Social competence following pediatric stroke: contributions of brain insult and family environment.

Limited information is available regarding predictors of psychosocial difficulties in children following stroke. This study aimed to (i) compare social competence of children with arterial ischemic stroke (AIS) to those with chronic illness and healthy controls and (ii) investigate the contribution of stroke pathology, neurological outcome and environment. Thirty-six children with AIS > 12 months prior to recruitment were compared with children with chronic illness (asthma) (n = 15) and healthy controls (n = 43). Children underwent intellectual assessment, and children and parents completed questionnaires to assess social competence. Children with AIS underwent MRI scan and neurological evaluation. Child AIS was associated with poorer social adjustment and participation, and children with AIS were rated as having more social problems than controls. Lesion volume was not associated with social outcome, but subcortical stroke was linked to reduced social participation and younger stroke onset predicted better social interaction and higher self-esteem. Family function was the sole predictor of social adjustment. Findings highlight the risk of social impairment following pediatric stroke, with both stroke and environmental factors influencing children's social competence in the chronic stages of recovery. They indicate the potential for intervention targeting support at the family level.

Cognitive outcomes following arterial ischemic stroke in infants and children.

This study sought to investigate cognitive outcomes following pediatric arterial ischemic stroke and explore predictors. Participants included 36 children with perinatal or childhood arterial ischemic stroke and a comparison group of 15 children with asthma. Outcomes included cognitive ability, executive functions, and neurological function (Pediatric Stroke Outcome Measure). Magnetic resonance imaging measured lesion location and volume. Mean cognitive scores were at the low end of the average range. Children with arterial ischemic stroke performed significantly below normative populations and significantly below the asthma group on inhibitory control (Cohen's d = .68). Both the Pediatric Stroke Outcome Measure and lesion volume were negatively correlated with cognitive outcome (Spearman r = -.01 to -.42 Pediatric Stroke Outcome Measure; r =-.14 to -.32 Volume). Following arterial ischemic stroke, children performed at the low end of the average range on measures of cognitive functioning. Cognitive outcomes depend on a variety of factors.

An investigation of impaired scores on the frontal assessment battery in a VA population.

In a population of inpatients, individuals were observed to continually score in the impaired range on the Frontal Assessment Battery (FAB) without exhibiting other signs of frontal-lobe damage. Investigations were undertaken to determine if the subtest structure, demographic factors, or general cognitive functioning may be responsible for patients' poor performance on the FAB overall. Participants were inpatients at the Ann Arbor Veterans Hospital who were administered a standard neuropsychological screening battery. This battery included the FAB, among other tests, as part of regular clinical care. Included in these study analyses were 292 patients with a mean age of 67.27 years (SD = 12.41). Descriptive analyses revealed that 63.7% of patients scored in the impaired range on the FAB based on the criteria set forth by Dubois, Slachevsky, and Litvan ( 2000 ). Analyses of individual subtest performance failed to find any single test that would characterize participants' poor performance overall. Nonetheless, the total FAB score was related to age, general cognitive functioning, and premorbid estimates of intellectual functioning. The internal reliability also was found to be lower than that reported previously. While the FAB may measure frontal-lobe functions, it appears to be influenced by a multitude of other demographic and neuropsychological factors.

Agreement between parents and children on ratings of post-concussive symptoms following mild traumatic brain injury.

The level of parent-child agreement on post-concussive symptoms (PCS) was examined in children following mild traumatic brain injuries (TBI). As part of a larger longitudinal study, 186 children with mild TBI and 99 with orthopedic injuries (OI), from 8 to 15 years of age, were recruited prospectively. Parents and children completed the PCS Interview (PCS-I) and the Health and Behavior Inventory (HBI) at 2 weeks, 1 month, 3 months, and 12 months postinjury. Item-level correlations between child and parent ratings on both measures of PCS were significant but modest in both groups. Parent-child correlations for composite scales on the HBI and the total score on the PCS-I were significant in both groups, but somewhat higher in the OI group than in the mild TBI group. Mean symptom ratings tended to be significantly higher for children as compared to parents, especially for somatic symptoms. Parents and children display modest agreement when reporting PCS; their ratings correlate significantly, but children report higher mean levels of symptoms than parents.

Relationships among post-concussive symptoms and symptoms of PTSD in children following mild traumatic brain injury.

PRIMARY OBJECTIVE: To investigate the occurrence of post-concussive symptoms (PCS) and symptoms of post-traumatic stress disorder (PTSD) in children following mild traumatic brain injuries (TBI). RESEARCH DESIGN: Longitudinal study comparing the outcomes of mild TBI and orthopaedic injuries (OI) in children aged 8-15. METHODS AND PROCEDURES: One hundred and eighty-six children with mild TBI and 99 with OI were recruited prospectively. Parents rated children's PCS and symptoms of PTSD at 2 weeks, 3 months and 12 months post-injury. One hundred and sixty-seven with mild TBI and 84 with OI completed all assessments. MAIN OUTCOMES AND RESULTS: Controlling for symptoms of PTSD, the mild TBI group demonstrated more PCS than the OI group, although the magnitude of group differences diminished with time. Controlling for PCS, the OI group displayed more symptoms of PTSD than the mild TBI group at baseline, but not thereafter. Symptoms of PTSD and PCS were correlated significantly, but more highly in the OI group than the mild TBI group. CONCLUSIONS: Although PCS and symptoms of PTSD are correlated, children with mild TBI are more distinguishable from children with OI based on PCS than on symptoms of PTSD. The latter symptoms, moreover, do not account for increased PCS following mild TBI in children.