Traumatic brain injury (TBI) in childhood and adolescence can interrupt expected development, com... more Traumatic brain injury (TBI) in childhood and adolescence can interrupt expected development, compromise the integrity of the social brain network (SBN) and impact social skills. Yet, no study has investigated functional alterations of the SBN following pediatric TBI. This study explored functional connectivity within the SBN following TBI in two independent adolescent samples. First, 14 adolescents with mild complex, moderate or severe TBI and 16 typically developing controls (TDC) underwent resting-state functional magnetic resonance imaging 12-24 months post-injury. Region of interest analyses were conducted to compare the groups' functional connectivity using selected SBN seeds. Then, replicative analysis was performed in an independent sample of adolescents with similar characteristics (9 TBI, 9 TDC). Results were adjusted for age, sex, socioeconomic status and total gray matter volume, and corrected for multiple comparisons. Significant between-group differences were detected for functional connectivity in the dorsomedial prefrontal cortex and left fusiform gyrus, and between the left fusiform gyrus and left superior frontal gyrus, indicating positive functional connectivity for the TBI group (negative for TDC). The replication study revealed group differences in the same direction between the left superior frontal gyrus and right fusiform gyrus. This study indicates that pediatric TBI may alter functional connectivity of the social brain. Frontal-fusiform connectivity has previously been shown to support affect recognition and changes in the function of this network could relate to more effortful processing and broad social impairments.
Objective To assess the efficacy of cognitive interventions for children with neurological disord... more Objective To assess the efficacy of cognitive interventions for children with neurological disorders, acquired brain injuries, and neurodevelopmental disorders. Method We searched for randomized controlled trials of cognitive interventions; 13 studies met inclusion criteria. Risk of bias was rated for each study. Standardized effect size estimates were examined in 7 outcome domains. The overall quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation system. Results Significant positive treatment effects were found in all outcome domains aside from inhibitory control. Effects were large for attention, working memory, and memory tasks, and small for academic achievement and behavior rating scales. Results exhibited substantial heterogeneity in all domains. Overall quality of evidence was rated very low in all domains, suggesting substantial uncertainty about effect size estimates. Discussion The results provide some evidence of a positive benefit from cognitive interventions, but cannot be regarded as robust given the overall very low quality of the evidence. Key words intervention outcome; meta-analysis; neurological disorders; randomized controlled trial; systematic review. Pediatric neurological disorders (e.g., epilepsy, brain tumors), acquired brain injuries (e.g., traumatic brain injuries), and neurodevelopmental disorders (e.g., specific learning disabilities, autistic spectrum disorder; attentiondeficit/hyperactivity disorder [ADHD]) all share a common feature, which is that they are frequently associated with deficits in domain-general cognitive functions such as at
This study investigated the developmental levels of pragmatic language skills in children followi... more This study investigated the developmental levels of pragmatic language skills in children following head injury (HI), in comparison to their uninjured peers. Participants were 30 head-injured and 19 healthy controls, classified into a 'young' age group, 8-9 years, and an 'old' age group, 11-12 years. Participants were administered the WISC- III, a negotiating requests task and a hint task, the latter two assessing verbal reasoning skills and abilities to be indirect, respectively. It was found that negotiation and hinting strategies were rapidly developing in these age groups, where abilities to hint were less mature for all groups. Results found a main effect for injury on cognitive and functional language tasks, reflected by lower performance levels and inflexibility in reasoning for the head-injured group. Injury sustained at an earlier age consistently predicted poorer performance on the language tasks, complicating the ongoing development of generalized and higher-order communicative skills. Severity of injury did not predict performance on either language task.
Background To assess social skills, professionals require a tool that is grounded in science, age... more Background 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. Method 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. Results Six subscales were derived; Relationships, Participation, Social Rules, Social Communication, Social Cognition and Behaviour. PEERS-Q has good to very good internal consistency (α...
Mild traumatic brain injury (mTBI) is common in children aged < 5 years, however, less is know... more Mild traumatic brain injury (mTBI) is common in children aged < 5 years, however, less is known about their experience of post-concussive signs and symptoms. This systematic review aims to identify post-concussive signs and symptoms experienced by preschool children up to 12 months post-injury, and to review the methods used to report this data. Relevant findings, including rates, progression, and possible predictors of post-concussive signs and symptoms were also identified. Databases (Ovid MEDLINE, EMBASE, PsycInfo, PubMed, Scopus) and reference lists were searched for relevant articles, which were screened based on specified criteria. Eleven articles met the inclusion criteria, being original studies published in English and presenting data on post-concussive signs and symptoms specific to preschool children with mTBI. Most reviewed studies investigated acute presentations of mTBI, and identified that preschool children demonstrate post-concussive symptoms (PCS) similar to other age groups. Post-traumatic amnesia duration of approximately one day was reported in preschool children following mTBI, as were changes in mood and behavior during the recovery period. Parents were the main informants, with data obtained through either interview or questionnaire. Review findings highlight the lack of empirical data regarding the presentation and progression of PCS in preschoolers following mTBI and evidence on how to best manage this group during recovery.
BackgroundDespite increasing evidence of a link between early life brain injury and anti‐social b... more BackgroundDespite 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.MethodsThis 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)...
Purpose: To assess objective sleep outcomes and correlates in young adults with a history of chil... more Purpose: To assess objective sleep outcomes and correlates in young adults with a history of childhood traumatic brain injury. Materials and methods: Participants included 45 young adults who sustained brain injury in childhood (mild = 12, moderate = 22, and severe = 11) and 13 typically developing control participants. Sleep was assessed with actigraphy and sleep diaries recorded over 14 consecutive days. Rates of good sleep (sleep efficiency ! 85%) and poor sleep (sleep efficiency < 85%) were also evaluated. Results: At 20-years postinjury, participants with traumatic brain injury and controls presented with similar outcomes across the objective sleep parameters (all p > 0.050) and rates of poor sleepers were also similar between these groups (p ¼ 0.735): 67% and 77%, respectively. However, moderate and severe traumatic brain injury and female sex were associated with longer sleep duration. Conclusions: These findings provide preliminary insights into objective sleep outcome and associated factors in the very-long-term after childhood brain injuries. They also indicate the need to monitor sleep outcomes in young adults with and without traumatic brain injury. ä IMPLICATION FOR REHABILITATION Sustaining traumatic brain injury in childhood can impact on several functional domains including sleep. Sleep disturbances, particularly insomnia-related symptoms, are common in this population, with evidence of poor outcomes reported until adolescence postinjury, while outcomes beyond adolescence remain unexplored. In this first investigation of objective sleep outcomes in young adults with a history of childhood traumatic brain injury, we showed that insomnia-related symptoms are highly prevalent in both young adults with traumatic brain injury (67%) and healthy controls (77%). These findings suggest the need to routinely evaluate and treat sleep problem in young adults in general, irrespective of history of childhood traumatic brain injury.
The aim of investigation was to evaluate the quality of sleep, daytime sleepiness and used of sti... more The aim of investigation was to evaluate the quality of sleep, daytime sleepiness and used of stimulating substances in patients with musculoskeletal orofacial pain. Materials and methods: A cross-sectional study was carried out. Data of patients at the TMD and Orofacial Pain Clinic of the Universidad de La Frontera was evaluated, (2010 to January 2019). The variables reviewed were: sex, age, type of TMD, quality of sleep, daytime sleepiness, use of stimulating substances and type of substance. The data that did not show all the variables was excluded. Descriptive statistics was calculated. To estimate the association between variables, chi-square and T-test were applied (p value < 0.05). Software SPSS/Mac 23.0, SPSS, Chicago, IL was used. Results: In the study 225 clinical records were included, 82.9% was women (average age of 28.3 years, SD 15.7). 93.4% of the patients presented poor sleep quality, without statistically significant differences according to gender and age (p ¼ 0.505 and 0.195 respectively). 61.4% had some degree of daytime sleepiness, with mild diurnal sleepiness being more frequent. There were no statistically significant differences according to gender and age (p¼1,000 and 0.186 respectively). More than half of patients used some type of stimulating substance (54%, n¼136), without differences respecting sex or age. Coffee, tea and mate were the substances used most frequently. Patients with muscular and mixed pain had higher rate of stimulating substance use (p¼0.032, OR¼2.34, CI 1.13-4.86). Conclusions: Poor sleep quality and daytime sleepiness are frequent in patients with orofacial musculoskeletal pain, presenting a homogeneous distribution among different genders and age groups. Also, patients with muscular and mixed orofacial pain presented increased use of stimulating substances, indicative of a potential risk factor. It is important to research this habit which is associated with poor quality sleep, and has been increasingly observed in general population. There is an important need in modern day society to maintain wakefulness during daytime, and the action of these stimulating compounds could possibly contribute to, or perpetuate pain in these patients.
Children with acquired brain injury (ABI) are at risk of impairments in self-regulation and disru... more Children with acquired brain injury (ABI) are at risk of impairments in self-regulation and disruptive behavior. We aimed to investigate the effectiveness of the Signposts program to reduce disruptive behavior and improve self-regulation in Hispanic children with ABI, and reduce parental stress and improve parenting practices. Using a randomized controlled trial design, we assigned children (n = 71) and their parents to Signposts or generic telephone support. Blinded assessors conducted assessments at pre-intervention, immediately post-intervention, and at 3 months post-intervention. Signposts was effective in reducing dysfunctional parenting practices. Further, when analyzing participants at risk of behavioral disturbance (n = 46), Signposts was effective in reducing child disruptive behavior in the home environment and emotional self-regulation. No differences were found for parental stress, parent sense of competence, child disruptive behaviors at school, and child cognitive and behavioral selfregulation. The reduction in disruptive behavior was associated with the implementation of authoritative parenting practices (external regulation), and not associated with child self-regulation.
Annals of Physical and Rehabilitation Medicine, 2019
Traumatic brain injury (TBI) is a common cause of childhood death and disability and represents a... more Traumatic brain injury (TBI) is a common cause of childhood death and disability and represents a significant, worldwide public 16 health issue [1]. In the Australian context, recent estimates suggest 17 that 219 to 345 cases per 100,000 are reported annually [2]. These 18 injuries are often associated with a range of physical, emotional, 19 cognitive and social impairments, which may persist for many 20 years post-injury and contribute to reduced quality of life (QoL) for 21 children and their families [3-5]. 22 Historically, studies of childhood TBI have relied heavily on 23 functional outcome measures intended to assess the nature and 24 extent of functional problems. These scales are best conceptualised 25 as indices of functional status, and as such, are limited in their 26 capacity to capture the child's subjective experience of problems Annals of Physical and Rehabilitation Medicine xxx (2019) xxx-xxx
Parenting and the dysregulation profile predict executive functioning in children with acquired b... more Parenting and the dysregulation profile predict executive functioning in children with acquired brain injury, Child Neuropsychology,
Objective: To systematically appraise the literature on the prevalence, types, and predictors of ... more Objective: To systematically appraise the literature on the prevalence, types, and predictors of sleep-wake disturbances (SWD), and on the relationship between SWD, fatigue, depression, and quality of life in children and adolescents with traumatic brain injury (TBI). Methods: MEDLINE, PubMed, PsychInfo, Web of Science, and EMBASE databases were searched, reference lists of retrieved articles were also searched for relevant articles, and study methods were evaluated for risk of bias. Results: Of the 620 articles assessed, 16 met inclusion criteria. Sleep-wake disturbances were common in childhood TBI. The most common types of SWD reported were insomnia and excessive daytime sleepiness, with mild TBI participants showing a trend toward more sleep maintenance insomnia, while sleep-onset insomnia was typical in those with moderate-severe TBI. Predictors of SWD reported in studies involving mild TBI participants included TBI severity, male sex, preexisting SWD, high body weight, and dep...
BackgroundDeficits in social cognition may be among the most profound and disabling sequelae of p... more BackgroundDeficits in social cognition may be among the most profound and disabling sequelae of paediatric traumatic brain injury (TBI); however, the neuroanatomical correlates of longitudinal outcomes in this domain remain unexplored. This study aimed to characterize social cognitive outcomes longitudinally after paediatric TBI, and to evaluate the use of sub-acute diffusion tensor imaging (DTI) to predict these outcomes.MethodsThe sample included 52 children with mild complex-severe TBI who were assessed on cognitive theory of mind (ToM), pragmatic language and affective ToM at 6- and 24-months post-injury. For comparison, 43 typically developing controls (TDCs) of similar age and sex were recruited. DTI data were acquired sub-acutely (mean = 5.5 weeks post-injury) in a subset of 65 children (TBI = 35; TDC = 30) to evaluate longitudinal prospective relationships between white matter microstructure assessed using Tract-Based Spatial Statistics and social cognitive outcomes.ResultsW...
This study sought to investigate social and behavioral outcomes 12 months following childhood tra... more This study sought to investigate social and behavioral outcomes 12 months following childhood traumatic brain injury (TBI) and to identify predictors of these outcomes. The study also compared rates of impairment in social and behavioral outcomes at 12 months post-injury between children with TBI and a typically developing (TD) control group. The study comprised 114 children ages 5.5 to 16.0 years, 79 with mild, moderate, or severe TBI and 35 TD children, group-matched for age, sex and socio-economic status. Children with TBI were recruited via consecutive hospital admissions and TD children from the community. Social and behavioral outcomes were measured via parent-rated questionnaires. Analysis of covariance models identified a significant mean difference between the mild and moderate groups for social problems only, but the moderate and severe TBI groups showed a higher rate of impairment, particularly in externalizing problems. Pre-injury function, injury severity, parent mental...
Traumatic brain injury (TBI) in childhood and adolescence can interrupt expected development, com... more Traumatic brain injury (TBI) in childhood and adolescence can interrupt expected development, compromise the integrity of the social brain network (SBN) and impact social skills. Yet, no study has investigated functional alterations of the SBN following pediatric TBI. This study explored functional connectivity within the SBN following TBI in two independent adolescent samples. First, 14 adolescents with mild complex, moderate or severe TBI and 16 typically developing controls (TDC) underwent resting-state functional magnetic resonance imaging 12-24 months post-injury. Region of interest analyses were conducted to compare the groups' functional connectivity using selected SBN seeds. Then, replicative analysis was performed in an independent sample of adolescents with similar characteristics (9 TBI, 9 TDC). Results were adjusted for age, sex, socioeconomic status and total gray matter volume, and corrected for multiple comparisons. Significant between-group differences were detected for functional connectivity in the dorsomedial prefrontal cortex and left fusiform gyrus, and between the left fusiform gyrus and left superior frontal gyrus, indicating positive functional connectivity for the TBI group (negative for TDC). The replication study revealed group differences in the same direction between the left superior frontal gyrus and right fusiform gyrus. This study indicates that pediatric TBI may alter functional connectivity of the social brain. Frontal-fusiform connectivity has previously been shown to support affect recognition and changes in the function of this network could relate to more effortful processing and broad social impairments.
Objective To assess the efficacy of cognitive interventions for children with neurological disord... more Objective To assess the efficacy of cognitive interventions for children with neurological disorders, acquired brain injuries, and neurodevelopmental disorders. Method We searched for randomized controlled trials of cognitive interventions; 13 studies met inclusion criteria. Risk of bias was rated for each study. Standardized effect size estimates were examined in 7 outcome domains. The overall quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation system. Results Significant positive treatment effects were found in all outcome domains aside from inhibitory control. Effects were large for attention, working memory, and memory tasks, and small for academic achievement and behavior rating scales. Results exhibited substantial heterogeneity in all domains. Overall quality of evidence was rated very low in all domains, suggesting substantial uncertainty about effect size estimates. Discussion The results provide some evidence of a positive benefit from cognitive interventions, but cannot be regarded as robust given the overall very low quality of the evidence. Key words intervention outcome; meta-analysis; neurological disorders; randomized controlled trial; systematic review. Pediatric neurological disorders (e.g., epilepsy, brain tumors), acquired brain injuries (e.g., traumatic brain injuries), and neurodevelopmental disorders (e.g., specific learning disabilities, autistic spectrum disorder; attentiondeficit/hyperactivity disorder [ADHD]) all share a common feature, which is that they are frequently associated with deficits in domain-general cognitive functions such as at
This study investigated the developmental levels of pragmatic language skills in children followi... more This study investigated the developmental levels of pragmatic language skills in children following head injury (HI), in comparison to their uninjured peers. Participants were 30 head-injured and 19 healthy controls, classified into a &amp;amp;amp;amp;#39;young&amp;amp;amp;amp;#39; age group, 8-9 years, and an &amp;amp;amp;amp;#39;old&amp;amp;amp;amp;#39; age group, 11-12 years. Participants were administered the WISC- III, a negotiating requests task and a hint task, the latter two assessing verbal reasoning skills and abilities to be indirect, respectively. It was found that negotiation and hinting strategies were rapidly developing in these age groups, where abilities to hint were less mature for all groups. Results found a main effect for injury on cognitive and functional language tasks, reflected by lower performance levels and inflexibility in reasoning for the head-injured group. Injury sustained at an earlier age consistently predicted poorer performance on the language tasks, complicating the ongoing development of generalized and higher-order communicative skills. Severity of injury did not predict performance on either language task.
Background To assess social skills, professionals require a tool that is grounded in science, age... more Background 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. Method 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. Results Six subscales were derived; Relationships, Participation, Social Rules, Social Communication, Social Cognition and Behaviour. PEERS-Q has good to very good internal consistency (α...
Mild traumatic brain injury (mTBI) is common in children aged < 5 years, however, less is know... more Mild traumatic brain injury (mTBI) is common in children aged < 5 years, however, less is known about their experience of post-concussive signs and symptoms. This systematic review aims to identify post-concussive signs and symptoms experienced by preschool children up to 12 months post-injury, and to review the methods used to report this data. Relevant findings, including rates, progression, and possible predictors of post-concussive signs and symptoms were also identified. Databases (Ovid MEDLINE, EMBASE, PsycInfo, PubMed, Scopus) and reference lists were searched for relevant articles, which were screened based on specified criteria. Eleven articles met the inclusion criteria, being original studies published in English and presenting data on post-concussive signs and symptoms specific to preschool children with mTBI. Most reviewed studies investigated acute presentations of mTBI, and identified that preschool children demonstrate post-concussive symptoms (PCS) similar to other age groups. Post-traumatic amnesia duration of approximately one day was reported in preschool children following mTBI, as were changes in mood and behavior during the recovery period. Parents were the main informants, with data obtained through either interview or questionnaire. Review findings highlight the lack of empirical data regarding the presentation and progression of PCS in preschoolers following mTBI and evidence on how to best manage this group during recovery.
BackgroundDespite increasing evidence of a link between early life brain injury and anti‐social b... more BackgroundDespite 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.MethodsThis 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)...
Purpose: To assess objective sleep outcomes and correlates in young adults with a history of chil... more Purpose: To assess objective sleep outcomes and correlates in young adults with a history of childhood traumatic brain injury. Materials and methods: Participants included 45 young adults who sustained brain injury in childhood (mild = 12, moderate = 22, and severe = 11) and 13 typically developing control participants. Sleep was assessed with actigraphy and sleep diaries recorded over 14 consecutive days. Rates of good sleep (sleep efficiency ! 85%) and poor sleep (sleep efficiency < 85%) were also evaluated. Results: At 20-years postinjury, participants with traumatic brain injury and controls presented with similar outcomes across the objective sleep parameters (all p > 0.050) and rates of poor sleepers were also similar between these groups (p ¼ 0.735): 67% and 77%, respectively. However, moderate and severe traumatic brain injury and female sex were associated with longer sleep duration. Conclusions: These findings provide preliminary insights into objective sleep outcome and associated factors in the very-long-term after childhood brain injuries. They also indicate the need to monitor sleep outcomes in young adults with and without traumatic brain injury. ä IMPLICATION FOR REHABILITATION Sustaining traumatic brain injury in childhood can impact on several functional domains including sleep. Sleep disturbances, particularly insomnia-related symptoms, are common in this population, with evidence of poor outcomes reported until adolescence postinjury, while outcomes beyond adolescence remain unexplored. In this first investigation of objective sleep outcomes in young adults with a history of childhood traumatic brain injury, we showed that insomnia-related symptoms are highly prevalent in both young adults with traumatic brain injury (67%) and healthy controls (77%). These findings suggest the need to routinely evaluate and treat sleep problem in young adults in general, irrespective of history of childhood traumatic brain injury.
The aim of investigation was to evaluate the quality of sleep, daytime sleepiness and used of sti... more The aim of investigation was to evaluate the quality of sleep, daytime sleepiness and used of stimulating substances in patients with musculoskeletal orofacial pain. Materials and methods: A cross-sectional study was carried out. Data of patients at the TMD and Orofacial Pain Clinic of the Universidad de La Frontera was evaluated, (2010 to January 2019). The variables reviewed were: sex, age, type of TMD, quality of sleep, daytime sleepiness, use of stimulating substances and type of substance. The data that did not show all the variables was excluded. Descriptive statistics was calculated. To estimate the association between variables, chi-square and T-test were applied (p value < 0.05). Software SPSS/Mac 23.0, SPSS, Chicago, IL was used. Results: In the study 225 clinical records were included, 82.9% was women (average age of 28.3 years, SD 15.7). 93.4% of the patients presented poor sleep quality, without statistically significant differences according to gender and age (p ¼ 0.505 and 0.195 respectively). 61.4% had some degree of daytime sleepiness, with mild diurnal sleepiness being more frequent. There were no statistically significant differences according to gender and age (p¼1,000 and 0.186 respectively). More than half of patients used some type of stimulating substance (54%, n¼136), without differences respecting sex or age. Coffee, tea and mate were the substances used most frequently. Patients with muscular and mixed pain had higher rate of stimulating substance use (p¼0.032, OR¼2.34, CI 1.13-4.86). Conclusions: Poor sleep quality and daytime sleepiness are frequent in patients with orofacial musculoskeletal pain, presenting a homogeneous distribution among different genders and age groups. Also, patients with muscular and mixed orofacial pain presented increased use of stimulating substances, indicative of a potential risk factor. It is important to research this habit which is associated with poor quality sleep, and has been increasingly observed in general population. There is an important need in modern day society to maintain wakefulness during daytime, and the action of these stimulating compounds could possibly contribute to, or perpetuate pain in these patients.
Children with acquired brain injury (ABI) are at risk of impairments in self-regulation and disru... more Children with acquired brain injury (ABI) are at risk of impairments in self-regulation and disruptive behavior. We aimed to investigate the effectiveness of the Signposts program to reduce disruptive behavior and improve self-regulation in Hispanic children with ABI, and reduce parental stress and improve parenting practices. Using a randomized controlled trial design, we assigned children (n = 71) and their parents to Signposts or generic telephone support. Blinded assessors conducted assessments at pre-intervention, immediately post-intervention, and at 3 months post-intervention. Signposts was effective in reducing dysfunctional parenting practices. Further, when analyzing participants at risk of behavioral disturbance (n = 46), Signposts was effective in reducing child disruptive behavior in the home environment and emotional self-regulation. No differences were found for parental stress, parent sense of competence, child disruptive behaviors at school, and child cognitive and behavioral selfregulation. The reduction in disruptive behavior was associated with the implementation of authoritative parenting practices (external regulation), and not associated with child self-regulation.
Annals of Physical and Rehabilitation Medicine, 2019
Traumatic brain injury (TBI) is a common cause of childhood death and disability and represents a... more Traumatic brain injury (TBI) is a common cause of childhood death and disability and represents a significant, worldwide public 16 health issue [1]. In the Australian context, recent estimates suggest 17 that 219 to 345 cases per 100,000 are reported annually [2]. These 18 injuries are often associated with a range of physical, emotional, 19 cognitive and social impairments, which may persist for many 20 years post-injury and contribute to reduced quality of life (QoL) for 21 children and their families [3-5]. 22 Historically, studies of childhood TBI have relied heavily on 23 functional outcome measures intended to assess the nature and 24 extent of functional problems. These scales are best conceptualised 25 as indices of functional status, and as such, are limited in their 26 capacity to capture the child's subjective experience of problems Annals of Physical and Rehabilitation Medicine xxx (2019) xxx-xxx
Parenting and the dysregulation profile predict executive functioning in children with acquired b... more Parenting and the dysregulation profile predict executive functioning in children with acquired brain injury, Child Neuropsychology,
Objective: To systematically appraise the literature on the prevalence, types, and predictors of ... more Objective: To systematically appraise the literature on the prevalence, types, and predictors of sleep-wake disturbances (SWD), and on the relationship between SWD, fatigue, depression, and quality of life in children and adolescents with traumatic brain injury (TBI). Methods: MEDLINE, PubMed, PsychInfo, Web of Science, and EMBASE databases were searched, reference lists of retrieved articles were also searched for relevant articles, and study methods were evaluated for risk of bias. Results: Of the 620 articles assessed, 16 met inclusion criteria. Sleep-wake disturbances were common in childhood TBI. The most common types of SWD reported were insomnia and excessive daytime sleepiness, with mild TBI participants showing a trend toward more sleep maintenance insomnia, while sleep-onset insomnia was typical in those with moderate-severe TBI. Predictors of SWD reported in studies involving mild TBI participants included TBI severity, male sex, preexisting SWD, high body weight, and dep...
BackgroundDeficits in social cognition may be among the most profound and disabling sequelae of p... more BackgroundDeficits in social cognition may be among the most profound and disabling sequelae of paediatric traumatic brain injury (TBI); however, the neuroanatomical correlates of longitudinal outcomes in this domain remain unexplored. This study aimed to characterize social cognitive outcomes longitudinally after paediatric TBI, and to evaluate the use of sub-acute diffusion tensor imaging (DTI) to predict these outcomes.MethodsThe sample included 52 children with mild complex-severe TBI who were assessed on cognitive theory of mind (ToM), pragmatic language and affective ToM at 6- and 24-months post-injury. For comparison, 43 typically developing controls (TDCs) of similar age and sex were recruited. DTI data were acquired sub-acutely (mean = 5.5 weeks post-injury) in a subset of 65 children (TBI = 35; TDC = 30) to evaluate longitudinal prospective relationships between white matter microstructure assessed using Tract-Based Spatial Statistics and social cognitive outcomes.ResultsW...
This study sought to investigate social and behavioral outcomes 12 months following childhood tra... more This study sought to investigate social and behavioral outcomes 12 months following childhood traumatic brain injury (TBI) and to identify predictors of these outcomes. The study also compared rates of impairment in social and behavioral outcomes at 12 months post-injury between children with TBI and a typically developing (TD) control group. The study comprised 114 children ages 5.5 to 16.0 years, 79 with mild, moderate, or severe TBI and 35 TD children, group-matched for age, sex and socio-economic status. Children with TBI were recruited via consecutive hospital admissions and TD children from the community. Social and behavioral outcomes were measured via parent-rated questionnaires. Analysis of covariance models identified a significant mean difference between the mild and moderate groups for social problems only, but the moderate and severe TBI groups showed a higher rate of impairment, particularly in externalizing problems. Pre-injury function, injury severity, parent mental...
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Papers by Cathy Catroppa