Abstract
It is well documented that attention‐deficit hyperactivity disorder (ADHD) often presents with co‐occurring motor difficulties. However, little is known about the biological mechanisms that ...explain compromised motor skills in approximately half of those with ADHD. To provide insight into the neurobiological basis of poor motor outcomes in ADHD, this study profiled the development of white matter organization within the cortico‐spinal tract (CST) in adolescents with ADHD with and without co‐occurring motor problems, as well as non‐ADHD control children with and without motor problems. Participants were 60 children aged 9–14 years, 27 with a history of ADHD and 33 controls. All underwent high‐angular resolution diffusion MRI data at up to three time points (115 in scans total). We screened for motor impairment in all participants at the third time point (≈14 years) using the Developmental Coordination Disorder Questionnaire (DCD‐Q). Following pre‐processing of diffusion MRI scans, fixel‐based analysis was performed, and the bilateral CST was delineated using TractSeg. Mean fiber density (FD) and fiber cross‐section (FC) were extracted for each tract at each time‐point. To investigate longitudinal trajectories of fiber development, linear mixed models were performed separately for the left and right CST, controlling for nuisance variables. To examine possible variations in fiber development between groups, we tested whether the inclusion of group and the interaction between age and group improved model fit. At ≈10 years, those with ADHD presented with lower FD within the bilateral CST relative to controls, irrespective of their prospective motor status. While these microstructural abnormalities persisted into adolescence for individuals with ADHD and co‐occurring motor problems, they resolved for those with ADHD alone. Divergent maturational pathways of motor networks (i.e., the CST) may, at least partly, explain motor problems individuals with ADHD.
Objective: Only a handful of studies have attempted to explore very long-term outcomes from childhood traumatic brain injury (TBI). These studies have generally failed to fully consider the impact of ...injury severity or employ measures sensitive to the survivor's day-to-day function. This study examined outcomes in adulthood, with a focus on functional abilities including education, employment, and quality of life (QOL), and employed predictors including injury severity, age at injury, socioeconomic factors, intelligence, and personality. Method: The study was retrospective and cross-sectional and included 50 adult survivors of child TBI (31 males), aged 19-30 years at evaluation (M = 24.2, SD = 3.6), with injury on average 13.3 years prior to evaluation. Participants were divided according to injury severity-mild (n = 20), moderate (n = 12), and severe (n = 18)-completed an intellectual evaluation and questionnaires regarding educational and employment status, personality, and quality of life. Results: Intellectual and personality measures indicated good outcomes, with mean scores for all groups in the average range and few severity-based findings. In contrast, those with more severe TBI were more likely to have educational and employment problems. QOL was significantly reduced in the context of severe insult, with lower IQ and personality factors most predictive of outcome in this domain. Mild and moderate TBI were generally more benign. Conclusions: Findings suggest that, while TBI is a lifelong problem, its impact is most dramatic in the domain of QOL, where a complex interaction occurs between injury factors, cognition, and personality.
Children with attention deficit hyperactivity disorder (ADHD) often present with deficits in fine motor control. The cortico-spinal tract (CST) is critical for voluntary motor control. Although ...neuroimaging work has identified anomalous microstructural properties in the CST in ADHD, no study to date has attempted to investigate the link between deficits in fine motor performance and microstructural properties of the CST in children with ADHD. This study aimed to address this gap using a novel fixel-based analysis (FBA).
Participants were 50 right-handed medication naïve children with a history of ADHD and 56 non-ADHD controls aged 9–11 years. Fine motor control was assessed using the Grooved Pegboard task. Children underwent high angular resolution diffusion MRI. Following pre-processing, FBA was performed and the semi-automated deep-learning TractSeg was used to delineate the CST bilaterally. Fibre density (FD), fibre cross-section (FC-log), and fibre density/cross-section (FDC) were extracted for each tract.
Children with ADHD performed significantly worse than non-ADHD children on the Grooved Pegboard task when using their non-dominant hand. They also demonstrated widespread significantly lower diffusion metrics in both CSTs compared to non-ADHD controls. However, no correlations were observed between Grooved Pegboard performance and diffusion metrics for the CST in either hemisphere.
While we failed to detect a significant relationship between fine motor skill and FBA metrics in either group, this paper extends previous work by showing that children with ADHD and reduced fine motor competence demonstrate atypical microstructure within the CST relative to non-ADHD controls.
•This is the first study to adopt fixel-based analysis to examine white matter correlates of fine motor competence in ADHD.•Children with ADHD showed lower fibre density and cross-section of the corticospinal tract (CST) compared to controls.•The same children with ADHD showed poorer non-dominant fine motor performance.•Children with ADHD and reduced fine motor skill show atypical microstructure within the CST relative to non-ADHD controls.
Childhood traumatic brain injury (TBI) has implications for functional outcomes, but few studies have documented long-term outcomes. The purpose of this study was to plot recovery of cognitive and ...functional skills after early childhood TBI to 10 years postinjury and to identify the contribution of injury, environment, preinjury characteristics, and acute functional recovery.
Subjects were recruited consecutively to this prospective, longitudinal study, which used a between-factor design, with injury severity as the independent variable. Forty children with TBI aged 2 and 7 years were recruited on admission to a tertiary pediatric hospital, divided according to injury severity, and compared with 16 healthy controls acutely and 12 and 30 months and 10 years postinjury. Cognition, adaptive ability, executive function, and social/behavioral skills were examined.
Children with severe TBI had poorest outcomes, with deficits greatest for cognition. Recovery trajectories were similar across severity groups but with significant gains in verbal skills from 12 and 30 months to 12 months and 10 years. Predictors of outcome included preinjury ability (for adaptive function) and family function (social/behavioral skills).
Results confirm a high risk of persisting deficits after severe TBI in early childhood. Children with less severe TBI appear to recover to function normally. Contrary to speculation about "growing into deficits," after protracted recovery to 30 months, young children make age-appropriate progress at least to 10 years postinsult. Environmental factors were found to contribute to adaptive and social/behavioral recovery.
Paediatric traumatic brain injury (pTBI) results in inconsistent changes to regional morphometry of the brain across studies. Structural-covariance networks represent the degree to which the ...morphology (typically cortical-thickness) of cortical-regions co-varies with other regions, driven by both biological and developmental factors. Understanding how heterogeneous regional changes may influence wider cortical network organization may more appropriately capture prognostic information in terms of long term outcome following a pTBI. The current study aimed to investigate the relationships between cortical organisation as measured by structural-covariance, and long-term cognitive impairment following pTBI. T1-weighted magnetic resonance imaging (MRI) from n = 83 pTBI patients and 33 typically developing controls underwent 3D-tissue segmentation using Freesurfer to estimate cortical-thickness across 68 cortical ROIs. Structural-covariance between regions was estimated using Pearson's correlations between cortical-thickness measures across 68 regions-of-interest (ROIs), generating a group-level 68 × 68 adjacency matrix for patients and controls. We grouped a subset of patients who underwent executive function testing at 2-years post-injury using a neuropsychological impairment (NPI) rule, defining impaired- and non-impaired subgroups. Despite finding no significant reductions in regional cortical-thickness between the control and pTBI groups, we found specific reductions in graph-level strength of the structural covariance graph only between controls and the pTBI group with executive function (EF) impairment. Node-level differences in strength for this group were primarily found in frontal regions. We also investigated whether the top n nodes in terms of effect-size of cortical-thickness reductions were nodes that had significantly greater strength in the typically developing brain than n randomly selected regions. We found that acute cortical-thickness reductions post-pTBI are loaded onto regions typically high in structural covariance. This association was found in those patients with persistent EF impairment at 2-years post-injury, but not in those for whom these abilities were spared. This study posits that the topography of post-injury cortical-thickness reductions in regions that are central to the typical structural-covariance topology of the brain, can explain which patients have poor EF at follow-up.
Despite higher rates of irritability and socioemotional symptoms in ADHD, consensus is lacking regarding their developmental relationship and whether it differs by ADHD status. This longitudinal ...study sought to evaluate how peer and emotional difficulties relate to irritability in ADHD and control groups.
A community sample of 336 participants (45 % ADHD) were recruited for the Children's Attention Project. Participants completed the Affective Reactivity Index and the Strengths and Difficulties Questionnaire's emotional and peer difficulties scales at baseline (mean age 10.5 years) and 18-month follow-up. Latent Change Score models assessed how emotional and peer difficulties related to irritability at baseline and longitudinally.
For both groups, more severe baseline difficulties were associated with higher concurrent irritability, and reductions in emotional and peer difficulties were associated with declining irritability. Baseline emotional difficulties predicted change in irritability for the ADHD group, while baseline peer difficulties predicted change in irritability for both groups. Baseline irritability did not predict change in emotional or peer difficulties for either. The ADHD group showed elevated irritability, emotional, and peer difficulties, and stronger baseline correlation between peer difficulties and irritability.
Only two timepoints were captured, and associations with ADHD symptom severity and presentation were not investigated. Doing so may facilitate additional insights.
Change in irritability corresponded to change in socioemotional difficulties, and was driven by earlier levels of socioemotional difficulties. ADHD exacerbated aspects of the relationship between socioemotional difficulties and irritability. Socioemotional difficulties drive irritability, so may represent targets for clinical interventions.
•ADHD exacerbated the baseline relationship of peer difficulties and irritability.•Irritability in late childhood did not drive change in socioemotional difficulties.•Baseline emotional difficulties drove change in irritability for children with ADHD.•Baseline peer difficulties drove change in irritability for ADHD and control groups.•Socioemotional factors drive irritability, so may be clinical intervention targets.
A systematic review of the literature investigating the early traumatic stress responses in parents of children diagnosed with a serious illness/injury. A literature review was conducted (September ...2013) using Medline, PsycINFO, and CINAHL databases. Twenty-four studies related to parents of children hospitalized due to diagnosis of cancer, type 1 diabetes, meningococcal disease, trauma or serious injury, preterm birth and other serious illnesses requiring admission to intensive care were included. Parents were assessed for early traumatic stress symptoms within 3 months of their child’s diagnosis/hospitalization. Prevalence rates of acute stress disorder in parents ranged from 12 to 63 %. Prevalence of posttraumatic stress disorder ranged from 8 to 68 %. Variability was related to methodological factors including differences in study design, timing of assessments, measurement tools, and scoring protocols. Psychosocial factors rather than medical factors predicted parent distress. This review integrates and compares early traumatic reactions in parents with children suffering a range of serious illnesses. Findings suggest a high prevalence of acute and posttraumatic stress symptoms in parents. Methodological inconsistencies made comparison of early traumatic stress prevalence rates difficult. Risk factors associated with traumatic stress symptoms were identified.
ObjectiveSerious childhood illness is associated with significant parent psychological distress. This study aimed to (a) document acute and posttraumatic stress symptoms (PTSS) in parents of children ...with various life-threatening illnesses; (b) identify trajectory patterns of parental PTSS and recovery over 18 months; (c) determine psychosocial, demographic, and illness factors associated with trajectory group membership. MethodsIn total, 159 parents (115 mothers, 44 fathers) from 122 families participated in a prospective, longitudinal study that assessed parent psychological responses across four time points-at diagnosis, and 3, 6, and 18 months later. Children were admitted to the Cardiology, Oncology, and Pediatric Intensive Care Departments in a tertiary pediatric hospital. The primary outcome was parent PTSS. ResultsThree distinct parent recovery profiles were identified-"Resilient," "Recovery," and "Chronic." The "Resilient" class (33%) showed low distress responses across the trajectory period, whereas the "Recovery" class (52%) showed significantly higher levels of distress at the time of diagnosis that gradually declined over the first months following their child's illness. Both of these classes nevertheless remained within the normative range throughout. In contrast, the "Chronic" class (13%) was consistently high in severity, remaining within the clinical range across the entire period. Psychosocial factors such as mood, anxiety, and emotional responses predicted group membership, whereas demographic and illness factors did not. ConclusionsParents show considerable resilience in the face of children's life-threatening illnesses. Early assessment of parent psychosocial factors may aid identification of those who would benefit from early intervention.
This longitudinal study aimed to examine acute and posttraumatic stress symptoms and predictors of traumatic stress symptoms in parents of children recently diagnosed with cancer. The sample ...comprised 220 parents of 143 children who completed questionnaires at diagnosis (T1) focused on acute stress disorder (ASD); of these, 145 parents of 97 children completed questionnaires 6–8 months later (T2) focused on posttraumatic stress disorder (PTSD). Demographic, psychosocial, and treatment and illness variables were predictors. Results were that 63% of mothers and 60% of fathers met criteria for ASD at T1. At T2, 21% of mothers and 16% of fathers met criteria for PTSD, with 40% of parents reporting significant subthreshold symptoms. Predictors of ASD symptoms were female gender, presence of psychosocial risk factors, trait anxiety, family functioning, and central nervous system tumor diagnosis. Risk factors for PTSD symptoms were younger maternal age, severity of ASD symptoms, and trait anxiety at T1, and parent‐reported quality of life of the child at T2. The results suggest that screening for ASD may help identify parents at increased risk of persistent traumatic stress symptoms who could benefit from preventative, evidence‐based psychosocial interventions.
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