Nicolay Chertkoff Walz

This study examined how the family environment predicts long-term academic and behavioral functioning in school following traumatic brain injury (TBI) in early childhood. Using a concurrent cohort, prospective design, 15 children with severe TBI, 39 with moderate TBI, and 70 with orthopedic injury (OI) who were injured when they were 3-7 years of age were compared on tests of academic achievement and parent and teacher ratings of school performance and behavior on average 6.83 years postinjury. Soon after injury and at the longer term follow-up, families completed measures of parental psychological distress, family functioning, and quality of the home environment. Hierarchical linear regression analyses examined group differences in academic outcomes and their associations with measures of the early and later family environment. The severe TBI group, but not the moderate TBI group, performed worse than did the OI group on all achievement tests, parent ratings of academic performance, and teacher ratings of internalizing problems. Higher quality early and late home environments predicted stronger academic skills and better classroom behavior for children with both TBI and OI. The early family environment more consistently predicted academic achievement, whereas the later family environment more consistently predicted classroom functioning. The quality of the home environment predicted academic outcomes more strongly than did parental psychological distress or family functioning. TBI in early childhood has long-term consequences for academic achievement and school performance and behavior. Higher quality early and later home environments predict better school outcomes for both children with TBI and children with OI. (PsycINFO Database Record

Objective: The aim of this study was to investigate the association of neurocognitive functioning with internalizing and externalizing problems and school and social competence in children adopted internationally. Method: Participants included girls between the ages of 6–12 years who were internationally adopted from China (n = 32) or Eastern Europe (n = 25) and a control group of never-adopted girls (n = 25). Children completed the Vocabulary and Matrix Reasoning subtests from the Wechsler Abbreviated Scale of Intelligence and the Score! and Sky Search subtests from the Test of Everyday Attention for Children. Parents completed the Child Behavior Checklist and the Home and Community Social Behavior Scales. Results: Compared to the controls, the Eastern European group evidenced significantly more problems with externalizing behaviors and school and social competence and poorer performance on measures of verbal intelligence, perceptual reasoning, and auditory attention. More internalizing problems were reported in the Chinese group compared to the controls. Using generalized linear regression, interaction terms were examined to determine whether the associations of neurocognitive functioning with behavior varied across groups. Eastern European group status was associated with more externalizing problems and poorer school and social competence, irrespective of neurocognitive test performance. In the Chinese group, poorer auditory attention was associated with more problems with social competence. Conclusions: Neurocognitive functioning may be related to behavior in children adopted internationally. Knowledge about neurocognitive functioning may further our understanding of the impact of early institutionalization on post-adoption behavior.

This study examined the longer term effect of traumatic brain injury (TBI), approximately 18 months post‐injury, on emerging narrative discourse skills of 85 children with orthopaedic injury (OI), 43 children with moderate TBI, and 19 children with severe TBI who were between 3 years and 6 years 11 months at injury. Children with TBI performed worse than children with OI on most discourse indices. Children with severe TBI were less proficient than children with moderate TBI at identifying unimportant story information. Age and pragmatic skills were predictors of discourse performance.

This study examined the longer‐term effects of traumatic brain injury (TBI) on theory of mind (ToM) skills of children who were between the ages of 5 and 7 years at the time of injury. Fifty‐two children with orthopaedic injury, 30 children with moderate TBI, and 12 children with severe TBI were evaluated approximately 1 year post‐injury (mean age=6.98 years, SD =0.59, range=6.02–8.26). Children with severe TBI did not engage in representation of first‐ and second‐order mental states at a developmental level comparable to their peers, suggesting stagnation or lack of development, as well as regression of putatively existing ToM skills. Age, task‐specific cognitive demands, and verbal abilities were strong predictors of ToM performance. However, even after taking those factors into account, children with severe TBI had poorer ToM performance than children with orthopaedic injuries.

Post-acute effects of early childhood traumatic brain injury (TBI) on first-order theory of mind (ToM) skills were examined in 86 children with orthopedic injury (OI), 42 children with moderate TBI, and 17 children with severe TBI aged 3 to 5 years at the time of injury. Three-year-olds with TBI performed more poorly than 3-year-olds with OI on an appearance–reality task. The severe TBI group was impaired on false-contents tasks compared to the moderate TBI and OI groups. Age and IQ were strong predictors of ToM performance; however, the relationship between ToM and IQ was not as strong for children with TBI.

Objective: To examine social information processing (SIP) skills, behavior problems, and social competence following adolescent TBI and to determine whether SIP skills were predictive of behavior problems and social competence. Design: Cross-sectional analyses of adolescents with TBI recruited and enrolled in a behavioral treatment study currently in progress. Setting: Two tertiary care children's hospitals with Level 1 trauma centers. Participants: Adolescents aged 11 to 18 years with severe TBI (n=19) and moderate TBI (n=24) who were injured up to 24 months prior to recruitment. Assessment of risk factors: TBI severity, race, maternal education, and age at testing. Main outcome measurements: a measure of SIP skills, Child Behavior Checklist (CBCL), Youth Self Report (YSR), and Home and Community Social Behavior Scale (HCSBS). Results: The severe TBI group did not obtain significantly lower scores on the SIP measures than the moderate TBI group. In comparison to adolescents with moderate TBI, those with severe TBI had significantly more parent-reported externalizing behaviors and self-reported weaknesses in social competence. SIP skills were strong predictors of problems and social competence in adolescents with TBI. More specifically, an aggressive SIP style predicted externalizing problems and a passive SIP style predicted internalizing problems. Both passive and aggressive SIP skills were related to social competence and social problems. Conclusions: Adolescents with TBI are at risk for deficits in social and behavioral outcomes. SIP skills are strongly related to behavior problems and social competence in adolescents with TBI. SIP skills, social competence, and behavior problems are important targets for intervention that may be amenable to change and lead to improved functional outcomes following TBI.

We sought to extend previous research that demonstrates reduced neurometabolite concentrations during the chronic phase of pediatric traumatic brain injury (TBI) in children injured during early childhood. We hypothesized that young children with TBI in the chronic phase post-injury would have lower N-acetyl aspartate (NAA) metabolite concentrations in gray and white matter in comparison to controls. We also hypothesized that metabolite levels would be correlated with acute TBI severity and neurobehavioral skills. Ten children with a history of TBI between the ages of 3 and 6 years were compared to an age, gender, and race-matched group of 10 children with a history of an orthopedic injury (OI). Children completed neurobehavioral testing at 12 months post-injury. Proton magnetic resonance (MR) spectroscopy was completed at least 12 months post-injury when the children were 6–9 years old. Groups were compared on metabolite concentrations in the medial frontal gray matter and left frontal white matter. Metabolite levels were correlated with Glasgow Coma Scale (GCS) scores and neurobehavioral functioning. There was a trend for lower NAA concentrations in the medial frontal gray matter for the TBI group. Late NAA and Cr levels in the medial frontal gray matter and NAA levels in the left frontal white matter were strongly positively correlated with initial GCS score. Metabolite levels were correlated with some neurobehavioral measures differentially for children with TBI or OI. Some neurometabolite levels differed between the TBI and OI groups more than 1 year post-injury and were related to injury severity, as well as some neurobehavioral outcomes following TBI during early childhood.

Research examining autistic symptoms in Angelman syndrome (AS) is limited. The goal of this study was to further characterize the nature of stereotyped behaviors, social interaction deficits, and developmental disturbances in individuals with AS. Parents of 248 individuals between the ages of 3 and 22 completed a survey of autistic symptomatology by mail, the Gilliam Autism Rating Scale. Results confirmed a high degree of developmental delay and limited expressive language skills. In terms of stereotyped behaviors and social interaction, areas of convergence and divergence between AS and behaviors typically associated with autism spectrum disorders are described. The relationship between child characteristics (age, gender, seizure disorder, genetic subtype) and autistic symptomatology are discussed.

The diagnostic criteria for Angelman syndrome includes sleep disturbance as an associated characteristic. There are, however, few researchers who have examined sleep problems in this population. Our goal in this study was to better characterize the sleep patterns and problems in individuals with Angelman syndrome. Parents of 339 individuals between the ages of 3 and 22 completed a previously validated sleep questionnaire. Results confirmed that a variety of sleep problems exist in a significant portion of individuals with Angelman syndrome, most prominently in the areas of sleep initiation, sleep duration, reliance on sleep facilitators, being awakened by loud noises, and being disoriented when aroused. Developmental trends, syndrome specificity of findings, clinical implications, and directions for future research are discussed.