Emerging narrative discourse skills 18 months after traumatic brain injury in early childhood

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.     

Temporal generalization in 3- to 8-year-old children

Children aged 3, 5, and 8 years were tested on temporal generalization with visual stimuli. Different groups received 4- and 8-s standards. Gradients at all ages superimposed when plotted on the same relative scale, indicating underlying scalar timing. The principal developmental changes were (i) increasing sharpness of the generalization gradient with increasing age and (ii) a change from symmetrical (3 and 5 years) to adultlike asymmetrical generalization gradients in the oldest children. Theoretical modeling attributed these changes to increasing precision of the reference memory of the standard with increasing age, as well as a decreased tendency to "misremember" the standard as being shorter than it actually was, as the children developed.     

Age at injury and long-term behavior problems after traumatic brain injury in young children

Objective: This study examined the effects of age at injury on the persistence of behavior problems and social skill deficits in young children with complicated mild to severe traumatic brain injury (TBI). Method: A concurrent cohort/prospective research design was used with repeated assessments of children with TBI (n = 82) or Orthopedic Injury (OI) (n = 114). Parents completed the Child Behavior Checklist, the Behavior Rating Inventory of Executive Functions, and the Preschool and Kindergarten Behavior Scales or the Home and Community Social and Behavior Scales shortly after injury to assess preinjury functioning, and at an extended follow-up an average of 38 months postinjury. Generalized linear modeling was used to examine the relationship of age at injury to the maintenance of behavior problems, and logistic regression was used to examine the persistence of clinically significant behavior problems. Results: At the extended follow-up, severe TBI was associated with significantly greater anxiety problems relative to the Group OI. With increasing time since injury, children who sustained a severe TBI at an earlier age had significantly higher levels of parent-reported symptoms of ADHD and anxiety than children who were older at injury. Conclusions: Findings suggest that longer-term treatment for behavior problems may be needed after severe TBI, particularly for those injured at an earlier age. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Cognitive contributions to theory of mind ability in children with a traumatic head injury

The objective of the current study is to examine the contribution of intellectual abilities, executive functions (EF), and facial emotion recognition to difficulties in Theory of Mind (ToM) abilities in children with a traumatic head injury. Israeli children with a traumatic head injury were compared with their non-injured counterparts. Each group included 18 children (12 males) ages 7–13. Measurements included reading the mind in the eyes, facial emotion recognition, reasoning the other’s characteristics based on motive and outcome, Raven’s Coloured Progressive Matrices, similarities and digit span (Wechsler Intelligence Scale for Children – Revised 95 subscales), verbal fluency, and the Behaviour Rating Inventory of Executive Functions. Non-injured children performed significantly better on ToM, abstract reasoning, and EF measures compared with children with a traumatic head injury. However, differences in ToM abilities between the groups were no longer significant after controlling for abstract reasoning, working memory, verbal fluency, or facial emotion recognition. Impaired ToM recognition and reasoning abilities after a head injury may result from other cognitive impairments. In children with mild and moderate head injury, poorer performance on ToM tasks may reflect poorer abstract reasoning, a general tendency to concretize stimuli, working memory and verbal fluency deficits, and difficulties in facial emotion recognition, rather than deficits in the ability to understand the other’s thoughts and emotions. ToM impairments may be secondary to a range of cognitive deficits in determining social outcomes in this population.     

Response inhibition in children with and without ADHD after traumatic brain injury

Children with attention‐deficit hyperactivity disorder (ADHD) and traumatic brain injury (TBI) show deficient response inhibition. ADHD itself is a common consequence of TBI, known as secondary ADHD (S‐ADHD). Similarity in inhibitory control in children with TBI, S‐ADHD, and ADHD would implicate impaired frontal‐striatal systems; however, it is first necessary to delineate similarities and differences in inhibitory control in these conditions. We compared performance of children with ADHD and those with TBI without pre‐injury ADHD on a stop signal, response inhibition task. Participants were 274 children aged 6–14 years. There were 92 children with ADHD, 103 children with TBI, and 79 typically developing children who served as controls. Among the TBI participants, injury severity ranged from mild to severe. Children with ADHD and TBI showed deficient inhibition. The deficit in children with ADHD was as great as or greater than that in children with TBI, regardless of degree of TBI severity or the presence of S‐ADHD. The finding indicates that TBI results in deficient inhibition regardless of the development of S‐ADHD.     

Selective learning in children after traumatic brain injury: a preliminary study.

Selective learning (SL) is the ability to select items to learn from among other items. It requires the use of the executive processes of metacognitive control and working memory, which are considered to be mediated by the frontal cortex and its circuitry. We studied the efficiency with which verbal items of greater value are selectively learned from among items varying in value in 14 children ages 8-15 years who had sustained severe traumatic brain injury (TBI) and in 39 typically developing age-matched children. We hypothesized that children with TBI would be disproportionately compromised in selective learning efficiency in contrast to memory span when compared to normally developing children. The results supported our hypothesis, as children with TBI performed significantly worse than controls on a measure of selective learning efficiency, but the two groups performed similarly on a measure of word recall within the same task. Furthermore, the effect of TBI on performance was demonstrated to take place at the time of encoding, rather than at retrieval.     

Electrophysiological correlates of emotional face processing after mild traumatic brain injury in preschool children

Evidence suggests that social skills are affected by childhood mild traumatic brain injury (mTBI), but the neural and affective substrates of these difficulties are still underexplored. In particular, nothing is known about consequences on the perception of emotional facial expressions, despite its critical role in social interactions and the importance of the preschool period in the development of this ability. This study thus aimed to investigate the electrophysiological correlates of emotional facial expressions processing after early mTBI. To this end, 18 preschool children (mean age 53 ± 8 months) who sustained mTBI and 15 matched healthy controls (mean age 55 ± 11 months) were presented with pictures of faces expressing anger, happiness, or no emotion (neutral) while event-related potentials (ERP) were recorded. The main results revealed that P1 amplitude was higher for happy faces than for angry faces, and that N170 latency was shorter for emotional faces than for neutral faces in the control group only. These findings suggest that preschool children who sustain mTBI do not present the early emotional effects that are observed in healthy preschool children at visuospatial and visual expertise stages. This study provides new evidence regarding the consequences of childhood mTBI on socioemotional processing, by showing alterations of emotional facial expressions processing, an ability known to underlie social competence and appropriate social interactions.     

Social problem-solving skills in children with traumatic brain injury: long-term outcomes and prediction of social competence.

The effects of childhood traumatic brain injury (TBI) on social problem-solving were examined in 35 children with severe TBI, 40 children with moderate TBI, and 46 children with orthopedic injuries (OI). The children were recruited prospectively following injuries that occurred between 6 and 12 years of age. They were followed longitudinally, and ranged from 9 to 18 years of age at the time of the current study, which occurred on average 4 years post injury. They were administered a semi-structured interview used in previous research on social problem-solving to assess the developmental level of their responses to hypothetical dilemmas involving social conflict. Children in the severe TBI group defined the social dilemmas and generated alternative strategies to solve those dilemmas at the same developmental level as did children in the OI group. However, they articulated lower-level strategies as the best way to solve the dilemmas and used lower-level reasoning to evaluate the effectiveness of the strategies. After controlling for group membership, race, socioeconomic status, IQ, and age, children's social problem-solving, and particularly the developmental level of their preferred strategies for resolving conflicts, predicted parents ratings of children's social skills, peer relationships, aggressive behavior, and academic performance. The findings indicate that children with severe TBI demonstrate selective, long-term deficits in their social problem-solving skills that may help to account for their poor social and academic outcomes.     

Attentional skills in the acute phase following pediatric traumatic brain injury.

Only a limited number of studies have investigated attention following pediatric head-injury. The present study examined sustained attention and processing speed in a group of children who had sustained a mild (n = 27), moderate (n = 33) or severe (n = 16) traumatic brain injury (TBI). No significant differences were evident between the TBI groups on reaction time measures. Results did show that the severe TBI group exhibited greater deficits in the area of sustained attention, in comparison to children with mild and moderate injuries, in the acute stage following traumatic brain injury. This difficulty may impact on the future development of skills dependent on intact attentional capacity.     

Anchoring in 4- to 6-year-old children relates to predictors of reading

Previous studies suggest that anchoring, a short-term dynamic and implicit process that allows individuals to benefit from contextual information embedded in stimulus sequences, might be causally related to reading acquisition. Here we report findings from two experiments in which two previously untested predictions derived from this anchoring hypothesis were tested: (a) that anchoring facilitates rapid naming and phonological short-term memory in children prior to the onset of formal reading instruction and (b) that anchoring makes a unique contribution to performance in two early predictors of reading (letter knowledge and phonological awareness). In line with those predictions, naming times were faster and memory spans were longer under conditions that encouraged the use of anchoring processes than under conditions that afforded little anchoring. Furthermore, performance in the anchoring-affording condition predicted significant amounts of variance in phonological awareness and letter knowledge even after controlling for the contribution of the conditions that did not afford anchoring. Therefore, we suggest that anchoring might contribute to the development of reading-related processes during the preschool years independent of the development of specific reading-related skills such as phonological processing.     

Response inhibition and adaptations to response conflict in 6- to 8-year-old children: Evidence from the Simon effect

Several studies have shown that the Simon effect, which is the advantage of spatial correspondence between stimulus and response locations when the stimulus location is task-irrelevant, decreases with increasing response times and is affected by preceding-trial correspondence. These modulations suggest the existence of control mechanisms that adapt our behavior to current goals by responding to the conflict experienced within a trial and by preventing the recurrence of a conflict in the subsequent trial. The aim of the present study was to assess whether these control mechanisms, which are well consolidated in adults and in children older than 8 years of age, are present in children between 6 and 8 years old. To this end, we tested 32 first-grade (6–7 years) and 34 second-grade (7–8 years) children on a Simon task in which correspondence sequence was manipulated on a trial-by-trial basis. The Simon effect was larger for first- than for second-graders and decreased with increasing response times only in second-graders. Crucially, for both groups, the effect was reduced when the preceding trial was noncorresponding, and the reductions were comparable for the two groups, indicating that trial-by-trial control mechanisms are already present in first-grade children and may be dissociated from within-trial control adjustments.     

Fantasy play in 5- and 6-year-old children

We studied the verbal pretend play of 5- and 6-year-old boys and girls to delineate age and sex differences during the later preoperational period. Sixteen children with average language ability were paired by age and sex and were videotaped for three 15-min intervals. Verbal interactions were transcribed, and the pretend play was classified as object fantasy, imaginative action plans/themes, or fantasy roles. Language used for pretend play increased in proportion to all utterances with age. Older children referred to more invented objects than younger ones but primarily in the service of realistic action formats. Girls' conversations were scored as having significantly more verbal pretending than boys' and a higher proportion of it referred to play roles. There were both age and sex differences in the types of themes, toys used, and roles enacted, including more sex-typed behavior in older children. The continued increase in the proportion of pretend play to all verbal interaction with age and the characteristics of play behavior is consistent with developmental theory.     

A review of social disinhibition after traumatic brain injury

Acquired social disinhibition refers to a debilitating behavioural syndrome commonly reported after a severe traumatic brain injury (TBI) and is characterized by inappropriate social behaviour, often described as immaturity and insensitivity towards others. These behaviours can have enduring effects on the social capability of the individual and their relationships with others. However, research into socially disinhibited behaviour after TBI has been thwarted by a lack of consensus in the literature on definition and measurement. This review provides an overview of our current understanding of the definition, measurement, prevalence, associated outcomes, neuropathology, and underlying mechanisms of social disinhibition after TBI. In addition, suggestions are made for future research to further our understanding of this syndrome with the eventual aim of rehabilitating problematic behaviours. It is concluded that an improved understanding of what causes disinhibited behaviour after TBI will be necessary for the development of effective treatment strategies aimed at the rehabilitation of underlying impairments.     

Recovery and predictors of language skills two years following pediatric traumatic brain injury

Subtle language processing difficulties may adversely affect scholastic performance, as well as communication and social skills. It is therefore crucial that language skills are monitored following traumatic brain injury (TBI) in childhood. The present study examined language skills in a group of 68 children who had sustained a mild, moderate or severe TBI. Results indicated that during the acute stage a dose-response relationship was evident, where severe TBI was associated with poorest performance and mild TBI with least deficits. By 24 months post-TBI, it was clear that for some language functions, the severe TBI group showed substantial recovery, and at times performed better than the moderate TBI group. Predictors of language and literacy skills at 24 months post TBI included pre-injury communication skills, socio-economic status, age at injury, and Vocabulary, as measured by the Wechsler Intelligence Scale for Children (WISC-111).     

Social interaction skills and theory of mind in young children

Two studies explored relations between peer social skills and theory of mind in young children. In Study 1, a global teacher rating of social skills with peers, performance on a traditional false-belief task, a standardized assessment of auditory language comprehension, and a time sampling of amount of speech with peers were obtained. Positive, but moderate, zero-order correlations were observed between the false-belief measure and social skills, and false belief accounted for a significant amount of additional variance in social skills after covarying age and the 2 measures of language. Study 2 replicated the findings of Study 1 by using a larger sample and a standardized teacher questionnaire. The results are discussed with regard to the critical role of a mentalistic theory of behavior for human social interactions.     

Exploration of perceptual and motor inhibition in children with traumatic brain injury

Perceptual and motor inhibition were examined using conflict resolution tasks for 12 children with traumatic brain injury and 24 matched controls. Direct comparisons of inhibition performances between the two groups showed a specific and disproportionate impairment of motor inhibition (compared with perceptual inhibition) for the children with traumatic brain injury, which suggests that inhibition processes might be differentially impaired in children after traumatic brain injury.     

Copy and recall performance of 6-8-year-old children after standard vs. Step-by-step administration of the Rey-Osterrieth complex figure.

The Rey-Osterrieth Complex Figure (ROCF; Rey 1941; Osterrieth, 1944) is frequently used in the neuropsychological assessment of children and adults. The present study was designed, in part, to examine the impact of providing organizational scaffolding to young children being tested with the ROCF. To this end, 6-, 7-, and 8-year-old children were administered the test either in the standard fashion, or using a format in which the 18 key elements of the figure were introduced sequentially. Participants included 132 children who were randomly assigned to the standard or step-by-step administration groups. Significantly higher accuracy and organization scores for both copy and recall were seen with the step-by-step format than with the standard format, even though children in the step-by-step condition took less time to execute their drawings. Retention of encoded information was not affected by age or testing format. The fact that 6-year-olds in the step-by-step condition performed as well as, or better than, 8-year-olds in the standard condition suggests that the primary problem young children experience with the ROCF lies with organizational strategy formation. Advantages of using the Step-by-step ROCF in clinical practice are discussed.     

Predictors of neuropsychological test performance after pediatric traumatic brain injury

The influence of neurological and demographic variables on neuropsychological test performance was examined in 100 9-to 16-year-old children with traumatic brain injury (TBI). Regression analyses were conducted to determine the relative contributions of coma, neuroimaging findings, ethnicity, socioeconomic status, and gender to variance in performance on the Wechsler Intelligence Scale for Children-Third Edition (WISC-III), California Verbal Learning Test--Children's Version (CVLT-C), and the Children's Category Test. Both neurological and demographic variables contributed to performance on various WISC-III factor index scores as well as the CVLT-C. No evidence for a moderating effect of demographic variables was found, but speed of information processing mediated the effect of neurological and demographic variables on CLVT-C performance. It is concluded that demographic variables have an incremental effect on the neuropsychological test performance of children with TBI above and beyond the influence of injury severity.     

A longitudinal analysis of the attention networks in 6- to 11-year-old children

Attention is critical for everyday functioning. Posner and Petersen’s model of attention describes three neural networks involved in attention control—the alerting network for arousal, the orienting network for selecting sensory input and reorienting attention, and the executive network for the regulatory control of attention. No longitudinal research has examined relative change in these networks in children. A modified version of the attention network task (ANT) was used to examine changes in the three attention networks, three times over 12 months, in 114 6-, 8- and 10-year-olds. Findings showed that the alerting network continued to develop over this period, the orienting network had stabilized by 6 years, and the conflict network had largely stabilized by 7 years. The reorienting of attention was also assessed using invalid cues, which showed a similar developmental trajectory to the orienting attention network and had stabilized by 6 years. The results confirm that age 6 to 7 years is a critical period in the development of attention, in particular executive attention. The largest improvement over the evaluation period was between 6 and 7 years; however, subtle changes were found in attention beyond 8 years of age.