The relationship between post-trauma problem reporting and carer quality of life after severe head injury

Abstract

Head injury is a significant cause of death and disability. This study examined the quality of life of carers of individuals following severe head injury from the acute neurosurgical care period to one year post discharge from hospital. The contribution of patterns of problem reporting by patients and their carers to quality of life was examined. Carer psychosocial adjustment and individual quality of life evaluations were significantly poorer than general population levels and did not change over a one year period. However, significant increases in the number of problems reported were noted over time. No significant differences were found between patients and carers in the numbers of problems identified at each of three assessments, although the level of agreement about problems identified was quite low. Female patients reported significantly more problems than male patients. Carer problem reporting was found to significantly predict carer quality of life and psychosocial functioning to a greater extent than patient problem reporting, a pattern which emerged after the patient had been discharged from hospital. The study demonstrates increasing problem profiles and differing perceptions of patients and carers over time. Combined with a lack of improvement in carer quality of life over a one year recovery period, this highlights the need for longer-term professional support and advice services aimed at both patients and carers.     

Binge-Drinking: A Test of the Role of Group Norms in the Theory of Planned Behaviour

A study was undertaken to assess the utility of the theory of planned behaviour in the prediction of students' binge-drinking. Additionally, a perspective was utilised to address the usually weak contribution of subjective norms in predicting behavioural intentions. Respondents were 289 undergraduate students. The study employed a longitudinal design, with the predictors of performing the behaviour under consideration assessed prior to the measure of reported behaviour. Support was found for the application of the theory of planned behaviour to binge-drinking. A reconceptualisation of norms in the theory of planned behaviour, from a social identity theory/self-categorization theory perspective, was also supported; consistent with expectations, the norms of a behaviourally relevant reference group predicted intentions to binge-drink, especially for participants who identified strongly with the reference group. The results are discussed in relation to measures which may help to reduce the incidence of binge-drinking by university students.     

Intention to Participate in Predictive Genetic Testing for Hereditary Cancer: The Role of Attitude toward Uncertainty

This study aimed to identify factors predictive of intentions to participate in genetic testing for hereditary cancer. Measures of the psychosocial influences on intention were based on the theories of reasoned action (TRA) and planned behaviour (TPB) and a new measure of Attitude toward Uncertainty. The participants (the breast cancer sample, n = 124; the colon cancer sample, n = 168) were recruited via a general practitioner's patient database and asked to complete postal questionnaires. The overall response rate was 57.4% (54.7% in the colon cancer sample, 61.4% in the breast cancer sample). In the colon cancer sample, 72% of respondents stated that they would choose to participate in genetic testing for colon cancer susceptibility. In the breast cancer sample, 77% of respondents stated that they would choose to participate in genetic testing for breast cancer susceptibility. The TRA components (attitudes and subjective norms) and Attitude toward Uncertainty emerged as the strongest predictors of intention. The Attitude toward Uncertainty appears to moderate intention in that participants with more negative attitudes toward uncertainty are more likely to undergo the test than those seeking more certainty.     

Psychological impact of remote combat/graphic media exposure among US Air Force intelligence personnel

Since 2001 there has been a significant increase in the use of intelligence, surveillance, and reconnaissance (ISR) analysis for tactical, operational, and strategic decision makers engaged in global operations. To meet this demand, US Air Force intelligence personnel participate in remote combat and graphic media exploitation operations (e.g., review of still imagery, video, and audio), the long-term psychological effects of which are not well understood. Research to date has focused primarily on outcomes related to how intelligence personnel work, versus the specifics of what they do. Military psychologists embedded in ISR units conducted studies to address this gap. Intelligence analysts participated in focus groups and surveys assessing the frequency of exposure, previous exposures to other potentially traumatic events, symptoms of PTSD, moral injury, and other psychosocial experiences. Results showed that exposure levels, albeit virtual, rivaled or exceeded those reported by a sample of special operations forces. Results also showed that specific types of exposures (e.g., witnessing US military casualties, civilian casualties, atrocities committed by the enemy) are related to increased posttraumatic stress and other sequelae that may not adequately be captured by standard posttraumatic stress disorder screening measures. The results contribute to the existing literature on posttraumatic stress, shed new light on the emerging construct of moral injury, and highlight challenges presented by remote combat and graphic media exploitation operations to force health sustainment and performance optimization. The authors provide directions for future research and recommendations for ongoing assessment, monitoring, and selection and training of ISR personnel.     

Neuropsychological profiles of six children with anoxic brain injury

Anoxic brain injury (ABI) often results in severe memory impairment and other cognitive and behavioral deficits, although limited information is available regarding pediatric cases. This study reported the neuropsychological outcomes in six children and adolescents who sustained ABI. Profiles were compared by mechanism of injury (ischemic vs. hypoxemic) and three cases were evaluated more than once. Severe intellectual, attention, memory, and behavioral impairments were observed in all six cases although academic achievement, internalizing behavioral problems, and visuospatial deficits were in general less severe than other cognitive and behavioral deficits. The longitudinal case studies varied but showed steady increases in memory and intellectual performance in the younger children with strongest improvement in nonverbal abilities and little change in parent-reported behavior. This study raises several possible hypotheses about specific cognitive and behavioral outcomes observed in pediatric ABI.     

Relationship between reaction time variability and motor skill development in ADHD

Slower and more variable reaction times to computerized tasks have been documented in children diagnosed with attention deficit/hyperactivity disorder (ADHD). Recent research supports a role for attentional lapses in generating abnormally variable and slow responses. However, given the association between ADHD and impairments in motor control, we hypothesized that slower or more variable reaction times might also correlate with motor development. The aim of this case-control study was to explore the relationship between motor function, reaction speed and variability, and ADHD. After comprehensive educational and clinical assessments, motor skill development was evaluated in 35 children ages 9 to 14 (19 with ADHD) using the Physical and Neurological Examination for Subtle Signs (PANESS) test battery. Finger-sequencing speed and variability were quantified with goniometers. Reaction times were measured with 20 trials each of computerized simple and choice (binary) tasks. Compared to healthy controls, children with ADHD had slower and more variable reaction times, and these findings correlated with impaired motor development (PANESS) and slow and variable finger sequencing (goniometers). Further studies of motor development in ADHD may identify factors influencing speed and variability of reaction times.     

An Examination of Lexical and Sublexical Reading Skills in Children with Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF1) is an inherited neurocutaneous disorder associated with a high frequency of cognitive and learning difficulties. Based on discrepancies between IQ and academic achievement, approximately 17% of children with NF1 have been classified as having reading impairments. In this study, the lexical and sublexical reading skills of children with NF1 (n = 30) were examined using the Castles' Word/Non-Word Test (modified version), together with measures of neuropsychological functioning and academic achievement. Twenty children (67%) demonstrated deficits in one or more reading subskills, with 75% of these meeting criteria for phonological dyslexia and 20% classified with mixed dyslexia. These findings indicate that a large proportion of children with NF1 may be characterized by a specific difficulty with the sublexical procedure, suggesting a difficulty employing spelling-to-sound rules to assemble a pronunciation when reading. In line with previous studies, the present findings also suggest that discrepancy-based methods may not be sufficiently sensitive to identify children who experience reading difficulties.     

Deficit in Response Inhibition in Children with Attention Deficit/Hyperactivity Disorder (ADHD): Impact of Motivation?

To date, neuropsychological and psycho-physiological studies have revealed inconsistent results regarding an executive or motivational deficit explaining the response inhibition deficit in children with attention deficit/hyperactivity disorder (ADHD). Research on differentiating neuropsychological processes in ADHD subtypes is still scarce. Therefore, the motivational impact on response inhibition among boys with ADHD was examined in this study. In the first study, 19 boys with ADHD-combined type (ADHD-C) and 19 age-matched healthy control subjects performed a modified Go/No-Go task with the following experimental conditions: neutral, auditory feedback, reward, response cost, and reward/response cost. Performance and physiological data (heart rate and skin conductance responses) were recorded. In a second study with the modified Go/No-Go task, data for six children with ADHD-C, six with ADHD-inattentive subtype (ADHD-I), and six healthy control subjects were compared. Neither of the two studies revealed group by condition interactions. In study 1, boys with ADHD-C generally made more commissions and omissions compared to the control group. However, feedback significantly improved the response inhibition in all children. The heart rate of all children was increased in the two conditions of reward and reward/response cost. Study 2 revealed that children with ADHD-I responded more slowly and showed increased reaction time variability compared to both other groups. The present study supports an executive rather than a motivational deficit in the response inhibition among children with ADHD-C, though further results also indicate the role of auditory feedback on response inhibition. Additionally, the findings support the differentiation of ADHD-C and ADHD-I, suggesting that ADHD-I children are characterized by a sluggish cognitive tempo.     

Processing Speed Weakness in Children and Adolescents with Non-Hyperactive but Inattentive ADHD (ADD)

DSM-IV-TR defines ADHD-Predominantly Inattentive as allowing up to five symptoms of hyperactivity/impulsivity, while theories of the inattentive type usually assume a group that is hypoactive and characterized by processing speed and cognitive interference deficits. In a community-recruited sample of 572 children and adolescents, a pure inattentive subtype of ADHD (ADD) was defined as those who met DSM-IV-TR criteria for ADHD-PI but had two or fewer hyperactive/impulsive symptoms. Processing and output speeds of those with ADD were compared to those identified with DSM-IV-TR ADHD combined type and non-ADHD controls. These results were then contrasted with those found when DSM-IV-TR defined ADHD-PI was compared with ADHD-C and controls. Processing and output speed were assessed with the Trailmaking A and B and the Stroop Naming Tests. Cognitive interference control was assessed with the interference score from the Stroop Task. Slower cognitive interference speed was found in the ADD vs. ADHD-C and controls comparisons, but not the ADHD-PI versus ADHD-C and controls comparisons. On output speed measures, ADD exhibited the slowest performance, significantly different from controls and the effect size for the set-shifting speed contrast (Trailmaking B) was double that of the ADHD-PI vs. control comparison. ADHD-Inattentive type as defined by the DSM-IV-TR is a heterogeneous condition with a meaningful proportion of those affected exhibiting virtually no hyperactive/impulsive symptoms. This subgroup may represent a distinct inattentive condition characterized by poor cognitive interference control and slow processing or output speed.     

Agreement between Parents and Children on Ratings of Post-Concussive Symptoms Following Mild Traumatic Brain Injury

The level of parent-child agreement on post-concussive symptoms (PCS) was examined in children following mild traumatic brain injuries (TBI). As part of a larger longitudinal study, 186 children with mild TBI and 99 with orthopedic injuries (OI), from 8 to 15 years of age, were recruited prospectively. Parents and children completed the PCS Interview (PCS-I) and the Health and Behavior Inventory (HBI) at 2 weeks, 1 month, 3 months, and 12 months postinjury. Item-level correlations between child and parent ratings on both measures of PCS were significant but modest in both groups. Parent-child correlations for composite scales on the HBI and the total score on the PCS-I were significant in both groups, but somewhat higher in the OI group than in the mild TBI group. Mean symptom ratings tended to be significantly higher for children as compared to parents, especially for somatic symptoms. Parents and children display modest agreement when reporting PCS; their ratings correlate significantly, but children report higher mean levels of symptoms than parents.