Quality of life 6 and 18 months after mild traumatic brain injury in early childhood: An exploratory study of the role of genetic, environmental, injury, and child factors.

Mild traumatic brain injury (mTBI) in early childhood is prevalent, and some children may be at risk for short- and long-term difficulties that could affect quality of life (QoL). Despite growing efforts to understand associations between potential risk factors and outcomes after injury, prognosis is elusive and lacks the inclusion of genetic variables which may convey additional predictive power. This study assessed which factors contribute to pediatric QoL 6 and 18 months post-recruitment in 159 participants (mTBI = 52; orthopedic injury [OI] = 43; typically developing controls [TDC] = 64) aged 18 to 60 months at the time of injury (M = 37.50, SD = 11.69). Family environment, injury characteristics, and child cognitive-behavioral functioning were assessed at 6 months via parent questionnaires and socio-cognitive assessment. QoL was determined using the Pediatric Quality of Life Inventory at both time points. Genetic information (Brain-derived neurotrophic factor [BDNF] genotype) was collected using saliva samples. Hierarchical regression analyses testing biological, family-environmental, injury and cognitive-behavioral factors revealed that the BDNF Val66Met polymorphism was a significant independent predictor of better QoL 6 months post-injury in the mTBI group. Lower parental distress significantly and independently predicted higher QoL 18 months after mTBI, and 6 months post-recruitment in the TDC group. At 18 months, models were non-significant for both control groups. Genetic factors involved in neuroplasticity may play an important role in recovery 6 months after mTBI and contribute to outcome via their interplay with environmental factors. Over time, family factors appear to become the primary determinants of post-mTBI outcome.

Long-term brain-injury-specific effects following preschool mild TBI: A study of theory of mind.

OBJECTIVE: A previous study conducted by our group found theory of mind (ToM) differences in preschool children who sustained mild traumatic brain injury (mTBI) compared with typically developing peers, 6 months postinjury. The goals of the current longitudinal study were to determine whether these findings are the result of a brain-injury-specific effect or rather a general-injury effect, to examine the long-term evolution of ToM skills following preschool mTBI, as well as to investigate the links between ToM abilities and general social functioning. METHOD: Seventy-two children who sustained mTBI between the ages of 18 and 60 months were evaluated 6 and 18 months postinjury on ToM tasks including desires and emotions reasoning and false belief understanding. They were compared with 58 participants who sustained an orthopedic injury (OI) and 83 typically developing children (TDC). RESULTS: The 3 groups did not differ on demographic and baseline characteristics. The mTBI group obtained poorer scores relative to both comparison groups on the desires and emotions reasoning task, both at 6 and 18 months injury. No correlations were found between injury characteristics and ToM performance. For the mTBI group, associations were found between ToM performance and global social competence. CONCLUSION: These findings suggest a brain-injury-specific effect that persists in the long-term following mTBI in preschool children. (PsycINFO Database Record

A Highly Diverse Portrait: Heterogeneity of Neuropsychological Profiles in cblC Defect.

Cobalamin C is a rare inborn disorder of metabolism that results in multisystemic abnormalities, including progressive visual deficits. Although the cellular pathophysiology of cblC is a field of active study, little attention has been dedicated to documenting the cognitive consequences of the defect. The neuropsychological assessment of nine individuals aged between 23 months and 24 years was conducted to establish cognitive profiles. Results reveal a marked heterogeneity, with intellectual functioning ranging from extremely low to average, and cognitive difficulties (e.g., attention) evidenced even in those who are not intellectually disabled. Central nervous system abnormalities and multisystem disease are likely to be major contributing factors to the observed cognitive impairments, with the presence of visual deficits constituting an additional impediment to normal cognitive development. This study underscores the importance of conducting in-depth neuropsychological assessments in individuals with cblC, the results of which may be particularly helpful for clinical management, guidance toward rehabilitation services, and educational/vocational planning.

When Injury Clouds Understanding of Others: Theory of Mind after Mild TBI in Preschool Children.

There is evidence to suggest that social skills, such as the ability to understand the perspective of others (theory of mind), may be affected by childhood traumatic brain injuries; however, studies to date have only considered moderate and severe traumatic brain injury (TBI). This study aimed to assess theory of mind after early, mild TBI (mTBI). Fifty-one children who sustained mTBI between 18 and 60 months were evaluated 6 months post-injury on emotion and desires reasoning and false-belief understanding tasks. Their results were compared to that of 50 typically developing children. The two groups did not differ on baseline characteristics, except for pre- and post-injury externalizing behavior. The mTBI group obtained poorer scores relative to controls on both the emotion and desires task and the false-belief understanding task, even after controlling for pre-injury externalizing behavior. No correlations were found between TBI injury characteristics and theory of mind. This is the first evidence that mTBI in preschool children is associated with theory of mind difficulties. Reduced perspective taking abilities could be linked with the social impairments that have been shown to arise following TBI.

The insular cortex: relationship to skin conductance responses to facial expression of emotion in temporal lobe epilepsy.

The insula plays an important role both in emotion processing and in the generation of epileptic seizures. In the current study we examined thickness of insular cortices and bilateral skin conductance responses (SCR) in healthy subjects in addition to a small number of patients with temporal lobe epilepsy. SCR measures arousal and is used to assess non-conscious responses to emotional stimuli. We used two emotion tasks, one explicitly about emotion and the other implicit. The explicit task required judgments about emotions being expressed in photographs of faces, while the implicit one required judgments about the age of the people in the photographs. Patients and healthy differed in labeling neutral faces, but not other emotions. They also differed in their SCR to emotions, though the profile depended on which hand the recordings were from. Finally, we found relationships between the thickness of the insula and SCR to each task: in the healthy group the thickness of the left insula was related to SCR to the emotion-labeling task; in the patient group it was between the thickness of the right insula and SCR in the age-labeling task. These patterns were evident only for the right hand recordings, thus underscoring the importance of bilateral recordings.

Bilateral skin conductance responses to emotional faces.

Skin conductance responses (SCR) measure objective arousal in response to emotionally-relevant stimuli. Central nervous system influence on SCR is exerted differentially by the two hemispheres. Differences between SCR recordings from the left and right hands may therefore be expected. This study focused on emotionally expressive faces, known to be processed differently by the two hemispheres. Faces depicting neutral, happy, sad, angry, fearful or disgusted expressions were presented in two tasks, one with an explicit emotion judgment and the other with an age judgment. We found stronger responses to sad and happy faces compared with neutral from the left hand during the implicit task, and stronger responses to negative emotions compared with neutral from the right hand during the explicit task. Our results suggest that basic social stimuli generate distinct responses on the two hands, no doubt related to the lateralization of social function in the brain.