate statistics are presented. RESULTS One-third (33.0%) of students who reported engaging in sport- or recreation-related activities self-reported experiencing a concussion in their lifetime. A higher percentage of boys, students who played contact sports, and those who played multiple seasons of school sports reported a concussion. Sex, contact level of primary sport played, and age of first concussion were also significantly associated with reporting a sports- or recreation-related concussion. CONCLUSIONS A sizeable proportion of private preparatory high school students reported experiencing a concussion, with some students at higher risk. Private preparatory high school-specific concussion prevention strategies may be needed.
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Affiliation(s)
- Jill Daugherty
- Epidemiologist, , National Center for Injury Prevention & Control, Centers for Disease Control & Prevention, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Dana Waltzman
- Behavioral Scientist, , National Center for Injury Prevention & Control, Centers for Disease Control & Prevention, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Katherine P Snedaker
- Founder and Executive Director, , PINK Concussions, 15 Shorefront Park, Norwalk, CT, 06854, USA
| | - Jason Bouton
- Head Athletic Trainer, , NEPSAC District 4 SMAC Representative, Founding Chair, FAA Athletic Trainers Organization, Adjunct Faculty, Sacred Heart University, 1450 Newfield Avenue, Stamford, CT, 06905, USA
| | - Xinjian Zhang
- Statistician, , National Center for Injury Prevention & Control, Centers for Disease Control & Prevention, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - David Wang
- Clinical Director, , Elite Sports Medicine, Connecticut Children's Medical Center, 399 Farmington Ave, Farmington, CT, 06032, USA
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Iverson GL, Wojtowicz M, Brooks BL, Maxwell BA, Atkins JE, Zafonte R, Berkner PD. High School Athletes With ADHD and Learning Difficulties Have a Greater Lifetime Concussion History. J Atten Disord 2020; 24:1095-1101. [PMID: 27431932 DOI: 10.1177/1087054716657410] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Examine lifetime history of concussions in adolescents who have developmental problems in comparison with those with no developmental problems. Method: Thirty-two thousand four hundred eighty-seven adolescent athletes completed baseline/pre-season evaluations. Based on self-reported histories, athletes were divided into four groups: ADHD only, ADHD and learning difficulties (LD), LD only, and controls. Results: Athletes with ADHD, LD, or ADHD plus LD reported a greater prevalence of prior concussions than athletes without these developmental conditions (ps < .05). When adjusting for sex differences in concussion prevalence rates (boys are greater than girls), there was an increase in prevalence of prior injuries in those with ADHD, and ADHD plus learning difficulties compared with those with LD only. This pattern was found for both girls and boys. There was no additive effect of having both conditions. Conclusion: Developmental conditions in adolescent athletes, such as ADHD and learning difficulties, are associated with a greater prevalence rate of prior concussion.
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Affiliation(s)
- Grant L Iverson
- Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, USA.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, USA
| | - Magdalena Wojtowicz
- Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, USA.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, USA
| | - Brian L Brooks
- Alberta Children's Hospital, Calgary, Canada.,University of Calgary, Alberta, Canada
| | | | | | - Ross Zafonte
- Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, USA.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, USA.,Massachusetts General Hospital, Boston, USA.,Brigham and Women's Hospital, Boston, MA, USA
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45
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McCarron RH, Gracey F, Bateman A. Detecting mental health problems after paediatric acquired brain injury: A pilot Rasch analysis of the strengths and difficulties questionnaire. Neuropsychol Rehabil 2020; 31:1048-1068. [PMID: 32401169 DOI: 10.1080/09602011.2020.1760111] [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] [Indexed: 01/26/2023]
Abstract
The parent-reported Strengths and Difficulties Questionnaire (SDQ-P) is commonly used to assess for mental health problems, but its psychometric properties have not been studied in the paediatric Acquired Brain Injury (ABI) population. This study investigated the properties of the SDQ-P and its subscales in this population using Rasch analysis. One hundred and forty-three SDQ-Ps and 123 Impact Supplements were analyzed. Sixty-nine percent of SDQ-Ps were completed by female carers, 59% of young people were male, and 58% had Traumatic Brain Injury (TBI). In this population the SDQ-P Total Difficulties Scale and the Conduct Problems subscale showed questionable construct validity. The individual subscales and Impact Supplement did not meet the criteria for reliability. Two items had disordered thresholds. The individual subscales showed mistargeting and 13-24% person misfit. Two items were significantly underdiscriminating. There was differential item functioning with age and time post-injury, and local dependence between subscale items. The Total Difficulties scale was multidimensional. The most easily endorsed items were in keeping with common symptoms of brain injury. These findings suggest the SDQ-P in its current form may not be a reliable and valid assessment measure for mental health difficulties in the paediatric ABI population and requires further investigation.
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Affiliation(s)
- Robyn Henrietta McCarron
- The Cambridge Centre for Paediatric Neuropsychological Rehabilitation, Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), Cambridge, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Fergus Gracey
- The Cambridge Centre for Paediatric Neuropsychological Rehabilitation, Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), Cambridge, UK.,Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of England Programme, National Institute of Health Research (NIHR), Cambridge, UK.,Department of Clinical Psychology, University of East Anglia, Norwich, UK
| | - Andrew Bateman
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,School of Health and Social Care, University of Essex, Colchester, UK
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Barlow KM, Girgulis KA, Goldstein G, Crowe EG, Vo MK, Su P, Esser MJ, Dewey D, Kirk VG. Sleep Parameters and Overnight Urinary Melatonin Production in Children With Persistent Post-concussion Symptoms. Pediatr Neurol 2020; 105:27-34. [PMID: 32029332 DOI: 10.1016/j.pediatrneurol.2019.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/19/2019] [Accepted: 11/03/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sleep disturbance is common after a mild traumatic brain injury (mTBI) in children, yet its biology is poorly understood. We aimed to explore sleep-related problems (SRPs), sleep-activity patterns, and endogenous melatonin production in children with different recovery trajectories following mTBI. We hypothesized that children with delayed recovery would have more SRPs and abnormal sleep-activity patterns, which would correlate with lower overnight melatonin production. METHODS In this prospective controlled cohort study, we enrolled 83 children with persistent symptoms, 26 children who had clinically recovered following mTBI, and 25 healthy controls. SRPs were evaluated using the sleep subscale of the Post-Concussion Symptom Inventory. Sleep actigraphy was performed for five to seven days at 37 (S.D. 7) days post-injury. Health-related quality of life and mood disturbance was assessed using the Child Health Questionnaire and the Behavior Assessment System for Children, respectively. Endogenous melatonin production was assessed using overnight urine collection. RESULTS The groups were similar in age (13.9 [S.D. 2.6] years) and sex (52% female). Regression analysis demonstrated increased SRP in the symptomatic group (9.0; 95% confidence interval: 7.6, 11.1) compared with the recovered group (1.6; 95% confidence interval: 1.0, 2.4) and controls (2.0; 95% confidence intervals: 1.2, 3.2). Actigraphy parameters and urinary melatonin levels were not significantly different between groups. Neither SRPs nor actigraphy parameters correlated with anxiety and depression scores. CONCLUSIONS Although children with persistent post-concussion symptoms reported more SRPs, this was not related to actigraphy sleep parameters or melatonin production. Further research is warranted to understand the pathophysiology of post-traumatic sleep disturbance.
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Affiliation(s)
- Karen M Barlow
- Department of Paediatrics, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; Faculty of Medicine, Children's Health Research Centre, University of Queensland, St Lucia, Australia.
| | - Katherine A Girgulis
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Section of Pediatrics, Alberta Children's Hospital, Calgary, Canada
| | | | - Erica G Crowe
- Section of Pediatrics, Alberta Children's Hospital, Calgary, Canada
| | - Mai K Vo
- Section of Pediatrics, Alberta Children's Hospital, Calgary, Canada
| | - Peter Su
- Faculty of Medicine, Children's Health Research Centre, University of Queensland, St Lucia, Australia
| | - Michael J Esser
- Department of Paediatrics, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Deborah Dewey
- Department of Paediatrics, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Valerie G Kirk
- Department of Paediatrics, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
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A Novel Text Message Intervention to Improve Adherence to Stimulants in Adults With Attention Deficit/Hyperactivity Disorder. J Clin Psychopharmacol 2020; 39:351-356. [PMID: 31162154 DOI: 10.1097/jcp.0000000000001055] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) is a prevalent neurobiological disorder associated with a wide range of adverse outcomes. Although large data sets document that stimulants decrease the risks for many ADHD-associated adverse outcomes, compliance with stimulants remains very poor. The main aim of this study was to assess the effectiveness of a novel text messaging-based intervention aimed at improving the poor rate of adherence to stimulant medications in adults with ADHD. METHODS Subjects were adults with ages 18 to 55, prescribed a stimulant medication for ADHD treatment. For comparators, we identified at a 5-to-1 ratio (age and sex matched) adult patients from the Partners HealthCare electronic medical record who had been prescribed stimulant medications over a 1-year period. We determined whether patients had timely prescription refills, defined as refilled within 37 days, using prescriptions documented in their electronic medical record. RESULTS Our results showed that 68% of the SMS intervention group refilled their prescriptions in a timely manner. In contrast, only 34% of patients receiving treatment as usual refilled their prescriptions in a timely fashion (odds ratio, 4.04; 95% confidence interval, 2.49-6.56; P < 0.001). CONCLUSIONS These data indicate that an innovative ADHD-centric text messaging intervention significantly improved patient engagement to treatment with stimulants in adults with ADHD. Findings provide strong support for the use of a readily accessible, inexpensive, and widely available technology to improve the poor rate of adherence to stimulant treatment in adults with ADHD. To the best of our knowledge, this study is the first digital health intervention aimed at improving adherence to stimulant medication for adults with ADHD.
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Ho RA, Hall GB, Noseworthy MD, DeMatteo C. Post-concussive depression: evaluating depressive symptoms following concussion in adolescents and its effects on executive function. Brain Inj 2020; 34:520-527. [DOI: 10.1080/02699052.2020.1725841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Rachelle A. Ho
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Geoffrey B. Hall
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Michael D. Noseworthy
- Imaging Research Centre, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
- McMaster School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Carol DeMatteo
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Mantey DS, Omega-Njemnobi O, Barroso CS, Kelder SH. Self-reported history of concussions is associated with risk factors for suicide completion among high school students. J Affect Disord 2020; 263:684-691. [PMID: 31740108 DOI: 10.1016/j.jad.2019.11.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/16/2019] [Accepted: 11/09/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Suicide is the third leading cause of death among adolescents. While research has found concussions to be a risk factor for suicide in adults, this relationship is not well studied in nationally representative samples of youth. This study examines the relationship between self-reported history of sports-related concussion and five risk factors for suicide completion. METHODS Data were obtained from the 2017 Youth Risk Behavior Surveillance Survey (n=13,353). Multivariate logistic regression models assessed the relationship between self-reported, sports-related concussion and five risk factors for suicide completion. Analyses controlled for sex, race/ethnicity, grade, bullying victimization, and sexual orientation. Subsample analyses were conducted stratified by sex. Interaction models examined biological sex as a possible effect modifier. RESULTS Overall, 15.0% of high school students reported a sports-related concussion in the past 12-months. Self-reported, sports-related concussion was significantly associated with greater odds of feeling sad/hopeless (Adj OR: 1.20; 95% CI:1.02-1.42), suicidal ideations (Adj OR: 1.25; 95% CI:1.02-1.55), suicide attempt (Adj OR: 1.60; 95% CI:1.31-1.96), and suicide attempt treated by a doctor/nurse (Adj OR: 2.35; 95% CI:1.68-3.29), adjusting for covariates. Stratified analyses demonstrated differences by sex, however, no direct evidence of effect modification was observed in interaction models. LIMITATIONS Data are cross-sectional, prohibiting causal inferences. Measures were assessed via self-report. No pre-concussion measures of mental health. CONCLUSION Self-reported sports-related concussion was associated with risk factors for suicide completion. No direct evidence of effect modification was observed but stratified analyses suggest biological sex may impact the observed relationship.
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Affiliation(s)
- Dale S Mantey
- University of Texas School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, Texas 78701, USA.
| | - Onyinye Omega-Njemnobi
- University of Texas School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, Texas 78701, USA
| | - Cristina S Barroso
- Department of Public Health, College of Education, Health, and Human Sciences, University of Tennessee, United States
| | - Steven H Kelder
- University of Texas School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, Texas 78701, USA
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Spencer T, Noyes E, Biederman J. Telemedicine in the Management of ADHD: Literature Review of Telemedicine in ADHD. J Atten Disord 2020; 24:3-9. [PMID: 31257978 DOI: 10.1177/1087054719859081] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: Telemedicine has been used successfully in several medical specialties with favorable patient outcomes, satisfaction, in a cost-effective manner. However, its use in the context of ADHD remains unclear. Our main aim was to investigate what is known about the use of telemedicine in ADHD. Method: We conducted a systematic search of the literature assessing telemedicine in ADHD in PubMed, PsycINFO, and Medline. Included were original articles published in English with the main aim to assess the use of telemedicine in ADHD. Results: Only 11 articles met our inclusion and exclusion criteria, coming from only three systematic trials of telemedicine in ADHD. The studies suggest that telemedicine is valued by its users, is well accepted, and is associated with improved outcomes. Conclusion: The limited research indicates that telemedicine has potential to expand the delivery of clinical services to patients with ADHD. More work is needed to further evaluate this finding.
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Affiliation(s)
- Thomas Spencer
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Joseph Biederman
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
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