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Objectives: People may experience a myriad of symptoms after mild traumatic brain injury (mTBI), but the relationship between symptoms and objective assessments is poorly characterized. This study sought to investigate the association between symptoms, resting heart rate (HR), and exercise tolerance in individuals following mTBI, with a secondary aim to examine the relationship between symptom-based clinical profiles and recovery. Methods: Prospective observational study of adults aged 18 to 65 years who had sustained mTBI within the previous 7 days. Symptoms were assessed using the Post-Concussion Symptom Scale, HR was measured at rest, and exercise tolerance was assessed using the Buffalo Concussion Bike Test. Symptom burden and symptom-based clinical profiles were examined with respect to exercise tolerance and resting HR. Results: Data from 32 participants were assessed (mean age 36.5 ± 12.6 years, 41% female, 5.7 ± 1.1 days since injury). Symptom burden (number of symptoms and symptom severity) was significantly associated with exercise intolerance (P = .002 and P = .025, respectively). Physiological and vestibular-ocular clinical profile composite groups were associated with exercise tolerance (P = .001 and P = .014, respectively), with individuals who were exercise intolerant having a higher mean number of symptoms in each profile than those who were exercise tolerant. Mood-related and autonomic clinical profiles were associated with a higher resting HR (>80 bpm) (P = .048 and P = .028, respectively), suggesting altered autonomic response for participants with symptoms relating to this profile. After adjusting for age and mechanism of injury (sports- or non–sports-related), having a higher mood-related clinical profile was associated with persisting symptoms at 3 months postinjury (adjusted odds ratio = 2.08; 95% CI, 1.11-3.90; P = .013). Conclusion: Symptom-based clinical profiles, in conjunction with objective measures such as resting HR and exercise tolerance, are important components of clinical care for those having sustained mTBI. These results provide preliminary support for the concept that specific symptoms are indicative of autonomic dysfunction following mTBI. [ABSTRACT FROM AUTHOR]

Siblings of individuals with neurodevelopmental conditions (NDCs) experience distinct challenges and have unique strengths compared to siblings of individuals without NDCs. The present study examined attributes and aspirations of siblings of individuals with and without neurodevelopmental conditions, and analyzed the association between qualitative responses and quantitative measures of growth mindset, positive and negative valence, and mental health diagnoses. A novel mixed methods thematic analysis was employed to explore the experiences of 166 siblings (75 NDC and 91 controls, aged 14–26, 66.27% female) completing an online survey as part of a larger study on sibling mental health. The overarching theme described The Process of Self‐Actualization and Integration, reflecting the journey siblings undergo in seeking to understand themselves and others amidst psychological challenges. It encompassed three subthemes: Personal Growth and Identity Formation; Connection and Belonginess; and Societal Perspective and Global Consciousness. Qualitative responses were analyzed within a Research Domain Criteria (RDoC) framework, and associations between phenomenology and mental health diagnoses examined. NDC siblings had higher negative valence and lower positive valence embedded in their responses, and quantitatively lower self‐reported growth mindset (i.e., beliefs about the capacity for personal growth), compared to control siblings, which correlated with self‐reported mental health diagnoses. Findings suggest clinical practice may focus on optimizing self‐identified strengths and offer opportunities for self‐actualization of hopes and ambitions, while providing support for families to attenuate bioecological factors impacting mental health. [ABSTRACT FROM AUTHOR]

Siblings of individuals with neurodevelopmental conditions (NDCs) are situated within a complex system of risk and resilience factors for poor outcomes, many of which overlap with the risk of traumatic brain injury (TBI) and correlate with poorer recovery trajectories. This study used Bayesian analyses to characterize and compare TBI and biopsychosocial risk factors among 632 siblings (207 NDC, 425 controls; mean age 20.54 years, range 10–30, 78.48% female). NDC siblings had a higher self-reported lifetime history of TBI compared to controls (14.98% versus 6.35%), with most reporting more than one TBI, and at an earlier age. TBI history was associated with psychiatric diagnoses and subclinical NDC features. Family and structural factors related to TBI included poorer parent-child relationship, NDC diagnoses of autism or fetal alcohol spectrum disorder, minority ethnicity, and lower income. Findings have implications for health literacy, TBI education and screening, and implementation of family support. [ABSTRACT FROM AUTHOR]

Background/Aims: Youth with prenatal alcohol exposure (PAE) are under‐recognised in the justice system, warranting improved identification. This study aimed to compare neuropsychological profiles of adolescents, with and without PAE and identify neuropsychological tasks predictive of PAE‐group membership. It was hypothesised that participants with PAE would score significantly lower on neuropsychological tests. Methods: Participants included 85 young people sentenced to detention (mean 15.7 years, 78 males), 46 with PAE. A one‐way‐multivariate analysis of variance tested differences in neuropsychological functioning between PAE/No‐PAE groups, while logistic regression determined tests predictive of PAE. Results: No statistically significant difference in test scores emerged between groups, and regression was not indicative of any models predictive of PAE‐group membership. Neuropsychological profiles were characterised by both strengths and weaknesses, with lower verbal and mathematical skills. Conclusion(s): While no statistically significant differences were found between the groups, the results provided a unique insight into the neurocognitive profile of Australian youth in detention. Routine screening assessments were recommended for young people sentenced to detention. [ABSTRACT FROM AUTHOR]

Emotional disorders are pervasive in the acquired brain injury (ABI) population, adversely affecting quality of life and rehabilitation. This study aimed to explore the unique associative effects of alexithymia as measured by the Perth Alexithymia Questionnaire (PAQ; i.e., difficulty identifying positive/negative feelings, difficulty describing positive/negative feelings, and externally orientated thinking), on emotional outcomes as measured by the Depression Anxiety Stress Scale-21 (DASS-21) and Mayo-Portland Adaptability Inventory (MPAI-4) Adjustment index, in 83 adults with ABI. The addition of alexithymia to hierarchical multiple regression models (controlling for demographic, injury-related, and functional outcome variables) yielded statistically significant changes in R2 for all emotional outcome measures (i.e., Depression, Anxiety, Stress, and Adjustment). Difficulty identifying negative feelings was found to be a significant unique predictor of Depression (β =.43 p = <.001), Anxiety (β =.40, p <.001), Stress (β =.49, p <.001), and Adjustment (β =.26, p =.001). Externally oriented thinking was found to be a significant unique predictor of Adjustment (β = -.15, p =.033). These findings strengthen the argument that alexithymia, especially difficulties identifying negative feelings, may be an important risk factor for psychological distress in ABI and should be considered during early rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience sleep difficulties such as difficulty initiating and maintaining sleep. Problem sleep may impact children's daily functioning and behaviors and exacerbate ADHD symptoms. Most effective behavioral interventions to improve sleep are conducted in person, limiting accessibility to treatment for individuals in remote or rural communities or those who are unable to attend a clinic. This trial aims to assess the efficacy of delivering an established behavioral intervention online, Sleeping Sound with ADHD©, compared to a face-to-face delivery mode. Methods: This parallel group, non-inferiority, randomized controlled trial (RCT) will include at least 68 children, aged 5–12 years old with ADHD. Families of children will be recruited from private developmental and psychological clinics and social media, within the state of Western Australia (WA). Once written informed consent and baseline questionnaires are completed, families are randomized to receive the behavioral intervention either in-person or online via Telehealth services. The intervention targets the assessment and management of reported sleep problems, through two individual consultations and a follow-up phone call with a trained clinician. The sleep outcomes assessed consist of a parent-reported sleep questionnaire and actigraphy. Discussion: To the best of our knowledge, this is the first RCT to investigate sleep treatment modality for children with ADHD. If effective, clinicians can provide an evidence-based sleep intervention in an accessible manner. Trial registration: ANZCTR, ACTRN12621001681842. Registered 9 December 2021—Retrospectively registered. [ABSTRACT FROM AUTHOR]

Patches Paediatrics is a specialised private multidisciplinary service in Western Australia (WA), offering a range of developmental diagnostic assessments such as foetal alcohol spectrum disorder (FASD). Many FASD assessments occur in children and youth who are engaged with the justice system in WA and the Northern Territory (NT). There are currently no studies outlining the types of clinical recommendations and management strategies made or implemented by clinicians for this clinical population within Australia. This study outlines therapeutic recommendations made as part of the youth justice FASD diagnostic process within Patches Paediatrics to ultimately refine recommendations to inform therapeutic strategies. This was a retrospective cross-sectional descriptive study of those aged 10 years to 17 years 11 months (N = 64) who were diagnosed with FASD within Patches Paediatrics; and referred from the youth justice system in WA and the NT between January 2017 and February 2019. Information on FASD recommendations was gathered by reviewing participants' source documents, such as FASD diagnostic reports. 'FASD recommendations' categories were divided into subdomains: medical, mental health, developmental, lifestyle, future goals and others. In the various categories of recommendations, the most prominent were referral for National Disability Insurance Scheme (NDIS) funding (75%) followed by education support (67.2%), occupational therapy (56.3%), and drug and alcohol services (45.3%). Significant correlations between impaired neurocognitive domains and recommendations were also observed. Similarly, there were significant correlations between comorbidities and recommendations. Our study highlighted gaps in recommendations for those with comorbid attention-deficit/hyperactivity disorder (ADHD), rural communities and access to NDIS, therapeutic rehabilitation programmes as well as community work programmes. Other gaps included making adequate recommendations for speech/language therapy, education support, life skills advice and staff/clinician education. This study was the first to describe therapeutic recommendations for the youth cohort assessed by Patches Paediatrics in WA and the NT. It also showed significant correlations between the neurocognitive/comorbidity profile and clinical recommendations. This highlights areas within the recommendations that can be individualised as well as ways to improve community integration. A discussion of limitations and suggestions for future research is also provided. [ABSTRACT FROM AUTHOR]

Objectives: A key feature of blood‐injection‐injury (BII) phobia is activation of disgust responses, in addition to fear. Yet, standard treatments have largely neglected addressing disgust responses. The disorder is further complicated by fainting in 75% of sufferers. Moreover, treatments have been traditionally delivered in an individual format, which may not be as efficient as group treatment. The aim of this study was to develop a group‐based programme for BII phobia, with components targeting fear, disgust, and fainting, to determine feasibility and effectiveness of such an intervention. Methods: Participants took part in an 8‐session, group‐based Cognitive Behavioural Therapy (CBT) programme for BII phobia (N = 40). The key outcome measure was the Multidimensional Blood/Injury Phobia Inventory, which assesses a range of phobic stimuli and responses (including fear, disgust, and fainting). Results: There were significant improvements, with large effect sizes, across symptoms over the course of treatment. Participants with higher disgust sensitivity reported higher pre‐treatment symptom severity and greater life interference than those with lower disgust scores. Despite this, neither pre‐treatment disgust sensitivity nor fainting history impacted on treatment response. For the first time, however, we showed that greater reductions in disgust to BII stimuli were associated with greater overall symptom reductions, highlighting the importance of disgust in the treatment of this disorder, and potentially others. Conclusion: Despite the heterogeneous nature of BII phobia, this group‐based, modified CBT intervention was effective in reducing a variety of phobic responses, including fear, disgust, and fainting. Practitioner points: Disgust is a key maintaining factor in blood‐injection‐injury phobia, which clinicians should consider in their assessment and treatment of this disorder. There is little in the existing literature to guide clinicians in this regard.This study examined a novel group treatment for blood‐injection‐injury phobia which included strategies to target disgust, in addition to traditional CBT strategies to address fear and fainting.The treatment was feasible and acceptable. Symptoms of fear, disgust, and fainting reduced significantly over treatment.Changes in disgust symptoms were associated with overall symptom changes, however a control group is needed to determine the effects of individual treatment components and to make more robust conclusions about the benefits of this enhanced approach. [ABSTRACT FROM AUTHOR]

Emotion dysregulation is a common sequela after a brain injury, and it can have serious negative consequences for individuals, families, and the community. A systematic review of the literature was conducted to identify and evaluate interventions designed to improve emotion regulation ability in adults with acquired brain injury. Studies were identified on ProQuest, PsycInfo, ScienceDirect, Scopus, and Web of Science; last searched on 3 August 2023. A review protocol was prospectively registered on PROSPERO (CRD42020218175). Risk of bias was assessed using the Cochrane Risk-of-Bias tool (version 2). Sixteen studies were included in the review comprising one case series, five pilot studies, four pre–post studies, and six RCTs. There was a total of 652 participants across studies. Fourteen of the sixteen studies reported statistically significant improvements in at least one emotional functioning variable. Ten studies reported medium-large effect sizes. Limitations included inconsistency in the measurement, reporting of intervention outcomes and processes. Future directions are discussed. [ABSTRACT FROM AUTHOR]

Pronounced difficulties in functional outcomes often follow acquired brain injury (ABI), and may be due, in part, to deficits in metacognitive knowledge (being unaware of one's cognitive strengths and limitations). A meta-analytic review of the literature investigating the relationship between metacognitive knowledge and functional outcomes in ABI is timely, particularly given the presence of apparently inconsistent findings. Twenty-two articles revealed two distinct methods of measuring metacognitive knowledge: (1) absolute (the degree of inaccurate self-appraisal regardless of whether the error tends towards under- or over-confident estimations) and (2) relative (the degree and the direction of the inaccuracy) discrepancy. Separate meta-analyses were conducted for absolute and relative discrepancy studies to assess the relationship between metacognitive knowledge and functional outcomes (affect-related quality of life, family and community integration, and work outcomes). The pattern of results found suggested that better metacognitive knowledge is related to better overall functional outcomes, but the relationship may differ depending on the outcome domain. These findings generally support the importance of focusing on metacognitive knowledge to improve outcomes following ABI. Nonetheless, the relatively small effect sizes observed suggest that other predictors of functional outcome should be investigated, including other subdomains of metacognition. [ABSTRACT FROM AUTHOR]