Understanding predictors of functional recovery and outcome 30 months following early childhood head injury.

Much is known about outcome following traumatic brain injury (TBI) in school-age children; however, recovery in early childhood is less well understood. Some argue that such injuries should lead to good outcome, because of the plasticity of the developing brain. Other purport that the young brain is vulnerable, with injury likely to result in a substantial impairment (H. G. Taylor & J. Alden, 1997). The aim of this study was to examine outcomes following TBI during early childhood, to plot recovery over the 30 months postinjury, and to identify predictors of outcome. The study compared 3 groups of children sustaining mild, moderate, and severe TBI, ages 2.0 to 6.11 years at injury, with healthy controls. Groups were comparable for preinjury adaptive and behavioral function, psychosocial characteristics, age, and gender. Results suggested a strong association between injury severity and outcomes across all domains. Further, 30-month outcome was predicted by injury severity, family factors, and preinjury levels of child function. In conclusion, children with more severe injuries and lower preinjury adaptive abilities, and whose families are coping poorly, are at greatest risk of long-term impairment in day-to-day skills, even several years postinjury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between visual memory function and lesions detected by magnetic resonance imaging after closed head injury.

45 patients (aged 16–73 yrs) with closed head injuries were followed up 6 mo postinjury with magnetic resonance imaging (MRI) and neuropsychological assessments. Ss were tested on visual and verbal measures of short-term memory and learning: pattern span, pattern learning, path span, path learning, digit span, and digit learning. Visual memory for patterns and paths was tested using a recall procedure. Compared with 22 controls (aged 15–70 yrs), Ss were significantly impaired on pattern span. Ss were also significantly impaired on measures of path learning and digit learning. Performance on the visual memory tasks was related to a rating of ventricular enlargement derived from MRI. It appears that diffuse damage remains of importance in predicting neuropsychological impairment in head injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of neuropsychological ability in brain-disordered versus normal children.

Examined the pattern of higher level vs lower level deficits in 25 brain-impaired children (aged 9–14 yrs) compared with 25 normal children (aged 9–24 yrs). It was hypothesized that measures of higher level abilities, such as abstract reasoning, would show greater differences between the groups than would measures of lower level abilities. Higher level functions measured included general neuropsychological functioning and verbal/academic skills; lower level functions measured included sensory and motor skills. Tests were selected from the Halstead-Reitan Neuropsychological Test Battery for Children, the Wechsler-Bellevue Intelligence Scale, the Wechsler Intelligence Scale for Children (WISC), and the Wide Range Achievement Test. Results show that the brain-impaired group was significantly poorer in each area of ability except sensory measures. Measures of motor functioning and general neuropsychological abilities best discriminated the brain-damaged group from the controls. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinically significant behavior problems during the initial 18 months following early childhood traumatic brain injury.

Objective: This study looked at the emergence of clinically significant problems in behavior, executive function skills, and social competence during the initial 18 months following traumatic brain injury (TBI) in young children relative to a cohort of children with orthopedic injuries (OI) and the environmental factors that predict difficulties postinjury. Participants: Children, ages 3–7 years, hospitalized for severe TBI, moderate TBI, or OI were seen shortly after their injury (M = 40 days) and again 6 months, 12 months, and 18 months postinjury. Design: Behavioral parent self-reports, demographic data, family functioning reports, and home environment reports were collected at injury baseline and each time point postinjury. Results: Results suggest that, compared with the OI group, the severe TBI group developed significantly more externalizing behavior problems and executive function problems following injury that persisted through the 18-month follow-up. Minimal social competence difficulties appeared at the 18-month follow-up, suggesting a possible pattern of emerging deficits rather than a recovery over time. Conclusions: Predictors of the emergence of clinically significant problems included permissive parenting, family dysfunction, and low socioeconomic status. The findings are similar to those found in school-age children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of short- and long-term outcomes after traumatic brain injury in children: Behavior and achievement.

Longitudinal behavior and achievement outcomes of traumatic brain injury (TBI) were investigated in 53 children with severe TBI, 56 children with moderate TBI, and 80 children with orthopedic injuries not involving brain insult. Measures of preinjury child and family status and of postinjury achievement skills were administered shortly after injury. Assessments were repeated 3 times across a mean follow-up interval of 4 years. Results from mixed model analysis revealed persisting sequelae of TBI. Recovery of math skills was observed in the severe TBI group but only for children from less stressed families. Social disadvantage in children with TBI predicted more adverse behavioral sequelae and less favorable changes in some outcome measures. The findings suggest that pediatric TBI has long-term effects on behavior and achievement but that postinjury progress is influenced by the family environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Connaissance des résultats et contr?le spatiotemporel dans une tache d'anticipation-co?ncidence chez des enfants de 6 à 10 ans.

Studied the effects of knowledge of results (KR), either spatial or temporal, on performance of a coincidence-timing task among Canadian children. Human subjects: 90 male and female Canadian children (aged 6–10 yrs). Ss were divided into 3 age groups (mean age 6.8 yrs, 8.3 yrs, and 10.2 yrs). Each age group was divided into 3 experimental groups: 1 group received spatial KR, 1 group received temporal KR, and 1 group received no KR during practice sessions for a coincidence-timing task. The task consisted of moving an object horizontally with the hand to a spot corresponding to the movement of a visual stimulus. The object was to reach the correct spot at the same time as the visual stimulus, which came from either the right or the left at speeds of 100 or 152 cm/s. The results were analyzed according to Ss' age, speed of stimulus, direction of stimulus, type of KR training, and whether or not the S's object arrived before or after the visual stimulus. A multivariate analysis of variance (MANOVA) was used. (English abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age and visual field differences in computing visual-spatial relations.

Age and brain hemispheric differences in visual–spatial performance were investigated using 2 versions of categorical and coordinate (metric) spatial relations tasks. 32 young adults (M?=?19.2 yrs) and 32 older adults (M?=?68.8 yrs) participated. An overall age-related decrement in computing visual–spatial relations was obtained for lateralized presentations and when items were presented centrally. In contrast to some previous findings, there was no evidence to suggest differential aging of the right hemisphere in computing visual–spatial relations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influences on first-year recovery from traumatic brain injury in children.

This study examined recovery over the first year following traumatic brain injury (TBI) in children 6–12 years of age. Forty-two children with severe TBI and 52 with moderate TBI were compared to 58 children with orthopedic injuries. The children and their families were evaluated at a baseline assessment and at 6- and 12-month follow-ups. Findings documented cognitive, achievement, and behavioral sequelae of TBI, with only limited evidence for recovery over the first year postinjury. Outcomes were predicted by preinjury factors, TBI severity, and measures of the postinjury family environment. Some of the sequelae of severe TBI were more marked in the context of higher compared with lower levels of family burden or dysfunction. The findings confirm the need to consider environmental contributions to outcomes of TBI in children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical disability, physical attractiveness, and social outcomes in children's small groups.

Examined the sociometric status of children with obvious physical handicaps in an integrated (approximately 70% Black, 20% Puerto Rican, and 10% White) summer camp setting containing 61 girls (aged 7.5–14 yrs) and 60 boys (aged 7.75–14 yrs). 23% of Ss had obvious physical handicaps (e.g., spinal injuries, limb deformities), and 33% had some form of chronic illness or physical condition (e.g., sickle cell anemia, pulmonary insufficiency). Ss were interviewed during the 3rd wk of camp on questions concerning who they liked best in their groups and how they made friends. In addition, 12 male and 12 female children from neighboring camps were shown full-body photographs of all Ss and asked to rate them for attractiveness. Results indicate that handicapped Ss were less preferred as friends than their able-bodied peers. Physical attractiveness was also related to sociometric standing, as well as to the presence or absence of a physical handicap. An analysis of the relationship between physical attractiveness and social status for Ss alone indicated that these variables were significantly related for this group. Significant differences were found between obviously handicapped and able-bodied Ss on a knowledge-of-friend-making task; but among the latter group, role-play scores did not differentiate high- from low-status Ss. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rotation of mental images and asymmetries in word recognition in disabled readers.

Two experiments with 72 right-handed children (9–11 yrs old) revealed marked dissimilarities in perceptual coding between impaired and fluent readers. In Exp I, 26 boys with reading disabilities and average intelligence were compared to 26 good readers on a test of visual–spatial, short-term memory. Both groups performed equally well in their spatial recall on transformed visual fields. However, poor readers coded the test stimuli differently, in a nonanalytic and synchronous fashion. In a follow-up experiment, 10 disabled readers compared with 10 good readers showed a lower right- over left-field advantage when reporting single words presented tachistoscopically. Taken together, results disconfirm the widely held ideas that poor readers are suffering from spatial disorientation, left–right confusion, mirror-image equivalence, or lack of cerebral dominance. Findings suggest that the perceptual "anormalies" often linked with reading disability may result from nonpathological variations in the structural operations used to encode visual information. This difference in the organization of encodings in visual memory may be related to asymmetries in brain functioning. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unilateral injury of posterior parietal cortex and spatial learning in hooded rats

The influences of bilateral or unilateral injuries within the posterior parietal cortex (PPC) upon spatial learning in a water maze were examined in three experiments. Place-learning and response-learning were investigated in a four-alley 'Greek-cross' shaped water maze with extra-maze visual cues available. No differences were detected on any of several measures sensitive to learning between the lesion groups on the place-learning task. Microanalysis of behavior within trials revealed that animals with either bilateral or right unilateral PPC injuries committed significantly more total errors, initial alley entrance ('reference memory') errors, and re-entry ('working memory') errors in the response-learning paradigm than did either the control or left PPC-injured rats. No differences were detected between the latter two groups on these measures. Unilateral lesions resulted in asymmetrical placing responses ipsilateral to the injury 10 days after surgery whereas bilateral injuries resulted in asymmetrical placing with mixed directionality. The acquisition of the response-learning problem in the absence of visual cues was studied on animals prepared with unilateral lesions and housed post-operatively either in isolation or in a 'complex environment.' In the absence of visual cues both right and left PPC-injured rats committed more errors than sham controls, and differential post-surgical housing did not attenuate these impairments. These same animals were trained on the landmark navigation task. Although no differences appeared between the lesion groups, a generalized but transient facilitation of learning was observed in animals housed in the 'complex' environment. Unilateral injuries placed in sham controls failed to disturb retention of the landmark navigation strategy. Because none of the PPC-injured animals were deficient in the landmark task, a result which is contrary to observations in other laboratories, the influence of post-surgical recovery interval upon acquisition of the landmark navigation strategy was explored. Animals were prepared with right PPC injuries and trained following either a 5 or 35 day recovery interval. Only those animals limited to the short recovery interval proved to have a spatial deficit in the landmark task. It is concluded that injuries in the PPC of either hemisphere disturb egocentric spatial functions. However, animals with left PPC injuries are able to compensate by using allocentric visual cues if they are available. It is due to the special role played by the right PPC in complex visuospatial functions that animals with this injury are unable to compensate.     

Skill development in different components of arithmetic and basic cognitive functions: Findings from a 3-year longitudinal study of children with different types of learning difficulties.

Arithmetic and cognitive skills of children with mathematical difficulties (MD-only), with comorbid reading difficulties (MD-RD), with reading difficulties (RD-only), and normally achieving children were examined at 3 points from Grades 3–4 to Grades 5–6 (age range, 9–13 years). Both MD groups displayed severe weaknesses in 4 domain-specific arithmetic components (factual, conceptual, procedural, and problem-solving skills) during all 3 measure points. Telling time and approximate arithmetic were also problematic for children with MD. Both MD groups displayed a small weakness related to visual–spatial working memory, and the MD-RD group also displayed small weaknesses related to verbal short-term memory, processing speed, and executive functions. The 4 groups developed at similar rates within all domain-specific components as well as basic cognitive functions. These findings demonstrate that children identified as having MD when they are 9 years old do not catch up with their normally achieving peers in later school grades, when they are 13 years old. They also continue to lag behind their peers with respect to the domain-general cognitive system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The neuropsychological significance of lateral preference for complex visual activities in children with learning disabilities

In the present study the relationship between neuropsychological functioning and lateral preference for visual activities was examined with learning disordered children. Specifically, the relationship between measures of the Lateral Dominance Exam (LDE), scores on the Halstead-Reitan Neuropsychological Battery (HRNB), and the Wechsler Intelligence Scale for Children-Revised (WISC-R) were explored. A canonical analysis suggested that composites of neuropsychological functioning and lateral preference shared 22% of variance. Learning disabled children with strong right or left preference for visually guided motor activities showed lower performance in spatial tasks on the ipsilateral side and in simple motor skills on the contralateral side. Children in the present study with strong right preference patterns for visually assisted motor activities also showed low performance on visual tracking tasks. These data offer some support for assessing lateral preference in learning disabled children.     

Family life-styles and child behaviors: A study of direction of effects.

Examined the direction of effects between slow-learning children and their families in 3 family types: learning-oriented (LO), high residential quality; achievement-oriented (AO), low residential quality; and outer-directed (OD), with little achievement orientation. Child variables examined were measures of adjustment and adaptive behavior. Family variables (assessed on measures including the Family Environment Scale) included levels of community and recreational participation, expressiveness, achievement orientation, provision of learning materials, harmony, quality of the residential environment, and openness with the interviewer. There were 56 LO children (mean age 12.6 yrs [mean IQ 69.6]), 37 AO children (mean age 12.2 yrs [mean IQ 68.5]), and 32 OD children (mean age 12.7 yrs [mean IQ 69.5]). Cross-lagged panel analysis revealed different directions of effect in the 3 family types. In LO families, the child influenced the family for all variables except for expressiveness; in AO families, parents influenced the child; and in OD families, there were bidirectional effects whereby the child's self-help skills influenced parents, but parents influenced the child in higher-level skills such as social adjustment, motivation, and competency in community living. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A model for teaching and evaluating brief psychotherapy with children and their families.

A pilot study with 5 children (aged 7–22 yrs) and 5 therapists with 1–3 yrs of supervised clinical experience demonstrated the feasibility of teaching a method of planned time-limited therapy with children and their families to relatively inexperienced therapists in a clinical setting. Significant features of the therapy, which consisted of 10–22 sessions over a 16-wk period, included a focus on client-suggested goals; an emphasis on skills deficits rather than pathology; and some techniques from structural family therapy and from educational, behavioral, and cognitive interventions. Reasons for the success of the present therapy method are considered. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reading, memory, and metacognition.

Investigated relations among reading skills, metareading (knowledge about reading), memory, and metamemory (knowledge about memory) as they relate to reading ability (good vs poor readers), operativity, and grade level. 40 2nd graders (aged 7.25–9.83 yrs) and 40 4th graders (aged 9.42–22.00 yrs) were interviewed to assess the reading–memory variables. Significant but low correlations were obtained between metareading and reading, metamemory and memory, metareading and metamemory, and reading and memory. Significant effects of operativity were revealed on all dependent measures. Operative Ss had higher scores on the metareading and metamemory tasks, read at higher levels, and remembered more items on the memory tasks than did nonoperative Ss. Effects of grade level were revealed on most dependent measures. Fourth-grade Ss received higher scores on the metareading and metamemory tasks and read at higher levels than did 2nd-grade Ss. An interaction between operativity and grade level revealed that operative 2nd-grade and both groups of 4th-grade Ss made fewer total reading errors than did nonoperative 2nd-grade Ss. The effects of operativity, experience, and metacognition on reading and memory skills are discussed. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The epidemiology of urban pediatric neurological trauma: evaluation of, and implications for, injury prevention programs

OBJECTIVE: To describe the incidence and causes of pediatric head, spinal cord, and peripheral nerve injuries in an urban setting and to assess the implications of these data for injury prevention programs. METHODS: Pediatric deaths and hospital admissions secondary to neurological trauma included in the Northern Manhattan Injury Surveillance System from 1983 to 1992 were linked to census counts to compute incidence rates. Rates before the implementation of a nonspecific injury prevention program were compared with rates after the implementation, and rates for the target population were compared to rates for the control population. Rates were analyzed on the basis of the cause of injury as well as the age, gender, and neighborhood income level of the injured. RESULTS: The incidence of neurological injuries resulting in hospitalization or death was 155 incidents per 100,000 population per year; the mortality rate was 6 people per 100,000 population per year. Neurological injuries represented 18% of all pediatric injuries and accounted for 23% of all traumatic deaths. Spinal cord and peripheral nerve injuries were relatively rare (5%) compared to head injuries (95%). Minor head injuries, including isolated cranial fractures, minor concussions (<1 h loss of consciousness), and unspecified minor head injuries, accounted for the majority of neurological injuries (76%), whereas severe head injuries, including severe concussion (>1 h loss of consciousness), cerebral laceration/contusion, intracerebral hemorrhage, and unspecified major injuries, were less common (18% of all neurological injuries). Boys were more often affected than girls at every age, and this preference increased with age. Children younger than 1 year showed the highest incidence of both major and minor injuries. One- to 4-year olds showed the lowest rates, with steady increases thereafter. Traffic accidents and falls were the leading causes (38 and 34%, respectively), and assaults were the next leading causes (12%). Among children admitted to surveillance system hospitals, falls were most common in children younger than 4 years, pedestrian motor vehicle accidents were most common in late childhood, and assaults were most common in early adolescence. Case:fatality rates were 5 to 7% for all age groups except 5- to 12-year-olds, for whom the case:fatality rate was 1.9%. Residence in a low-income neighborhood was associated with an increased risk of injury (rate ratio, 1.71; confidence interval, 95%, 1.54, 1.89). The average hospitalization cost per injury was $8502. Medicaid (54%) and other government sources (5%) covered the majority of expenses, including indirect reimbursement of usually uncollected self-pay billing (19%). Although injury incidence rates fell in both the control and intervention cohorts during implementation of a nonspecific injury prevention program, targeted age and population groups demonstrated greater relative reductions in injuries than nontargeted ones, suggesting a positive effect. CONCLUSIONS: Deaths and hospital admissions secondary to pediatric neurological trauma represent a significant public health problem, with the majority of the direct cost being born by government agencies. Future efforts to prevent neurological trauma in children who live in inner cities should focus on families with low incomes and provide novel education programs regarding infant abuse, infant neglect, and infant injury avoidance. Age-appropriate school-based programs should also be developed to address traffic safety and conflict resolution.     

Multimodal assessment of impulsiveness in abusing, neglecting, and nonmaltreating mothers and their preschool children.

Three groups of 12 mothers who had a history of child abuse (mean age 26.67 yrs), child neglect (mean age 25.75 yrs), or no known history of child maltreatment (mean age 29.08 yrs) and their 48–70 mo old children were compared on the nature and extent of their impulsiveness in a multimodal assessment procedure. Children were also rated by their mothers on the Revised Conners Parent Rating Scale and by their teachers on the Conners Teacher Rating Scale. Results indicate that comparison mothers performed better than did abusing mothers on 2 measures of motor inhibition, a modified Matching Familiar Figures Test and the Stroop Color and Word Test. Neglectful mothers rated their children as having more conduct problems than did comparison mothers. No significant differences were found on the other child measures of impulsiveness. Implications for assessing and treating child maltreatment are discussed. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of sudden bereavement: Marital and parent-child relationships and children's reactions.

Explored long-term family adjustment to sudden, unexpected bereavement by conducting interviews with 40 Ss whose spouse died in a motor vehicle crash 4–7 yrs earlier and with 39 matched controls. Interviews were also conducted with 54 parents whose 1–28 yr old child died in a motor vehicle crash 4–7 yrs earlier and with 61 matched controls. Findings indicate that marital relationships generally strengthened or dissolved after a child's death. Most bereaved adults reported feeling closer to their children after the loss of a family member. Parental reports suggest that the death of a parent or sibling is overwhelmingly negative for children, and extremely so for a significant percentage. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The preschool child witness: Errors in accounts of traumatic injury.

Because errors in recall are an important contributor to assessments of children's credibility as witnesses, the author explored children's errors when recounting details of trauma injuries that resulted in hospital Emergency Room treatment. 37 preschool aged children (aged 2–5 yrs) and 11 9-yr-olds (comparison Ss) were recruited in the emergency room and interviewed at home both within a few days of the injury and after 6 mo. Adult witnesses were also interviewed to corroborate children's accounts. Although 2-yr-old Ss made more errors than did older children, the information provided was accurate, even 6 mo after their injuries. The errors were not random; rather, information that was likely to be important in real-world cases was retained quite accurately, while some other categories of information (e.g., the 1st person to respond to their injury) were more error-prone. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)