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Adequate social functioning during childhood requires context-appropriate social decision-making. To make such decisions, children rely on their social norms, conceptualized as cognitive models of shared expectations. Since social norms are dynamic, children must adapt their models of shared expectations and modify their behavior in line with their social environment. This study aimed to investigate children's abilities to use social information to adapt their fairness norm and to identify the computational mechanism governing this process. Thirty children (7–11 years, M = 7.9 SD = 0.85, 11 girls) played the role of Responder in a modified version of the Ultimatum Game–a two-player game based on the fairness norm–in which they had to choose to accept or reject offers from different Proposers. Norm adaptation was assessed by comparing rejection rates before and after a conditioning block in which children received several low offers. Computational models were compared to test which best explains children's behavior during the game. Mean rejection rate decreased significantly after receiving several low offers suggesting that children have the ability to dynamically update their fairness norm and adapt to changing social environments. Model-based analyses suggest that this process involves the computation of norm-prediction errors. This is the first study on norm adaptation capacities in school-aged children that uses a computational approach. Children use implicit social information to adapt their fairness norm to changing environments and this process appears to be supported by a computational mechanism in which norm-prediction errors are used to update norms. [ABSTRACT FROM AUTHOR]

This study aimed to test a four-wave sequential mediation model linking mother-child attachment to children's school readiness through child executive functioning (EF) and prosociality in toddlerhood and the preschool years. Mother-child attachment security was assessed when children (N = 255) were aged 15 months and 2 years, child EF at age 2, prosocial behavior at age 4, and finally cognitive school readiness in kindergarten (age 6). The results revealed three indirect pathways linking attachment to school readiness: one through EF only, one through prosocial behavior only, and a last pathway involving both EF and prosocial behavior serially. These findings suggest that secure attachment may equip children with both cognitive and social skills that are instrumental to their preparedness for school. [ABSTRACT FROM AUTHOR]

Objective: Concussion in children and adolescents is a prevalent problem with implications for subsequent physical, cognitive, behavioral, and psychological functioning, as well as quality of life. While these consequences warrant attention, most concussed children recover well. This study aimed to determine what pre-injury, demographic, and injury-related factors are associated with optimal outcome ("wellness") after pediatric concussion. Method: A total of 311 children 6–18 years of age with concussion participated in a longitudinal, prospective cohort study. Pre-morbid conditions and acute injury variables, including post-concussive symptoms (PCS) and cognitive screening (Standardized Assessment of Concussion, SAC), were collected in the emergency department, and a neuropsychological assessment was performed at 4 and 12 weeks post-injury. Wellness, defined by the absence of PCS and cognitive inefficiency and the presence of good quality of life, was the main outcome. Stepwise logistic regression was performed using 19 predictor variables. Results: 41.5% and 52.2% of participants were classified as being well at 4 and 12 weeks post-injury, respectively. The final model indicated that children who were younger, who sustained sports/recreational injuries (vs. other types), who did not have a history of developmental problems, and who had better acute working memory (SAC concentration score) were significantly more likely to be well. Conclusions: Determining the variables associated with wellness after pediatric concussion has the potential to clarify which children are likely to show optimal recovery. Future work focusing on wellness and concussion should include appropriate control groups and document more extensively pre-injury and injury-related factors that could additionally contribute to wellness. (JINS , 2019, 25 , 375–389) [ABSTRACT FROM AUTHOR]

Studies examining the associations between adolescent social media use and depression/anxiety symptoms show inconsistent results and do not elucidate the direction of associations. Differences in how studies operationalize social media use and consider potential moderating effects of sex and extraversion could contribute to inconsistencies. A distinction has been made between three types of social media use: passive, active and problematic. This study examined longitudinal associations between these types of adolescents' social media use and depression/anxiety symptoms and moderation effects of sex or extraversion. At ages 13 (T1) and 14 (T2), 257 adolescents completed an online questionnaire regarding their depression and anxiety symptoms and problematic social media use as well as three social media use diaries. Cross-lagged panel modeling (CLPM) revealed a positive association between problematic use and later anxiety symptoms (β =.16, p =.010). Extraversion moderated the association between active use and anxiety (β = -.14, p =.032). Specifically, active use predicted higher subsequent anxiety symptoms only in adolescents with low to moderate levels of extraversion. No sex moderation was found. While social media use (active or problematic) predicted later anxiety symptoms (but not depression), the reverse was not the case. However, highly extraverted individuals seem to be less vulnerable to potential negative effects of social media use. [ABSTRACT FROM AUTHOR]

Pediatric traumatic brain injury (TBI) research depends on comparisons of profiles and outcomes between brain-injured individuals and groups consisting either of injured controls (e.g., orthopedic injuries, OI) or uninjured, typically developing children recruited from the community (community controls, CC). Children with OI are thought to provide optimal comparisons for individuals with TBI because they share injury-related experiences and pre-morbid characteristics; however, a study by Mathias and colleagues (2013)1 in adults has called into question the added value of injury control groups in TBI research. The comparability of these control groups has not been established in young children. Seventy-two children with OI and 84 CC aged between 18 and 60 months were compared on a range of demographic variables, developmental and medical history, pre-injury behavioral and adaptive profiles, as well as on measures of adaptive functioning, behavior, family functioning, post-concussive symptoms, and cognition (intellectual functioning, verbal abilities, executive functioning, social cognition) 6 months after the OI. There were no statistically significant differences between the OI and CC groups on any of the variables tested, whether they related to pre-injury or post-injury characteristics. The findings are applicable to studies seeking to identify appropriate control groups in the context of preschool TBI research, and suggest no clear advantage in recruiting OI controls based on the variables studied and the methodology used. However, further work is necessary to verify additional factors and outcomes relevant to pediatric TBI research, as well as to compare outcomes between these two groups at more acute stages (i.e., prior to 6 months post-injury). [ABSTRACT FROM AUTHOR]

Children with traumatic brain injury (TBI) are at risk for social impairment, but research has yet to document the trajectory of these skills post-injury and factors that may predict social problems. This study addressed these gaps in knowledge, reporting on findings from a prospective, longitudinal follow-up study that investigated social outcomes post-injury and explored factors contributing to these outcomes at two years post-injury. The sample included 113 children, 74 with TBI and 39 typically developing (TD) controls. TBI participants were recruited on presentation to the hospital. Parents rated pre-injury function at that time, and all children underwent magnetic resonance imaging (MRI). Participants were followed up at two years post-injury. Outcomes were social adjustment, social participation, social relationships, and social cognition. Predictors of social outcomes examined included brain lesion characteristics, child cognition (6 months post-TBI), and behavior and environmental factors (pre-injury and two years). Reduced social adjustment ( p = 0.011) and social participation ( p < 0.001) were evident in children with TBI compared with TD controls. Poor social adjustment was predicted by externalizing behavior problems and younger age at injury. Reduced social participation was linked to internalizing behavior problems. Greater lesion volume, lower socioeconomic status, and family burden contributed to poorer social relationships, whereas age at injury predicted social cognition. Within the TBI group, 23% of children exhibited social impairments. Younger age at injury, greater pre-injury, and current behavior problems and family dysfunction, and poorer intelligence quotient (IQ), processing speed, and empathy were linked to impairment. Further follow-up is required to track social recovery and the influences of cognition, brain, and environment over time. [ABSTRACT FROM AUTHOR]

Neuropsychological assessment aims to identify individual performance profiles in multiple domains of cognitive functioning; however, substantial variation exists in how deficits are defined and what cutoffs are used, and there is no universally accepted definition of neuropsychological impairment. The aim of this study was to derive and validate a clinical case definition rule to identify neuropsychological impairment in children and adolescents. An existing normative pediatric sample was used to calculate base rates of abnormal functioning on eight measures covering six domains of neuropsychological functioning. The dataset was analyzed by varying the range of cutoff levels [1, 1.5, and 2 standard deviations (SDs) below the mean] and number of indicators of impairment. The derived rule was evaluated by bootstrap, internal and external clinical validation (orthopedic and traumatic brain injury). Our neuropsychological impairment (NPI) rule was defined as “two or more test scores that fall 1.5 SDs below the mean.” The rule identifies 5.1% of the total sample as impaired in the assessment battery and consistently targets between 3 and 7% of the population as impaired even when age, domains, and number of tests are varied. The NPI rate increases in groups known to exhibit cognitive deficits. The NPI rule provides a psychometrically derived method for interpreting performance across multiple tests and may be used in children 6–18 years. The rule may be useful to clinicians and scientists who wish to establish whether specific individuals or clinical populations present within expected norms versus impaired function across a battery of neuropsychological tests. (JINS, 2015, 21, 596–609) [ABSTRACT FROM AUTHOR]

In light of emerging evidence suggesting that the affective quality of parent-child relationships may relate to individual differences in young children's executive functioning (EF) skills, the aim of this study was to investigate the prospective associations between attachment security in toddlerhood and children's EF skills in kindergarten. Mother-child dyads (N = 105) participated in 2 toddlerhood visits in their homes, when children were 15 months and 2 years of age. Mother-child attachment security was assessed with the Attachment Q-Sort during both these visits. When children were in kindergarten (ages 5-6), they were administered a battery of EF tasks, and their teachers completed the Behavior Rating Inventory of Executive Function to assess children's EF problems. The results indicated that kindergarteners who were more securely attached to their mothers in toddlerhood showed better performance on all EF tasks, and were considered by their teachers to present fewer EF problems in everyday school situations. These results held above family socioeconomic status (SES) and child age, sex, and general cognitive functioning. The fact that early attachment security uniquely predicted both teacher reports and children's objective EF task performance suggests that parent-child attachment may be a promising factor to consider in the continuing search for the social antecedents of young children's EF. [ABSTRACT FROM AUTHOR]

The transition to school is associated with a greater requirement to inhibit irrelevant or inappropriate thought and behavior in order to concentrate on effective learning and to interact successfully with peers. Current knowledge of inhibitory control development in the early school years is limited due to a lack of normative data from age-appropriate, sensitive measures. In this study, three pictorial versions of the Stroop task were administered to investigate inhibitory control development in early school-aged children. Age-related trajectories of inhibition and effects of gender were examined in 80 children (42 boys) aged 5 to 8 years. All children were assessed with the Cognitive Assessment System Expressive Attention subtest (Big-Small Stroop), Fruit Stroop, and Boy-Girl Stroop. The Big-Small Stroop revealed substantial age-related improvement in inhibition from 5 to 7 years with a levelling of performance at 8 years of age, while the Fruit Stroop and Boy-Girl Stroop demonstrated clear but nonsignificant age trends. In particular, older children committed fewer errors and corrected their errors more frequently than younger children. Performance on all Stroop tasks correlated significantly, providing evidence that they tap similar cognitive abilities. Some gender differences were found. This study indicates that inhibitory skills develop rapidly in the early school years and suggests that error awareness may be a useful indicator of the development of cognitive inhibition for this age group. [ABSTRACT FROM AUTHOR]

Fatigue may be among the most profound and debilitating consequences of pediatric traumatic brain injury (TBI); however, neurostructural risk factors associated with post-injury fatigue remain elusive. This prospective study aimed to evaluate the independent value of susceptibility-weighted imaging (SWI) biomarkers, over-and-above known risk factors, to predict fatigue symptom severity in children with TBI. Forty-two children were examined with structural magnetic resonance imaging (sMRI), including a SWI sequence, within eight weeks post-injury. The PedsQL Multi-Dimensional Fatigue Scale (MFS) was administered 24 months post-injury. Compared with population expectations, the TBI group displayed significantly higher levels of general fatigue (Cohen d = 0.44), cognitive fatigue (Cohen d = 0.59), sleep/rest fatigue (Cohen d = 0.37), and total fatigue (Cohen d = 0.63). In multi-variate models adjusted for TBI severity, child demographic factors, and depression, we found that subacute volume of SWI lesions was independently associated with all fatigue symptom domains. The magnitude of the brain-behavior relationship varied by fatigue symptom domain, such that the strongest relationships were observed for the cognitive fatigue and total fatigue symptom scales. Overall, we found that total subacute volume of SWI lesions explained up to 24% additional variance in multi-dimensional fatigue, over-and-above known risk factors. The subacute SWI has potential to improve prediction of post-injury fatigue in children with TBI. Our preliminary findings suggest that volume of SWI lesions may represent a novel, independent biomarker of post-injury fatigue, which could help to identify high-risk children who are likely to benefit from targeted psychoeducation and/or preventive strategies to minimize risk of long-term post-injury fatigue. [ABSTRACT FROM AUTHOR]

This study investigated the prospective links between sleep in infancy and preschoolers' cognitive performance. Mothers of 65 infants completed a sleep diary when infants were aged 1 year, and children completed two subscales of the Wechsler Preschool and Primary Scale of Intelligence at 4 years, indexing general cognitive ability and complex executive functioning. Consistent with hypotheses, children getting higher proportions of their sleep at night as infants were found to perform better on executive functions, but did not show better general cognition. Relations held after controlling for family socioeconomic status and prior cognitive functioning. These findings suggest that the special importance of sleep for higher order cognition, documented among adults, may appear very early in life. [ABSTRACT FROM AUTHOR]

Children with traumatic brain injury (TBI) are at risk for social impairment. This study aimed to examine social function at 6 months post-TBI and to explore the contribution of injury, cognitive, and environmental influences. The sample included 136 children, 93 survivors of TBI, and 43 healthy controls. TBI participants were recruited on admission and underwent magnetic resonance imaging scan within 8 weeks of injury and behavioral assessment at 6 months post-injury. Healthy controls underwent magnetic resonance imaging scans and behavioral assessment on recruitment. Assessment included parent and child questionnaires tapping social outcome and child-direct testing of cognitive abilities important for social competence (communication, attention/executive function, social cognition). Injury characteristics and environmental measures were collected. At 6-months post-injury, social problems were evident, but not global. Social participation appeared most vulnerable, with more severe injuries leading to greater problems. Greater injury severity and poorer communication skills were associated with poorer social adjustment and social participation, with the impact of family function also significant. Processing speed, younger age, and male gender also contributed to social outcomes. Further follow-up is required to track the recovery of social skills and the changing influences of cognition, brain, and environment over time. (JINS, 2013, 19, 1–12) [ABSTRACT FROM PUBLISHER]

Aim: The corpus callosum (CC) can be affected by childhood traumatic brain injury (TBI), through focal lesions, reductions in size and arrested development. Little is known, however, about what constitutes normal CC shape and appearance and how it may be affected in the long-term after early TBI. Methods: In this study, the appearance of the CC was investigated in individuals with TBI assessed 10 years post-injury ( n == 52, mean age == 16.82 years, SD == 3.55 years, 24 male) and compared to age-matched healthy controls ( n == 44, mean age == 15.77 years, SD == 1.21 years, 18 male). A simple visual analysis technique was used to code the appearance of the CC according to location of focal thinning and severity of thinning and results between groups were compared using Chi-square analysis. Results: A significantly higher proportion of patients with childhood TBI had focal posterior thinning of the CC than age-matched controls ( p == 0.001). Conclusions: The findings call into question previous conclusions that focal posterior thinning is a normal variant of development. Instead, attenuations of the posterior portion of the CC in the long-term may reflect altered cortical and callosal development as a result of early brain injury, although the functional significance of this remains to be determined. [ABSTRACT FROM AUTHOR]

Aim: The corpus callosum (CC) can be affected by childhood traumatic brain injury (TBI), through focal lesions, reductions in size and arrested development. Little is known, however, about what constitutes normal CC shape and appearance and how it may be affected in the long-term after early TBI. Methods: In this study, the appearance of the CC was investigated in individuals with TBI assessed 10 years post-injury (n = 52, mean age = 16.82 years, SD = 3.55 years, 24 male) and compared to age-matched healthy controls (n = 44, mean age = 15.77 years, SD = 1.21 years, 18 male). A simple visual analysis technique was used to code the appearance of the CC according to location of focal thinning and severity of thinning and results between groups were compared using Chi-square analysis. Results: A significantly higher proportion of patients with childhood TBI had focal posterior thinning of the CC than age-matched controls (p = 0.001). Conclusions: The findings call into question previous conclusions that focal posterior thinning is a normal variant of development. Instead, attenuations of the posterior portion of the CC in the long-term may reflect altered cortical and callosal development as a result of early brain injury, although the functional significance of this remains to be determined. [ABSTRACT FROM AUTHOR]

Despite significant advances in the field of social neuroscience, much remains to be understood regarding the development and maintenance of social skills across the life span. Few comprehensive models exist that integrate multidisciplinary perspectives and explain the multitude of factors that influence the emergence and expression of social skills. Here, a developmental biopsychosocial model (SOCIAL) is offered that incorporates the biological underpinnings and socio-cognitive skills that underlie social function (attention/executive function, communication, socio-emotional skills), as well as the internal and external (environmental) factors that mediate these skills. The components of the model are discussed in the context of the social brain network and are supported by evidence from 3 conditions known to affect social functioning (autism spectrum disorders, schizophrenia, and traumatic brain injury). This integrative model is intended to provide a theoretical structure for understanding the origins of social dysfunction and the factors that influence the emergence of social skills through childhood and adolescence in both healthy and clinical populations. [ABSTRACT FROM AUTHOR]

• A novel multidimensional intervention for patients with mild traumatic brain injury (mTBI) was developed. • The intervention targets factors that perpetuate post-concussive symptoms after mTBI. • The intervention is based on current best practices management. • This article provides support to develop, replicate and/or implement new interventions. Mild traumatic brain injury (mTBI) is associated with persistent post-concussive symptoms (PCSs) in approximately 15% of cases. These symptoms can be somatic (e.g., headache), cognitive (e.g., forgetfulness, poor attention and concentration capacities), emotional (e.g., anxiety, depression, irritability) and/or sleep-arousal complaints (e.g., fatigue, sleep problems). Although practice guidelines recommend early intervention to prevent and treat PCS, we still lack an effective, standardized, integrative, post-acute intervention based on a sound and validated theoretical model. The purpose of this article is to present the development and theoretical background underpinning a novel intervention for patients with PCSs in the post-acute phase after mTBI (1-3 months post-injury). With a biopsychosocial approach (Hou et al., 2012) and best practice recommendations, we developed a novel multidimensional intervention targeting factors that perpetuate PCSs and that can be changed with the intervention. This individual-session intervention provides practical tools for managing PCSs and is designed to provide psycho-education and reassurance, reinforce individual objectives and promote a return to activities. Each session targets one category of PCSs: Sleep/fatigue, Attention, Anxiety/depressed mood, Memory/Organization (SAAM intervention). The rationale underlying the choices of format and content for the intervention is discussed, as are the associated strengths, limitations, opportunities and challenges. This article could support researchers and clinicians to develop, replicate and/or implement interventions addressing current best practices in mTBI management. [ABSTRACT FROM AUTHOR]

A computerized version of the Tower of London task was used to investigate cognitive skill learning. Thirty-six healthy volunteers were assigned to either a random condition (nonrecurring problems), or to a sequence condition in which, unbeknownst to the subjects, a repeating sequence of three problems was presented. Indices of execution, planning, and total time, as well as number of moves performed, were used to measure behavioural change. Subjects' performance improved in both conditions across blocks of practice. A distinct learning effect related to the repeating sequence was also observed. This suggests that a specific skill that reflects procedural learning of the strategies, rules, and procedures pertaining to repeating problems can develop over and above a more general skill at solving cognitive planning problems with practice. [ABSTRACT FROM AUTHOR]

Studies show robust links between disorganized attachment in infancy and socioemotional maladjustment in childhood. Little is known, however, about the links between disorganized attachment and brain development, and whether attachment-related differences in brain morphology translate into meaningful variations in child socioemotional functioning. This study examined the links between infants' disorganized attachment behaviors toward their mothers, whole-brain regional grey matter volume and thickness, and peer rejection in late childhood. Thirty-three children and their mothers took part in this study. The Strange Situation Procedure was used to assess mother–infant attachment when infants were 18 months old. Magnetic resonance imaging was performed when they were 10 years old to assess cortical thickness and grey matter volumes. Children and teachers reported on peer rejection 1 year later, as an indicator of socioemotional maladjustment. Results indicated that disorganized attachment was not associated with grey matter volumes. However, children who exhibited more disorganized attachment behaviors in infancy had significantly thicker cortices in bilateral middle and superior frontal gyri, and extending to the inferior frontal gyrus, as well as the orbitofrontal and insular cortices in the right hemisphere in late childhood. Moreover, children with thicker cortices in these regions experienced greater peer rejection, as rated by themselves and their teachers. Although preliminary, these results are the first to indicate that disorganized attachment may play a role in cortical thickness development and that changes in cortical thickness are associated with differences in child socioemotional functioning. [ABSTRACT FROM AUTHOR]

Developmental Coordination Disorder (DCD) is a condition characterized by difficulties in motor planning and coordination and affects 5 to 6% of all school-aged children. Children with DCD frequently present with difficulties with academic activities such as handwriting. However, no study to date has comprehensively described mathematical capacity and its potential associated factors in this high-risk group. We aimed to describe the frequency and nature of mathematical difficulties of school-aged children with DCD and to evaluate potential factors associated with mathematical performance. A total of 55 elementary school-aged children with DCD underwent comprehensive standardized assessments of mathematical, visuoperceptual (VP), attentional, visual-motor integration (VMI), and motor skills. The contribution of each factor to mathematical capacity was established using hierarchical multivariate linear regression models. Children with DCD (9.1 ± 1.5 years, 44 males) had lower overall mathematical capacity compared to normative data (−0.59 SD) on the KeyMath 3rd edition, with poorer performance in basic concepts and problem-solving. Thirty-eight percent of the sample performed below the 15th percentile in overall mathematical skills. VP skills were the most important factors associated with most mathematical domains. Thirty-four percent of the variance of overall mathematical capacity was explained by VP skills, inattention, VMI and motor impairments while controlling for household income (F [5,49]=5.029, p <.0001). Children with DCD present with mathematical difficulties in basic concepts and problem-solving, which are partially explained by VP skills. Our findings stress the important of systematically assessing mathematical difficulties children with DCD to ensure they receive the necessary support that leads to academic success. • Children with DCD frequently present with significant mathematical difficulties. • Visuoperceptual skills are strong determinants of overall mathematical capacity in children with DCD. • Children with DCD should be systematically assessed for mathematical difficulties. [ABSTRACT FROM AUTHOR]

Advanced magnetic resonance imaging (MRI) techniques indicate that concussion (i.e., mild traumatic brain injury) disrupts brain structure and function in children. However, the functional connectivity of brain regions within global and local networks (i.e., functional connectome) is poorly understood in pediatric concussion. This prospective, longitudinal study addressed this gap using data from the largest neuroimaging study of pediatric concussion to date to study the functional connectome longitudinally after concussion as compared with mild orthopedic injury (OI). Children and adolescents (n = 967) 8–16.99 years with concussion or mild OI were recruited from pediatric emergency departments within 48 h post-injury. Pre-injury and 1-month post-injury symptom ratings were used to classify concussion with or without persistent symptoms based on reliable change. Subjects completed a post-acute (2–33 days) and chronic (3 or 6 months via random assignment) MRI scan. Graph theory metrics were derived from 918 resting-state functional MRI scans in 585 children (386 concussion/199 OI). Linear mixed-effects modeling was performed to assess group differences over time, correcting for multiple comparisons. Relative to OI, the global clustering coefficient was reduced at 3 months post-injury in older children with concussion and in females with concussion and persistent symptoms. Time post-injury and sex moderated group differences in local (regional) network metrics of several brain regions, including degree centrality, efficiency, and clustering coefficient of the angular gyrus, calcarine fissure, cuneus, and inferior occipital, lingual, middle occipital, post-central, and superior occipital gyrus. Relative to OI, degree centrality and nodal efficiency were reduced post-acutely, and nodal efficiency and clustering coefficient were reduced chronically after concussion (i.e., at 3 and 6 months post-injury in females; at 6 months post-injury in males). Functional network alterations were more robust and widespread chronically as opposed to post-acutely after concussion, and varied by sex, age, and symptom recovery at 1-month post-injury. Local network segregation reductions emerged globally (across the whole brain network) in older children and in females with poor recovery chronically after concussion. Reduced functioning between neighboring regions could negatively disrupt specialized information processing. Local network metric alterations were demonstrated in several posterior regions that are involved in vision and attention after concussion relative to OI. This indicates that functioning of superior parietal and occipital regions could be particularly susceptibile to the effects of concussion. Moreover, those regional alterations were especially apparent at later time periods post-injury, emerging after post-concussive symptoms resolved in most and persisted up to 6 months post-injury, and differed by biological sex. This indicates that neurobiological changes continue to occur up to 6 months after pediatric concussion, although changes emerge earlier in females than in males. Changes could reflect neural compensation mechanisms. [ABSTRACT FROM AUTHOR]

Paediatric acquired brain injury is a life-long condition which impacts on all facets of the individual's lived experience. The existing evidence base continues to expand and new fields of enquiry are established as clinicians and researchers uncover the extent of these impacts. To add to recommendations described in the International Paediatric Brain Injury Society's 2016 paper on post-acute care for children with acquired brain injury and highlight new areas of enquiry. Recommendations were made based on the opinions of a group of experienced international clinicians and researchers who are current or past members of the board of directors of the International Paediatric Brain Injury Society. The importance of each recommendation was agreed upon by means of group consensus. This update gives new consideration to areas of study including injuries which occur in pre-school children, young people in the military, medical referral, young offenders and the use of technology in rehabilitation. [ABSTRACT FROM AUTHOR]

Concussion is commonly characterized by a cascade of neurometabolic changes following injury. Magnetic Resonance Spectroscopy (MRS) can be used to quantify neurometabolites non-invasively. Longitudinal changes in neurometabolites have rarely been studied in pediatric concussion, and fewer studies consider symptoms. This study examines longitudinal changes of neurometabolites in pediatric concussion and associations between neurometabolites and symptom burden. Participants who presented with concussion or orthopedic injury (OI, comparison group) were recruited. The first timepoint for MRS data collection was at a mean of 12 days post-injury (n = 545). Participants were then randomized to 3 (n = 243) or 6 (n = 215) months for MRS follow-up. Parents completed symptom questionnaires to quantify somatic and cognitive symptoms at multiple timepoints following injury. There were no significant changes in neurometabolites over time in the concussion group and neurometabolite trajectories did not differ between asymptomatic concussion, symptomatic concussion, and OI groups. Cross-sectionally, Choline was significantly lower in those with persistent somatic symptoms compared to OI controls at 3 months post-injury. Lower Choline was also significantly associated with higher somatic symptoms. Although overall neurometabolites do not change over time, choline differences that appear at 3 months and is related to somatic symptoms. [ABSTRACT FROM AUTHOR]

Higher psychological resilience is correlated with less severe post-concussion symptoms (PCS) after mild traumatic brain injury (mTBI) in children, but the directional nature of this relationship remains uncertain. Although traditionally regarded as a stable, trait-like construct, resilience may be malleable and potentially influenced by mTBI and post-concussive symptoms. The current study sought to examine the stability of resilience, elucidate the dynamic nature of the resilience-PCS relation, and determine whether resilience-symptom associations are specific to mTBI or applicable to traumatic injury in general. Participants were children aged 8–16.99 years with either mTBI (n = 633) or orthopedic injury (OI; n = 334) recruited to participate in a prospective cohort study after presenting acutely to five Canadian pediatric emergency departments (EDs). Symptoms and psychological resilience were assessed at 1 week, 3 months, and 6 months post-injury. Group differences in resilience over time were examined using a mixed linear model, and associations between resilience and symptoms over time were examined using random intercepts cross-lagged panel modeling (RI-CLPM). The mTBI group reported significantly lower resilience than the OI group, but the difference was significantly larger 1 week post-injury (d = 0.50) than at 3 months (d = 0.08) and 6 months (d = 0.10). Cross-lagged panel models indicated that resilience had both stable and dynamic aspects, and both affected and was affected by PCS, although their association varied by time post-injury, symptom measure, and reporter (parent vs. child). Higher parent-reported cognitive symptom severity at 1 week was significantly associated with higher resilience at 3 months (β = 0.23, p = 0.001). Higher resilience at 3 months was associated with lower levels of parent-reported somatic symptom severity (β = −0.14, p = 0.004) and fewer total symptoms (β = −0.135, p = 0.029) at 6 months. Higher resilience at 3 months was associated with fewer child-reported symptoms at 6 months (β = −0.11, p = 0.030) and, reciprocally, fewer child-reported symptoms at 3 months were associated with higher resilience at 6 months (β = −0.22, p = 0.001). Notably, injury group was not a significant moderator in cross-lagged models, suggesting that resilience-symptom associations are not specific to mTBI. Psychological resilience and symptoms have bidirectional relationships after injury. Interventions designed to foster resilience have the potential to promote recovery after mTBI specifically and injury more generally. [ABSTRACT FROM AUTHOR]

Objective: Socio-emotional skills, including social competence and social cognition, form the basis for robust relationships and wellbeing. Despite their importance, these skills are poorly defined and measured, particularly in children with developmental vulnerabilities. As a consequence, targets for effective management and treatment remain unclear. We aimed to i) phenotype social competence and social cognition in typically developing children (TDC) and in children with neurodevelopmental or mental health disorders (clinical groups) and ii) establish the relationships between these child-direct measures and parent ratings of social competence and behavior. Method: Using a multi-site, cross-sectional study design, we recruited 513 TDC and 136 children with neurodevelopmental (autism spectrum disorder [ASD], attention deficit hyperactivity disorder [ADHD]) or mental health (Anxiety Disorder [ANX]) diagnoses (age range 5–15 years). We administered the Paediatric Evaluation of Emotions, Relationships and Socialisation (PEERS) to children, and parents completed standardised questionnaires rating children's socio-emotional function. Results: Standardised parent questionnaires revealed a global pattern of everyday socio-emotional impairment that was common to all clinical groups, while PEERS identified disorder-specific socio-cognitive profiles for children with ASD, ADHD and ANX. Compared to TDCs, children with ASD demonstrated global socio-cognitive impairment. Children with ADHD were impulsive, demonstrating difficulties managing speed accuracy trade-offs. Children with ANX exhibited slowed social decision-making, but otherwise intact skills. Conclusions: Standardized parent questionnaires of child socio-emotional function reveal differences between children with typical and atypical development, but do not yield disorder-specific, socio-emotional profiles. In contrast, findings from the PEERS objective assessment suggest that that ASD, ADHD and ANX are associated with distinct socio-cognitive phenotypes, to more accurately guide and target management and treatment of impaired social competence. [ABSTRACT FROM AUTHOR]

Mentalizing is defined as the ability to attribute mental states to oneself and others. In the context of parental behavior, parents' tendency to comment on their child's mental activities refers to the concept of mind-mindedness (MM). MM has been positively associated with various developmental outcomes in children, notably their own ability to mentalize, known as theory of mind (ToM). Although parental (MM) and child (ToM) mentalizing have important implications during childhood, their associations with children's neural structures are largely unknown. Among 62 mother-child dyads, maternal MM was rated from free-play sequences when children were aged 1 year, child ToM was assessed using a first-order false-belief task at 4 years of age, and structural MRI images were acquired at 10 years of age. Maternal MM was positively associated with gray matter volumes (GMV) in the dorsal prefrontal cortex and the superior temporal pole. Child ToM abilities were positively associated with GMV in the ventromedial prefrontal cortex. Though cortical regions associated with MM and ToM showed no anatomical overlap, many are functionally connected through a neural network highly involved in self-referential strategies for mentalizing. These findings suggest that MM and ToM may contribute to distinct sub-processes that collectively support social cognition development. [ABSTRACT FROM AUTHOR]

A significant proportion of children and adolescents report psychological distress following concussion, but little is known about the predictors of these problems. The purpose of this study was to examine predictive factors of psychological distress following pediatric concussion. It was hypothesized that the presence of pre-injury psychological distress would be the strongest predictor of psychological distress post-concussion, with other demographic and acute injury factors adding incrementally to prediction. This is a prospective, multi-center cohort. Children and adolescents (6–17 years old; n = 311) who sustained a concussion and were assessed through four pediatric emergency departments. Participants were reassessed at 4-weeks (n = 275) and 12-weeks (n = 190) post-injury. Emergency department (ED) assessment documented injury mechanism, acute symptomatology, acute cognitive functioning, and pre-injury functioning. Psychological distress at 4- and 12-weeks follow-up was categorized as present if one or more psychological scores from the parent-completed measures (Child Behavior Checklist, Strengths and Difficulties Questionnaire) exceeded established cutoffs. The presence of psychological distress at each follow-up was predicted using multi-variable logistic regressions. Psychological distress was reported in 23% of youth at both 4- and 12-weeks post-concussion. A pre-injury diagnosis of anxiety and acutely forgetting recent information were significant predictors of psychological distress at 4 weeks, whereas worse acute orientation assessment in the ED predicted psychological distress at 12 weeks. Nearly one of four youth experienced psychological distress after concussion. Clinicians in acute care settings should screen for the factors (pre-injury anxiety, acute mental status) associated with post-injury psychological distress and consider proactively referring patients for further assistance. [ABSTRACT FROM AUTHOR]

Abstract Childhood and adolescence represent sensitive developmental periods for brain networks implicated in a range of complex skills, including executive functions (EF; inhibitory control, working memory, and cognitive flexibility). As a consequence, these skills may be particularly vulnerable to injuries sustained during these sensitive developmental periods. The present study investigated 1) whether age at injury differentially affects EF 6 months and 2 years after TBI in children aged 5–15 years, and 2) whether the association between brain lesions and EF depend on age at injury. Children with TBI (n = 105) were categorized into four age-at-injury groups based on previous studies and proposed timing of cerebral maturational spurts: early childhood (5–6 years, n = 14), middle childhood (7–9 years, n = 24), late childhood (10–12 years, n = 52), and adolescence (13–15 years, n = 15). EF were assessed with performance-based tasks and a parent-report of everyday EF. TBI patients' EF scores 6 months and 2 years post-injury were compared to those of typically developing (TD) controls (n = 42). Brain lesions were identified using susceptibility weighted imaging (SWI). Results indicated that inhibitory control performance 2 years post-injury was differentially affected by the impact of TBI depending on age at injury. Follow-up analyses did not reveal significant differences within the age groups, preventing drawing strong conclusions regarding the contribution of age at injury to EF outcome after TBI. Tentatively, large effect sizes suggest that vulnerability is most apparent in early childhood and adolescence. Everyday inhibitory control behaviour was worse for children with TBI than TD children across childhood and adolescence at the 2-year assessment. There was no evidence for impairment in working memory or cognitive flexibility after TBI at the group level. Given small group sizes, findings from analyses into correlations between EF and SWI lesions should be interpreted with caution. Extent, number and volume of brain lesions correlated with adolescent everyday EF behaviour 6 months post-injury. Taken together, the results emphasize the need for long-term follow-up after paediatric TBI during sensitive developmental periods given negative outcomes 2-year post injury. Inhibitory control seems to be particular vulnerable to the impact of TBI. Findings of associations between EF and SWI lesions need to be replicated with larger samples. Highlights • Inhibitory control has been established sensitive to (long-term) consequences of TBI. • SWI is associated with parent-reported EF behaviour of adolescents. • Early childhood and adolescence may be vulnerable periods for TBI impact on EF. [ABSTRACT FROM AUTHOR]

Understanding the negative impact of the pandemic on children and adolescents is essential in order to provide proper support and intervention. Nonetheless, surmounting adversity, such as COVID‐19, may also provide positive lessons for youth to overcome the negative consequences of the pandemic and prepare society for future crises. The objective of the current qualitative study was to document the perceived positive aspects identified by children and adolescents during COVID‐19 and how they made sense of their experience. Participants (N = 67, 5–14 years old) were recruited in May and June 2020. Semi‐structured interviews were conducted via a videoconferencing platform. Based on the transcribed and coded interviews, a thematic qualitative analysis was derived utilizing NVivo. Participants' answers were grouped into four main themes and sub‐themes: (1) school changes, (2) bonding time, (3) free time, and (4) technology usage. Analysing youth perspectives on their experience of the COVID‐19 pandemic provides insight into some of the positive changes and lessons that can be gained amidst the overwhelming negative consequences of the pandemic. [ABSTRACT FROM AUTHOR]

Background: Psychosocial deficits, such as emotional, behavioral and social problems, reflect the most common and disabling consequences of pediatric traumatic brain injury (TBI). Their causes and recovery likely differ from physical and cognitive skills, due to disruption to developing brain networks and the influence of the child's environment. Despite increasing recognition of post-injury behavioral and social problems, there exists a paucity of research regarding the incidence of social impairment, and factors predicting risk and resilience in the social domain over time since injury. Methods: Using a prospective, longitudinal design, and a bio-psychosocial framework, we studied children with TBI (n = 107) at baseline (pre-injury function), 6 months, 1 and 2-years post-injury. We assessed intellectual ability, attention/executive function, social cognition, social communication and socio-emotional function. Children underwent structural magnetic resonance imaging (MRI) at 2–8 weeks post-injury. Parents rated their child's socio-emotional function and their own mental health, family function and perceived burden. Results: We distinguished five social recovery profiles, characterized by a complex interplay between environment and pre- and post-TBI factors, with injury factors playing a lesser role. Resilience in social competence was linked to intact family and parent function, intact pre-injury adaptive abilities, post-TBI cognition and social participation. Vulnerability in the social domain was related to poor pre- and post-injury adaptive abilities, greater behavioral concerns, and poorer pre- and post-injury parent health and family function. Conclusions: We identified five distinct social recovery trajectories post-child-TBI, each characterized by a unique biopsychosocial profile, highlighting the importance of comprehensive social assessment and understanding of factors contributing to social impairment, to target resources and interventions to children at highest risk. [ABSTRACT FROM AUTHOR]

Background : Mild traumatic brain injury (mTBI) sustained in early childhood affects the brain at a peak developmental period and may disrupt sensitive stages of skill acquisition, thereby compromising child functioning. However, due to the challenges of collecting non-sedated neuroimaging data in young children, the consequences of mTBI on young children's brains have not been systematically studied. In typically developing preschool children (of age 3–5years), a brief behavioral-play familiarization provides an effective alternative to sedation for acquiring awake magnetic resonance imaging (MRI) in a time- and resource-efficient manner. To date, no study has applied such an approach for acquiring non-sedated MRI in preschool children with mTBI who may present with additional MRI acquisition challenges such as agitation or anxiety. Objective: The present study aimed to compare the effectiveness of a brief behavioral-play familiarization for acquiring non-sedated MRI for research purposes between young children with and without mTBI, and to identify factors associated with successful MRI acquisition. Materials and methods: Preschool children with mTBI (n=13) and typically developing children (n=24) underwent a 15-minutes behavioral-play MRI familiarization followed by a 35-minutes non-sedated MRI protocol. Success rate was compared between groups, MRI quality was assessed quantitatively, and factors predicting success were documented. Results: Among the 37 participants, 15 typically developing children (63%) and 10 mTBI (77%) reached the MRI acquisition success criteria (i.e., completing the two first sequences). The success rate was not significantly different between groups (p=.48; 95% CI [-0.36 14.08]; Cramer's V=.15). The images acquired were of high-quality in 100% (for both groups) of the structural images, and 60% (for both groups) of the diffusion images. Factors associated with success included older child age (Β=0.73, p=.007, exp(B)=3.11, 95% CI [1.36 7.08]) and fewer parental concerns (Β=-1.56, p=.02, exp(Β)=0.21, 95% CI [0.05 0.82]) about the MRI procedure. Conclusion: Using brief behavioral-play familiarization allows acquisition of high-quality non-sedated MRI in young children with mTBI with success rates comparable to those of non-injured peers. [ABSTRACT FROM AUTHOR]

Objectives: To validate the two-factor structure (i.e., cognitive and somatic) of the Health and Behaviour Inventory (HBI), a widely used post-concussive symptom (PCS) rating scale, through factor analyses using bifactor and correlated factor models and by examining measurement invariance (MI). Methods: PCS ratings were obtained from children aged 8–16.99 years, who presented to the emergency department with concussion (n = 565) or orthopedic injury (OI) (n = 289), and their parents, at 10-days, 3-months, and 6-months post-injury. Item-level HBI ratings were analyzed separately for parents and children using exploratory and confirmatory factor analyses (CFAs). Bifactor and correlated models were compared using various fit indices and tested for MI across time post-injury, raters (parent vs. child), and groups (concussion vs. OI). Results: CFAs showed good fit for both a three-factor bifactor model, consisting of a general factor with two subfactors (i.e., cognitive and somatic), and a correlated two-factor model with cognitive and somatic factors, at all time points for both raters. Some results suggested the possibility of a third factor involving fatigue. All models demonstrated strict invariance across raters and time. Group comparisons showed at least strong or strict invariance. Conclusions: The findings support the two symptom dimensions measured by the HBI. The three-factor bifactor model showed the best fit, suggesting that ratings on the HBI also can be captured by a general factor. Both correlated and bifactor models showed substantial MI. The results provide further validation of the HBI, supporting its use in childhood concussion research and clinical practice. [ABSTRACT FROM AUTHOR]

Millions of children sustain a concussion annually. Concussion disrupts cellular signaling and neural pathways within the brain but the resulting metabolic disruptions are not well characterized. Magnetic resonance spectroscopy (MRS) can examine key brain metabolites (e.g., N‐acetyl Aspartate (tNAA), glutamate (Glx), creatine (tCr), choline (tCho), and myo‐Inositol (mI)) to better understand these disruptions. In this study, we used MRS to examine differences in brain metabolites between children and adolescents with concussion versus orthopedic injury. Children and adolescents with concussion (n = 361) or orthopedic injury (OI) (n = 184) aged 8 to 17 years were recruited from five emergency departments across Canada. MRS data were collected from the left dorsolateral prefrontal cortex (L‐DLPFC) using point resolved spectroscopy (PRESS) at 3 T at a mean of 12 days post‐injury (median 10 days post‐injury, range 2–33 days). Univariate analyses for each metabolite found no statistically significant metabolite differences between groups. Within each analysis, several covariates were statistically significant. Follow‐up analyses designed to account for possible confounding factors including age, site, scanner, vendor, time since injury, and tissue type (and interactions as appropriate) did not find any metabolite group differences. In the largest sample of pediatric concussion studied with MRS to date, we found no metabolite differences between concussion and OI groups in the L‐DLPFC. We suggest that at 2 weeks post‐injury in a general pediatric concussion population, brain metabolites in the L‐DLPFC are not specifically affected by brain injury. [ABSTRACT FROM AUTHOR]

Early childhood experiences are considered to influence the strength and effectiveness of neural connections and thus the development of brain connectivity. As one of the most pervasive and potent early relational experiences, parent-child attachment is a prime candidate to account for experience-driven differences in brain development. Yet, knowledge of the effects of parent-child attachment on brain structure in typically developing children is scarce and largely limited to grey matter, whereas caregiving influences on white matter (i.e. neural connections) have seldom been explored. This study examined whether normative variation in mother-child attachment security predicts white matter microstructure in late childhood and explored associations with cognitive-inhibition. Mother-child attachment security was assessed using home observations when children (N = 32, 20 girls) were 15 and 26 months old. White matter microstructure was assessed using diffusion magnetic resonance imaging when children were 10 years old. Child cognitive-inhibition was tested when children were 11 years old. Results revealed a negative association between mother-toddler attachment security and child white matter microstructure organization, which in turn related to better child cognitive-inhibition. While preliminary given the sample size, these findings add to the growing literature that suggests that rich and positive experiences are likely to decelerate brain development. [ABSTRACT FROM AUTHOR]

Recognition of pediatric mental health concerns often depends on assessment by parents, educators, and primary care professionals. Therefore, a psychosocial screening instrument suitable for routine use in schools and primary care is needed. The Pediatric Quality of Life (PedsQL) and the Strengths and Difficulties Questionnaire (SDQ) are widely used for screening but lack adolescent-specific mental health measures. MyHEARTSMAP is an instrument assessing aspects of youth psychosocial health via four domains: Psychiatry, Function, Social, and Youth Health. We evaluated MyHEARTSMAP convergent validity with PedsQL and SDQ among 122 child-parent dyads participating in a larger concussion study. Convergent validity was assessed via correlations: MyHEARTSMAP Psychiatry and Function domains correlated strongly (r ≥ 0.44) and Social domain correlated weakly (r ≤ 0.25) to corresponding PedsQL and SDQ subscales, while Youth Health domain correlated moderately (r ≥ 0.31) to the tools' total scales. In conclusion, MyHEARTSMAP converges with PedsQL and SDQ, and benefits from the inclusion of adolescent-specific psychosocial measures. [ABSTRACT FROM AUTHOR]

Developmental Coordination Disorder (DCD) is a chronic condition affecting motor coordination in daily activities. While motor difficulties are well documented in this population, it is unclear how frequent and to what extent academic activities are affected. This systematic review aims to comprehensively summarize the knowledge regarding the prevalence and extent of academic difficulties in reading, writing and mathematics in school-aged children with DCD. Two independent reviewers analyzed original studies on academic difficulties in school-aged children with DCD. A binary random-effects model was used to calculate the pooled prevalence by academic difficulty. A random-effects model using standardized mean differences (g statistic) was calculated to estimate the extent of the academic difficulties. Twenty-four studies were included. A pooled prevalence of 84% of handwriting difficulties and 89.5% of mathematical difficulties was reported. No pooled prevalence of difficulties could be calculated for the other academic outcomes. Children with DCD present with poorer performance in handwriting legibility (g = −1.312) and speed (g = −0.931), writing (g = −0.859), mathematics (g = −1.199) and reading (g = −1.193). This review highlights the high frequency and severity of academic difficulties in children with DCD, specifically in mathematics, which stresses the importance of evaluating academic performance to target interventions to support optimal functioning in daily life. [ABSTRACT FROM AUTHOR]

Mild traumatic brain injuries (mTBI) are highly prevalent during early childhood and can lead to behavioral difficulties. Parent report questionnaires are widely used to assess children's behavior, but they are subject to parental bias. The aim of this study was to investigate parental discrepancies in internalized and externalized behavior ratings of children who sustain mTBI in early childhood (i.e., between 18 and 60 months) and to determine if parenting stress or family burden related to the injury contribute to parental discrepancies. Mothers and fathers of 85 children with mTBI, 58 orthopedic injured (OI), and 82 typically developing children (TDC) completed the Child Behavior Checklist 6 months after the injury. The primary caregiver completed the Parental Distress subscale of the Parenting Stress Index and the Family Burden of Injury Interview. Mothers reported more internalized and externalized behavior problems than fathers in the mTBI group. No group difference was found in the OI or TDC groups. Neither parenting stress nor family burden related to the injury predicted discrepancies in behavior ratings. Mothers' and fathers' perceptions of behavior after their young child sustains mTBI appear to differ, suggesting that both parents' views are useful in understanding outcome. This difference was not found in either of the comparison groups indicating that factors related to mTBI may underlie the rating discrepancies. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the association between early screen time (7-10 days postinjury) and postconcussion symptom severity in children and adolescents with concussion, as compared to those with orthopedic injury (OI). METHODS: This was a planned secondary analysis of a prospective longitudinal cohort study. Participants were 633 children and adolescents with acute concussion and 334 with OI aged 8 to 16, recruited from 5 Canadian pediatric emergency departments. Postconcussion symptoms were measured using the Health and Behavior Inventory at 7 to 10 days, weekly for 3 months, and biweekly from 3 to 6 months postinjury. Screen time was measured by using the Healthy Lifestyle Behavior Questionnaire. Generalized least squares models were fit for 4 Health and Behavior Inventory outcomes (self- and parent-reported cognitive and somatic symptoms), with predictors including screen time, covariates associated with concussion recovery, and 2 3-way interactions (self- and parent-reported screen time with group and time postinjury). RESULTS: Screen time was a significant but nonlinear moderator of group differences in postconcussion symptom severity for parent-reported somatic (P = .01) and self-reported cognitive symptoms (P = .03). Low and high screen time were both associated with relatively more severe symptoms in the concussion group compared to the OI group during the first 30 days postinjury but not after 30 days. Other risk factors and health behaviors had stronger associations with symptom severity than screen time. CONCLUSIONS: The association of early screen time with postconcussion symptoms is not linear. Recommending moderation in screen time may be the best approach to clinical management. [ABSTRACT FROM AUTHOR]

Background: Good quality friendships and relationships are critical to the development of social competence and are associated with quality of life and mental health in childhood and adolescence. Through social distancing and isolation restrictions, the COVID‐19 pandemic has had an impact on the way in which youth socialize and communicate with friends, peers, teachers and family on a daily basis. In order to understand children's social functioning during the pandemic, it is essential to gather information on their experiences and perceptions concerning the social changes unique to this period. The objective of this study was to document children and adolescents' perspectives regarding their social life and friendships during the COVID‐19 pandemic, through qualitative interviews. Methods: Participants (N = 67, 5–14 years) were recruited in May and June 2020. Semi‐structured interviews were conducted via a videoconferencing platform. A thematic qualitative analysis was conducted based on the transcribed and coded interviews (NVivo). Results: The upheavals related to the pandemic provoked reflection among the participants according to three main themes, each of which included sub‐themes: (1) the irreplaceable nature of friendship, (2) the unsuspected benefits of school for socialization and (3) the limits and possibilities of virtual socialization. Conclusions: The collection of rich, qualitative information on the perspectives of children and adolescents provides a deeper understanding of the consequences of the pandemic on their socialization and psychological health and contributes to our fundamental understanding of social competence in childhood. [ABSTRACT FROM AUTHOR]

Sociomoral reasoning (SMR) is an essential component of social functioning allowing children to establish judgments based on moral criteria. The progressive emergence and complexification of SMR during childhood is thought to be underpinned by a range of characteristics and abilities present in the preschool years. Past studies have mostly examined concurrent associations between individual factors and SMR. Using a more comprehensive and predictive approach to identify early predictors of school-age SMR would contribute to a more complete picture of SMR development. This study aimed to investigate the contribution of four domains of preschool predictors to SMR at school-age: demographic (age, sex, parental education), cognitive (executive and sociocognitive functions), behavioral (internalizing and externalizing behaviors), and familial (parent–child interactions, parental stress) factors. Parents of 122 children 3 to 5 years (M = 3.70, SD = 0.66 years, 51% girls) completed questionnaires and children were administered executive and sociocognitive tasks. Parent–child interactions were assessed using an observational approach. SMR was measured four years later using the SoMoral task. A four-step hierarchical regression analysis revealed that executive functions and internalizing problems were significant independent predictors of SMR. These findings provide a more comprehensive understanding of the early precursors of SMR during childhood. [ABSTRACT FROM AUTHOR]

In the largest sample studied to date, white matter microstructural trajectories and their relation to persistent symptoms were examined after pediatric mild traumatic brain injury (mTBI). This prospective, longitudinal cohort study recruited children aged 8–16.99 years with mTBI or mild orthopedic injury (OI) from five pediatric emergency departments. Children's pre‐injury and 1‐month post‐injury symptom ratings were used to classify mTBI with or without persistent symptoms. Children completed diffusion‐weighted imaging at post‐acute (2–33 days post‐injury) and chronic (3 or 6 months via random assignment) post‐injury assessments. Mean diffusivity (MD) and fractional anisotropy (FA) were derived for 18 white matter tracts in 560 children (362 mTBI/198 OI), 407 with longitudinal data. Superior longitudinal fasciculus FA was higher in mTBI without persistent symptoms relative to OI, d (95% confidence interval) = 0.31 to 0.37 (0.02, 0.68), across time. In younger children, MD of the anterior thalamic radiations was higher in mTBI with persistent symptoms relative to both mTBI without persistent symptoms, 1.43 (0.59, 2.27), and OI, 1.94 (1.07, 2.81). MD of the arcuate fasciculus, −0.58 (−1.04, −0.11), and superior longitudinal fasciculus, −0.49 (−0.90, −0.09) was lower in mTBI without persistent symptoms relative to OI at 6 months post‐injury. White matter microstructural changes suggesting neuroinflammation and axonal swelling occurred chronically and continued 6 months post injury in children with mTBI, especially in younger children with persistent symptoms, relative to OI. White matter microstructure appears more organized in children without persistent symptoms, consistent with their better clinical outcomes. [ABSTRACT FROM AUTHOR]

Sophisticated network‐based approaches such as structural connectomics may help to detect a biomarker of mild traumatic brain injury (mTBI) in children. This study compared the structural connectome of children with mTBI or mild orthopedic injury (OI) to that of typically developing (TD) children. Children aged 8–16.99 years with mTBI (n = 83) or OI (n = 37) were recruited from the emergency department and completed 3T diffusion MRI 2–20 days postinjury. TD children (n = 39) were recruited from the community and completed diffusion MRI. Graph theory metrics were calculated for the binarized average fractional anisotropy among 90 regions. Multivariable linear regression and linear mixed effects models were used to compare groups, with covariates age, hemisphere, and sex, correcting for multiple comparisons. The two injury groups did not differ on graph theory metrics, but both differed from TD children in global metrics (local network efficiency: TD > OI, mTBI, d = 0.49; clustering coefficient: TD < OI, mTBI, d = 0.49) and regional metrics for the fusiform gyrus (lower degree centrality and nodal efficiency: TD > OI, mTBI, d = 0.80 to 0.96; characteristic path length: TD < OI, mTBI, d = −0.75 to −0.90) and in the superior and middle orbital frontal gyrus, paracentral lobule, insula, and thalamus (clustering coefficient: TD > OI, mTBI, d = 0.66 to 0.68). Both mTBI and OI demonstrated reduced global and regional network efficiency and segregation as compared to TD children. Findings suggest a general effect of childhood injury that could reflect pre‐ and postinjury factors that can alter brain structure. An OI group provides a more conservative comparison group than TD children for structural neuroimaging research in pediatric mTBI. [ABSTRACT FROM AUTHOR]

The relationship between brain injury and attentional control (AC) long after a childhood traumatic brain injury (TBI) has received limited investigation. The aim of this article was to investigate the impact that lesion presence, location, and severity has on AC in a group of young persons who had sustained a moderate to severe TBI 10 years earlier during childhood. The participants in this study were a subset of a larger 10-year, follow-up assessment comprised of 31 persons in late adolescence and early adulthood (21 males), with a mean age at testing of 15.4 years (standard error 0.6; range 10.7-21.2 years). Analyses revealed that in regard to AC abilities, the presence of a lesion(s) appears to have a differential effect depending on the testing measure used. When using standardized testing with subtests of the TEA-ch, no differences in performance between those with and those without a lesion at 10 years post-TBI were found. On standardized behavioral measures such as parental reports of perceived AC (Behavior Rating Inventory of Executive Function), however, the presence of a lesion was found to have a detrimental effect on the ability to self-regulate and monitor behavior in late adolescence and the early stages of adulthood. We discuss these results and propose that there is a network of brain regions associated with AC, and generalized lesions have the greatest influence on such abilities. [ABSTRACT FROM AUTHOR]

To assess social skills, professionals require a tool that is grounded in science, age-appropriate and sensitive to deviations from normal expectations. The Paediatric Evaluation of Emotions, Relationships and Socialisation Questionnaire (PEERS-Q) was developed to address this gap. This study aimed to detail the psychometric properties of PEERS-Q. 571 parents of children aged 5-15 years completed questionnaires about their child's social competence (PEERS-Q, Social Skills Improvement System (SSIS), Strengths and Difficulties Questionnaire (SDQ)). Children completed a measure of estimated IQ. Confirmatory factor analysis explored reliability and validity of PEERS-Q. Age- and sex-adjusted T-scores were derived and relationships between these and validation instruments were explored. Six subscales were derived; Relationships, Participation, Social Rules, Social Communication, Social Cognition and Behaviour. PEERS-Q has good to very good internal consistency (α = 0.89, subscales 0.78-0.95); good convergent validity with the SSIS and the SDQ (r = 0.76, subscales 0.47 to 0.59), and good discriminant validity using Matrix Reasoning (r = – 0.11, subscales – 0.08 to – 0.11). PEERS-Q is a useful tool for measuring domains of social competence in children/adolescents. PEERS-Q may improve a clinician's ability to identify a young person's social difficulties and hence guide intervention. Further research in clinical populations is required to determine these benefits. KEY POINTS What is already known about this topic: (1) There is currently a lack of robust and developmentally appropriate social skills assessment tools for children and adolescents. (2) Exisiting measures either fail to assess the complexity of social function, or are included as smaller sub-scales of broader outcome measures. (3) Without valid and reliable measures that target the specific subdomains of social skills, interventions cannot be targeted to specific social skills strengths and weaknesses. What this topic adds: (1) The PEERS-Q is a new tool for measuring social skills in children, grounded in developmental neuroscience. (2) PEERS-Q is a valid and reliable measure. (3) PEERS-Q may improve a clinician's ability to identify a young person's social difficulties and tailor the type of intervention required. [ABSTRACT FROM AUTHOR]

Recently, there has been a surge of interest and research in social functioning throughout childhood and adolescence, and how social development is affected by acquired brain injury (ABI). Despite ongoing research and theoretical advances, there remains a lack of specific, relevant and robust measurement tools that draw upon current clinical and social neuroscience knowledge, and which are developmental in nature, to assess social competence within the nonclinical and the ABI population. The aim of the current project was to develop a questionnaire to measure social competence and the quality of relationships of children and adolescents between the ages of 5 and 18 years. This questionnaire, the Developmental Assessment of Social Competence (DASC), also aimed to be sensitive to the specific social problems often associated with children who have suffered ABI. The current article outlines the process and challenges faced in developing such a measure up to the initial pilot stage. Participants included a pilot group of 40 parents who completed the pilot questionnaire, as well as an established questionnaire that assesses social functioning. Parents rated their own children who were aged between 6 and 14 years, and who were within the nonclinical population. Preliminary analyses found that the children generally scored highly on the DASC, and that a higher score on most scales of the DASC tended to be associated with a higher score on an established questionnaire measuring social skills. These data are promising, and provide important information for the following stages of development and evaluation of this new questionnaire. [ABSTRACT FROM AUTHOR]

Objective: The study sought to present normative and psychometric data and reliable change formulas for the Health and Behavior Inventory (HBI), a postconcussive symptom rating scale embedded in the Child Sport Concussion Assessment Tool 5th edition (Child SCAT5). Design: Prospective cohort study with longitudinal follow-up. Setting: Pediatric emergency departments (EDs). Participants: As part of 3 studies conducted in the United States and Canada between 2001 and 2019,450 children aged 8 to 16 years with mild orthopedic injuries were recruited during ED visits and assessed postacutely (M = 9.38 days, SD = 3.31) and 1 month and 3 months postinjury. Independent variables were rater (child vs parent), sex, and age at injury. Main Outcome Measure: HBI ratings. Methods: Children and parents rated children's symptoms at each time point; parents also rated children's preinjury symptoms retrospectively. Normative data (mean, SD, skewness, kurtosis, and percentiles) were computed for child and parent ratings. Internal consistency was assessed using Cronbach alpha (a), and test-retest reliability and interrater agreement were assessed with intraclass correlations (ICCs). Reliable change formulas were computed using linear regression and mixed models. Results: HBI ratings were positively skewed. Mean ratings and percentiles were stable overtime. Child and parent ratings demonstrated good-to-excellent internal consistency (a 0.76-0.94) and moderate-to-good test-retest reliability (ICC 0.51-0.76 between adjacent assessments). However, parent-child agreement was poor to moderate (ICC 0.31-0.69). Conclusions: The HBI demonstrates acceptable normative and psychometric characteristics. Modest parent-child agreement highlights the importance of multiple informants when assessing postconcussive symptoms. The results will facilitate the use of the HBI in research and clinical practice. [ABSTRACT FROM AUTHOR]

The identification of children with traumatic brain injury (TBI) who are at risk of death or poor global neurological functional outcome remains a challenge. Magnetic resonance imaging (MRI) can detect several brain pathologies that are a result of TBI; however, the types and locations of pathology that are the most predictive remain to be determined. Forty-two critically ill children with TBI were recruited prospectively from pediatric intensive care units at five Canadian children's hospitals. Pathologies detected on subacute phase MRIs included cerebral hematoma, herniation, cerebral laceration, cerebral edema, midline shift, and the presence and location of cerebral contusion or diffuse axonal injury (DAI) in 28 regions of interest were assessed. Global functional outcome or death more than 12 months post-injury was assessed using the Pediatric Cerebral Performance Category score. Linear modeling was employed to evaluate the utility of an MRI composite score for predicting long-term global neurological function or death after injury, and nonlinear Random Forest modeling was used to identify which MRI features have the most predictive utility. A linear predictive model of favorable versus unfavorable long-term outcomes was significantly improved when an MRI composite score was added to clinical variables. Nonlinear Random Forest modeling identified five MRI variables as stable predictors of poor outcomes: presence of herniation, DAI in the parietal lobe, DAI in the subcortical white matter, DAI in the posterior corpus callosum, and cerebral contusion in the anterior temporal lobe. Clinical MRI has prognostic value to identify children with TBI at risk of long-term unfavorable outcomes. [ABSTRACT FROM AUTHOR]

Background: Despite increasing evidence of a link between early life brain injury and anti‐social behavior, very few studies have assessed factors that explain this association in children with traumatic brain injury (TBI). One hypothesis suggests that childhood TBI elevates risk for anti‐social behavior via disruption to anatomically distributed neural networks implicated in executive functioning (EF). In this longitudinal prospective study, we employed high‐resolution structural neuroimaging to (a) evaluate the impact of childhood TBI on regional morphometry of the central executive network (CEN) and (b) evaluate the prediction that lower EF mediates the prospective relationship between structural differences within the CEN and postinjury anti‐social behaviors. Methods: This study involved 155 children, including 112 consecutively recruited, hospital‐confirmed cases of mild‐severe TBI and 43 typically developing control (TDC) children. T1‐weighted brain magnetic resonance imaging (MRI) sequences were acquired sub‐acutely in a subset of 137 children [TBI: n = 103; TDC: n = 34]. All participants were evaluated using direct assessment of EF 6 months postinjury, and parents provided ratings of anti‐social behavior 12 months postinjury. Results: Severe TBI was associated with postinjury volumetric differences within the CEN and its putative hub regions. When compared with TD controls, the TBI group had significantly worse EF, which was associated with more frequent anti‐social behaviors and abnormal CEN morphometry. Mediation analysis indicated that reduced EF mediated the prospective association between postinjury volumetric differences within the CEN and more frequent anti‐social behavior. Conclusions: Our longitudinal prospective findings suggest that detection of neurostructural abnormalities within the CEN may aid in the early identification of children at elevated risk for postinjury executive dysfunction, which may in turn contribute to chronic anti‐social behaviors after early life brain injury. Findings underscore the potential value of early surveillance and preventive measures for children presenting with neurostructural and/or neurocognitive risk factors. [ABSTRACT FROM AUTHOR]

Social skills are the basis of human interactions and functioning in society. Social competence (SC) is thought to evolve gradually during childhood and adolescence via the interplay of multiple factors. In particular, the early years of life are marked by the emergence of basic social abilities and constitute the foundation for successful social development. The biopsychosocial SOcio‐Cognitive Integration of Abilities modeL (SOCIAL) posits that internal (child‐based), external (environment), and cognitive factors are critical to SC in the context of normal brain maturation; but this has yet to be shown empirically and comprehensively. This study tested the SOCIAL model in a sample of typically developing preschool children. Parents of 103 children (M = 67.59 months, SD = 11.65) completed questionnaires and children underwent neuropsychological assessment of executive functioning (EF), communication skills and social cognition. Three‐step hierarchical regression analyses (1) Internal factors, 2) External factors, 3) Cognitive factors) confirmed that each step of the regression model significantly predicted SC. In the final model, general cognitive and socio‐cognitive factors significantly predicted SC above and beyond internal and external factors: children with lower temperamental negative affect and less parent‐reported executive dysfunction, as well as better non‐verbal communication and theory of mind had better SC. Our findings support the conceptual SOCIAL model, and highlight the importance of internal, external, and cognitive factors for SC in the preschool years. Identification of factors associated with early social development can inform both normative and clinical approaches to identifying intervention loci and optimizing SC in those at risk for maladaptive social functioning. [ABSTRACT FROM AUTHOR]

Despite many children experiencing fatigue after childhood brain injury, little is known about the predictors of this complaint. To date, traditional indices of traumatic brain injury (TBI) severity have not predicted reliably persisting fatigue (up to three years post-injury). This study aimed to establish whether persisting fatigue is predicted by serum biomarker concentrations in child TBI. We examined whether acute serum biomarker expression would improve prediction models of 12-month fatigue based on injury severity. Blood samples were collected from 87 children (1–17 years at injury) sustaining mild to severe TBI (Glasgow Coma Scale [GCS] range 3–15; mean 12.43; classified as mild TBI [n = 50, 57%] vs. moderate/severe TBI [n = 37, 43%]), and presenting to the emergency departments (ED) and pediatric intensive care units (PICU) at one of three tertiary pediatric hospitals (Royal Children's Hospital (RCH); Hospital for Sick Children (HSC), Toronto; St Justine Children's Hospital (SJH), Montreal). Six serum biomarker concentrations were measured within 24 h of injury (interleukin-6, interleukin-8 [IL-8], soluble vascular cell adhesion molecule [SVCAM], S100 calcium binding protein B [S100B], neuron specific enolase [NSE], and soluble neural cell adhesion molecule [sNCAM]). Fatigue at 12 months post-injury was measured using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (parent report), classified as present/absent using previously derived cut-points. At 12 months post-injury, 22% of participants experienced fatigue. A model including IL-8 was the best serum biomarker for estimating the probability of children experiencing fatigue at 12 months post-injury. The IL-8 also significantly improved predictive models of fatigue based on severity. [ABSTRACT FROM AUTHOR]