Differences in Health-Related Quality of Life after Traumatic Brain Injury between Varying Patient Groups: Sensitivity of a Disease-Specific (QOLIBRI) and a Generic (SF-36) Instrument.

Factors associated with health-related quality of life (HRQOL) in patients after traumatic brain injury (TBI) include severity of initial injury, different grades of trauma recovery, sociodemographic status, and psychological characteristics. Yet, sensitivity of HRQOL instruments to such effects is often underexplored. Thus, we aimed to compare the capacity of the disease-specific QOLIBRI (Quality of Life after Brain Injury) and the generic Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey(SF-36) to detect significant differences in HRQOL between patients. Patients (n = 795) completed HRQOL, sociodemographic, clinical, psychological, and health status questionnaires. Univariate (Wilcoxon-Mann-Whitney) and multi-variate (Wei-Lachin) non-parametric analyses were conducted using the Wilcoxon-Mann-Whitney approach to compare the sensitivity of the QOLIBRI and the SF-36. For both instruments, HRQOL was particularly influenced by patients' reliance on others, depression, anxiety, and recovery status, whereas smaller effects were found for living arrangements and participation in leisure activities. Both HRQOL instruments were sensitive to group differences, but the QOLIBRI was able to detect a greater number of and finer differences between specific patient groups, which is particularly important in clinical and therapeutic contexts. This finding is likely explained by the QOLIBRI's greater specificity to disease-specific aspects of consequences of TBI. This head-to-head HRQOL instrument comparison resulted in a recommendation for the use of the QOLIBRI when detailed insight in the subjective consequences and impact of TBI on patients is required.

Informants' ratings of activity level in infancy predict ADHD symptoms and diagnoses in childhood.

We tested the hypothesis that high activity levels in infancy would predict self-regulatory problems and later symptoms of attention deficit and hyperactivity disorder (ADHD) in a longitudinal study of British families (N = 321). Infants' activity levels were assessed at 6 months, using 3 informants' reports from the Infant Behavior Questionnaire (IBQ) and ActiGraphs during baseline, attention, and restraint tasks. At a mean of 33 months, the children were assessed on self-regulatory tasks; at a mean of 36 months, 3 informants reported symptoms of ADHD. At a mean of 7.0 years, the children were assessed on executive function tasks; 3 informants reported on the child's symptoms of ADHD; and diagnoses of disorder were obtained using the Preschool Age Psychiatric Assessment. Informants' reports of high activity levels at 6 months predicted ADHD symptoms in early childhood and diagnoses of ADHD with clinical impairment at age 7. The IBQ activity scale was also associated with the children's later performance on self-regulation tasks in early and middle childhood. Activity level in infancy reflects normal variation and is not a sign of psychopathology; however, these findings suggest that further study of the correlates of high activity level in infancy may help identify those children most at risk for disorder.

If You Go Down to the Woods Today: Infants' Distress During a Teddy Bear's Picnic in Relation to Peer Relations and Later Emotional Problems.

Infants' emotional reactions to an unusual event were assessed at a simulated birthday party during which two costumed characters enacted a Teddy Bear's Picnic. Two hundred and fifty-eight firstborn infants in a representative British community sample were observed at a mean age of 12.8 months in the presence of their parents and other participating families, in a laboratory sitting room decorated with balloons and banners. The picnic scenario was followed by free play with the other participating infants. At a mean of 36 months of age, mothers, fathers, and another informant who knew the child well completed the Child Behaviour Check List (CBCL). The majority of infants showed no vocal distress during the picnic scenario. A minority of infants expressed strong distress, which was correlated with elevated heart rate and production of cortisol. Infants who were not distressed were more likely to direct social behavior to their peers and especially likely to use physical force against peers. In comparison with strongly distressed and nondistressed infants, those who had shown mild distress during the picnic scenario were least likely to manifest later emotional problems. This pattern was particularly marked for boys. Taken together, the findings indicate that infants' strong distress during naturalistic encounters that are meant to be entertaining can suppress sociability and might indicate risk for subsequent emotional problems.