As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury.

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.

Post-Concussion and Post-Traumatic Stress Symptoms after Pediatric Traumatic Brain Injury: Shared Vulnerability Factors?

Following pediatric traumatic brain injury (TBI), post-concussion symptoms (PCS) and post-traumatic stress symptoms (PTSS) occur commonly; however, it is unknown to what degree they overlap. The study examined PCS and PTSS persisting 7 weeks after injury in children and adolescents ages 8-15 years with TBI (n = 89) or extracranial injury (EI; n = 40) after vehicle collisions. TBI was divided into mild, complicated-mild/moderate, and severe groups. Parents retrospectively rated children's pre-injury symptoms and behavior problems, and children completed self-report measures after injury. PCS and PTSS total scores were significantly correlated in TBI and EI groups, respectively, for child (rs = 0.75; rs = 0.44), and adolescent (rs = 0.61; rs = 0.67) cohorts. Generalized linear models examined whether injury type and severity, age, sex, and pre-injury symptom ratings predicted PCS and PTSS total scores and factor scores. Specific PCS and PTSS factor scores were elevated in different TBI severity groups, with most frequent problems following mild or severe TBI. PCS did not differ by age; however, girls had more emotional symptoms than boys. Only PTSS were predicted by pre-injury externalizing behavior. Significant age by sex interactions indicated that adolescent girls had more total, avoidance, and hyperarousal PTSS symptoms than younger girls or all boys. PCS and PTSS significantly overlapped in both TBI and EI groups, highlighting shared persistent symptoms after injury. Shared vulnerability factors included female sex, milder TBI, and poorer pre-injury adjustment. Older age was a unique vulnerability factor for PTSS. Psychological health interventions after injury should be customized to address comorbid symptoms.

The effect of the Preparing Pequeños small-group cognitive instruction program on academic and concurrent social and behavioral outcomes in young Spanish-speaking dual-language learners.

Academic achievement for young dual language learners (DLL) is a critically acknowledged problem of national significance that has been understudied. To address this shortage, this study evaluated the effectiveness of Preparing Pequeños, an integrated small-group instruction program designed to promote increased learning for Spanish speaking DLL in language, literacy, and math. The DLL in the randomized Preparing Pequeños intervention classrooms were compared to control DLL with comparable Spanish language delays and in which the school district's core curriculum was being implemented. Intervention teachers and paraprofessionals, as part of Preparing Pequeños, implemented new classroom and time management systems in order to conduct 90 min of small-group instruction four days each week across the school year. In total, 51 control and 52 intervention classrooms participated; pre-test measures were completed with 829 children, with 777 of these children also completing post-test measures (7% attrition). Results showed that intervention teachers and paraprofessionals, as compared to control, showed greater increases in most of the targeted areas of cognitive instruction (d range = 0.60-2.38) and in the use of small groups (d range = 3.32-4.46), progress monitoring (d = 0.17) to inform instruction, and team teaching (d = 1.94). Intervention children, as compared to control, showed significantly greater gains in Spanish oral language, print knowledge, phonological awareness, and phonics with small to large effect sizes (d range = 0.14-0.52). Also, potentially as a result of greater attention to children's individual needs and support for managing their behavior, intervention children, as compared to control, showed greater decreases in school avoidance, anger, and aggression with small effect sizes (d range = -0.22 to -0.29). Results are discussed in relation to the need for greater attention in teachers' training in effective approaches for small-group instruction.

Self-regulation and the Development of Literacy and Language Achievement from Preschool through Second Grade.

Previous research has established that higher levels of behavioral self-regulation are associated with higher levels of language and literacy. In this study, we take a more developmental perspective by considering how trajectories of self-regulation development (early, intermediate, late) predict the way literacy and language skills develop from preschool through second grade. Children (n = 351) were assessed twice per year for up to four years on indicators of decoding, reading comprehension, phonological awareness, and vocabulary. Using non-linear growth curve models, we found that children who demonstrated self-regulation earlier had higher language and literacy skills throughout preschool to second grade. More specifically, earlier self-regulation trajectories were associated with both higher levels and earlier development of both decoding and reading comprehension, but not faster development. Children with early self-regulation trajectories developed phonological awareness earlier than those with late self-regulation trajectories. Finally, children with early self-regulation trajectories had higher levels of vocabulary than children with intermediate trajectories, but did not differ on the rate or timing of vocabulary development. Findings point to the enduring and interconnected nature of self-regulation and children's language and literacy development.

Nurturing the preterm infant brain: leveraging neuroplasticity to improve neurobehavioral outcomes.

An intrinsic feature of the developing brain is high susceptibility to environmental influence-known as plasticity. Research indicates cascading disruption to neurological development following preterm (PT) birth; yet, the interactive effects of PT birth and plasticity remain unclear. It is possible that, with regard to neuropsychological outcomes in the PT population, plasticity is a double-edged sword. On one side, high plasticity of rapidly developing neural tissue makes the PT brain more vulnerable to injury resulting from events, including inflammation, hypoxia, and ischemia. On the other side, plasticity may be a mechanism through which positive experience can normalize neurological development for PT children. Much of the available literature on PT neurological development is clinically weighted and focused on diagnostic utility for predicting long-term outcomes. Although diagnostic utility is valuable, research establishing neuroprotective factors is equally beneficial. This review will: (1) detail specific mechanisms through which plasticity is adaptive or maladaptive depending on the experience; (2) integrate research from neuroimaging, intervention, and clinical science fields in a summary of findings suggesting inherent plasticity of the PT brain as a mechanism to improve child outcomes; and (3) summarize how responsive caregiving experiences situate parents as agents of change in normalizing PT infant brain development.

Bidirectional Associations Between Parental Responsiveness and Executive Function During Early Childhood.

In this study, we examined bidirectional associations between parental responsiveness and executive function (EF) processes in socioeconomically disadvantaged preschoolers. Participants were 534 3- to 5-year-old children (71% Hispanic/Latino; 28% African American; 1% European American) attending Head Start programs. At Time 1 (T1) and 6.5 months later at Time 2 (T2), parents and children participated in a videotaped free play session and children completed delay inhibition (gift delay-wrap, gift delay-bow) and conflict EF (bear/dragon, dimensional change card sort) tasks. Parental warm acceptance, contingent responsiveness, and verbal scaffolding were coded from the free play videos and aggregated to create a parental responsiveness latent variable. A cross-lagged panel structural equation model indicated that higher T1 parental responsiveness significantly predicted more positive gain in delay inhibition and conflict EF from T1 to T2. Higher T1 delay inhibition, but not T1 conflict EF, significantly predicted more positive change in parental responsiveness from T1 to T2. These associations were not explained by several possible confounding variables, including children's age, gender, race/ethnicity, and verbal ability. Findings suggest that parental responsiveness may support EF development in disadvantaged children, with reciprocal effects of delay inhibition on parental responsiveness.

Cognitive predictors of a common multitasking ability: Contributions from working memory, attention control, and fluid intelligence.

Previous research has identified several cognitive abilities that are important for multitasking, but few studies have attempted to measure a general multitasking ability using a diverse set of multitasks. In the final dataset, 534 young adult subjects completed measures of working memory (WM), attention control, fluid intelligence, and multitasking. Correlations, hierarchical regression analyses, confirmatory factor analyses, structural equation models, and relative weight analyses revealed several key findings. First, although the complex tasks used to assess multitasking differed greatly in their task characteristics and demands, a coherent construct specific to multitasking ability was identified. Second, the cognitive ability predictors accounted for substantial variance in the general multitasking construct, with WM and fluid intelligence accounting for the most multitasking variance compared to attention control. Third, the magnitude of the relationships among the cognitive abilities and multitasking varied as a function of the complexity and structure of the various multitasks assessed. Finally, structural equation models based on a multifaceted model of WM indicated that attention control and capacity fully mediated the WM and multitasking relationship. (PsycINFO Database Record

The development of self-regulation across early childhood.

The development of early childhood self-regulation is often considered an early life marker for later life successes. Yet little longitudinal research has evaluated whether there are different trajectories of self-regulation development across children. This study investigates the development of behavioral self-regulation between the ages of 3 and 7 years, with a direct focus on possible heterogeneity in the developmental trajectories, and a set of potential indicators that distinguish unique behavioral self-regulation trajectories. Across 3 diverse samples, 1,386 children were assessed on behavioral self-regulation from preschool through first grade. Results indicated that majority of children develop self-regulation rapidly during early childhood, and that children follow 3 distinct developmental patterns of growth. These 3 trajectories were distinguishable based on timing of rapid gains, as well as child gender, early language skills, and maternal education levels. Findings highlight early developmental differences in how self-regulation unfolds, with implications for offering individualized support across children. (PsycINFO Database Record