Theory of mind (TOM), the ability to infer mental states to self and others, has been a pervasive research theme across many disciplines including developmental, educational, neuro-, and social ...psychology, social neuroscience and speech therapy. TOM abilities have been consistently linked to markers of social adaptation and have been shown to be affected in a broad range of clinical conditions. Despite the wealth and breadth of research dedicated to TOM, identifying appropriate assessment tools for young children remains challenging. This systematic review presents an inventory of TOM measures for children aged 0-5 years and provides details on their content and characteristics. Electronic databases (1983-2019) and 9 test publisher catalogs were systematically reviewed. In total, 220 measures, identified within 830 studies, were found to assess the understanding of seven categories of mental states and social situations: emotions, desires, intentions, percepts, knowledge, beliefs and mentalistic understanding of non-literal communication, and pertained to 39 types of TOM sub-abilities. Information on the measures' mode of presentation, number of items, scoring options, and target populations were extracted, and psychometric details are listed in summary tables. The results of the systematic review are summarized in a visual framework "Abilities in Theory of Mind Space" (ATOMS) which provides a new taxonomy of TOM sub-domains. This review highlights the remarkable variety of measures that have been created to assess TOM, but also the numerous methodological and psychometric challenges associated with developing and choosing appropriate measures, including issues related to the limited range of sub-abilities targeted, lack of standardization across studies and paucity of psychometric information provided.
This retrospective cohort study investigates how parenting stress, measured at 4 months of age by use of a classic three-dimensional parent-reported scale (Parenting Stress Index, 4th Ed. or PSI-4), ...can predict anxiety symptoms and quality of sleep at 24 months in toddlers with congenital heart disease (CHD).
Sixty-six toddlers with CHD followed at our cardiac neurodevelopmental follow-up clinic were included in this study. As part of their systematic developmental assessment program, parents completed questionnaires on their stress level (PSI-4) when their child was 4 months old, and on their child's anxiety symptoms and quality of sleep at 24 months. Eight multiple linear regression models were built on the two measures collected at 24 months using the PSI-4 scores collected at 4 months. For each measure, four models were built from the PSI-4 total score and its three subscales (Parental Distress, Parent-Child Dysfunctional Interaction, Difficult Child), controlling for sex and socioeconomic status.
The PSI-4 Difficult Child subscale, which focuses on parenting anxiety related to the child's behavioral problems and poor psychosocial adjustment, accounted for 17% of the child's anxiety symptoms at 24 months. The two other PSI-4 subscales (Parental Distress and Parent-Child Dysfunctional Interaction) and the PSI-4 total score did not contribute significantly to the models. None of the four regression models on perceived quality of sleep were significant. It is important to note that 33% of parents responded defensively to the PSI-4.
Parenting stress related to the child's behavioral problems and poor psychosocial adjustment, measured when the child is 4 months old, is associated with the child's ulterior anxiety symptoms. As very few standardized tools are available to assess the behavioral and psychoaffective development of infants, this study highlights the importance of early psychosocial screening in parents of infants with CHD. The high rate of significant Defensive Responding Indices reminds us to not take parent reports at face value, as their actual stress levels might be higher.
Purpose: This study aimed to determine whether two aspects of global intelligence, fluid (Gf) and crystallized (Gc) intelligence, could be improved in adolescents with below-average IQ by using a ...game-based cognitive intervention. Method: Thirty-four adolescents participated in cognitive interventions targeting either Gf (GAMEf, n = 12) or Gc (GAMEc, n = 12) or were assigned to a control group (n = 10). Interventions took place two days a week for one hour, over 8 weeks. Standard neuropsychological assessments were conducted prior to and after the intervention to measure possible improvements in Gc (using the Wechsler Scales, WISC-IV), and Gf (using the Test Of Non verbal Intelligence, TONI-4). Results: Adolescents in the GAMEf program improved on measures of Gf, while adolescents in the GAMEc program improved on both measures of Gc and Gf. Conclusions: The results indicate that individuals with below average IQ can improve their fluid and crystallized intellectual functioning through direct cognitive training using commercially available games, suggesting that intellectual functioning at this level may be more susceptible to remediation than previously thought. These findings could have direct implications for cognitive intervention and learning potential in clinical populations with below average IQ.
Sleep-wake disturbances (SWD) after traumatic brain injury (TBI) are frequently reported and can persist several years post-injury. The adult literature covering this topic is exhaustive; numerous ...robust studies using objective measures of sleep and advanced methodologies support the presence of SWD post-TBI. Despite being the leading cause of morbidity in children and adolescents, however, relatively few studies exist investigating SWD and symptoms of fatigue after pediatric TBI. We undertook a systematic search of the literature in PsycINFO, MEDLINE, CINAHL, and Web of Science databases with the aim of documenting persistent fatigue and SWD after pediatric TBI. Terms and keywords pertaining to TBI, children/adolescents, and sleep/fatigue were used, and of the 461 articles initially identified, 24 studies met our inclusion criteria. According to the results of the literature search, SWD and fatigue are common after pediatric TBI. The methodologies used in the studies reported varied widely, however, and were mainly subjective (e.g., questionnaires and interviews with caregivers). Moreover, no study targeted preschool children despite the fact that there is evidence regarding the critical importance of sleep for appropriate cognitive development, especially in high-order cognitive functioning. In sum, the results of the studies analyzed were consistent with the presence of SWD and fatigue after pediatric TBI, but there is a lack of information concerning this relationship in younger children. The use of more objective measures, such as actigraphy, could bring better insight to the impact of TBI on the quality of children's sleep.
Pediatric traumatic brain injury (TBI) is a leading cause of long-term disability in children and adolescents worldwide. Amongst the wide array of consequences known to occur after pediatric TBI, ...behavioral impairments are among the most widespread and may particularly affect children who sustain injury early in the course of development. The aim of this study was to investigate the presence of internalizing and externalizing behavioral problems 6 months after preschool (i.e. 18-60 months old) mild TBI.
This work is part of a prospective, longitudinal cohort study of preschool TBI. Participants (N = 229) were recruited to one of three groups: children with mild TBI, typically developing children and orthopedic injured (OI) children. Mothers of children in all three groups completed the Child Behavior Checklist as a measure of behavioral outcomes 6-month post-injury. Demographics, injury-related characteristics, level of parental distress, and estimates of pre-injury behavioral problems were also documented.
The three groups did not differ on baseline characteristics (e.g. demographics and pre-injury behavioral problems for the mild TBI and OI groups) and level of parental distress. Mothers' ratings of internalizing and externalizing behaviors were higher in the mild TBI group compared with the two control groups. Pre-injury behavioral problems and maternal distress were found to be significant predictors of outcome.
Our results show that even in its mildest form, preschool TBI may cause disruption to the immature brain serious enough to result in behavioral changes, which persist for several months post-injury.
Abstract
Objective
To document longitudinal changes in internalizing and externalizing behavioral symptoms after mild traumatic brain injury (mTBI) sustained in early childhood (i.e., between 18 and ...60 months of age).
Methods
Participants (N = 226) were recruited to one of three groups: children with mTBI, typically developing children and orthopedic injured children. The Child Behavior Checklist was used to document the presence of internalizing and externalizing behaviors at 6, 18, and 30 months postinjury. Linear mixed-model analyses were used to examine group effects on the trajectory of internalizing and externalizing behavioral manifestations over 30 months postinjury.
Results
Children who sustain mTBI during the preschool period have higher rates of internalizing and externalizing behavioral symptoms at the initial assessment time point and these symptoms persist up to 30 months postinjury. Moreover, results indicate that for up to 18 months postinjury, significantly more children with mTBI present behavioral difficulties that may require some form of clinical attention (i.e., scores in the borderline or clinical range), than do their orthopedically injured and noninjured peers.
Conclusions
Sustaining mTBI early in life may lead to long-lasting behavioral changes in young children (i.e., at least 30 months). These changes are likely the product of a complex interplay between neurological and non-neurological factors, both contributing to generating and maintaining behavioral difficulties.
Mild traumatic brain injuries (mTBI) are highly prevalent during early childhood and can lead to behavioral difficulties. Parent report questionnaires are widely used to assess children's behavior, ...but they are subject to parental bias. The aim of this study was to investigate parental discrepancies in internalized and externalized behavior ratings of children who sustain mTBI in early childhood (i.e., between 18 and 60 months) and to determine if parenting stress or family burden related to the injury contribute to parental discrepancies. Mothers and fathers of 85 children with mTBI, 58 orthopedic injured (OI), and 82 typically developing children (TDC) completed the Child Behavior Checklist 6 months after the injury. The primary caregiver completed the Parental Distress subscale of the Parenting Stress Index and the Family Burden of Injury Interview. Mothers reported more internalized and externalized behavior problems than fathers in the mTBI group. No group difference was found in the OI or TDC groups. Neither parenting stress nor family burden related to the injury predicted discrepancies in behavior ratings. Mothers' and fathers' perceptions of behavior after their young child sustains mTBI appear to differ, suggesting that both parents' views are useful in understanding outcome. This difference was not found in either of the comparison groups indicating that factors related to mTBI may underlie the rating discrepancies.
Despite medical advances, prematurity is associated with a higher risk of neurodevelopmental problems. Although social impairments are commonly reported in preterm children, their origins are not ...clearly determined though they may be associated with the integrity of social cognitive skills, such as theory of mind. This study aimed to assess social cognitive, social adaptive, and social behavior functioning in children born extremely prematurely. Thirty children born between 22 and 28 weeks of gestation and 30 children born at term completed measures of social cognition (theory of mind, affect recognition) between 4:6, 5:11 years of age (mean = 5.29, standard deviation = 0.28 years). Parents completed questionnaires measuring their child's adaptive social functioning and social behavior. Analyses of covariance controlling for cognitive, attentional, executive, sociodemographic, and perinatal characteristics were performed. Children born between 22 and 28 weeks displayed poorer theory of mind (p < 0.01) and affect recognition (p < 0.01) than term controls, and their parents reported lower adaptive social functioning (p < 0.01) and prosocial behavior (p = 0.04). Social cognitive, adaptive, and behavior functioning appear to be affected by extreme preterm birth. These findings may explain the social challenges experienced by extremely preterm children and provide potential loci for targeted interventions to optimize social functioning.
•Testing a comprehensive and longitudinal prediction model of quality of life after early mild TBI.•BDNF Val66Met polymorphism predicts better quality of life 6 months after early mild TBI.•Higher ...parental distress determines poorer quality of life 18 months after early mild TBI.•Genetic factors linked to neuroplasticity may be important to recovery in the early phase post-TBI.
Mild traumatic brain injury (mTBI) in early childhood is prevalent, and some children may be at risk for short- and long-term difficulties that could affect quality of life (QoL). Despite growing efforts to understand associations between potential risk factors and outcomes after injury, prognosis is elusive and lacks the inclusion of genetic variables which may convey additional predictive power. This study assessed which factors contribute to pediatric QoL 6 and 18 months post-recruitment in 159 participants (mTBI = 52; orthopedic injury OI = 43; typically developing controls TDC = 64) aged 18 to 60 months at the time of injury (M = 37.50, SD = 11.69). Family environment, injury characteristics, and child cognitive-behavioral functioning were assessed at 6 months via parent questionnaires and socio-cognitive assessment. QoL was determined using the Pediatric Quality of Life Inventory at both time points. Genetic information (Brain-derived neurotrophic factor BDNF genotype) was collected using saliva samples. Hierarchical regression analyses testing biological, family-environmental, injury and cognitive-behavioral factors revealed that the BDNF Val66Met polymorphism was a significant independent predictor of better QoL 6 months post-injury in the mTBI group. Lower parental distress significantly and independently predicted higher QoL 18 months after mTBI, and 6 months post-recruitment in the TDC group. At 18 months, models were non-significant for both control groups. Genetic factors involved in neuroplasticity may play an important role in recovery 6 months after mTBI and contribute to outcome via their interplay with environmental factors. Over time, family factors appear to become the primary determinants of post-mTBI outcome.
Le traumatisme crânio-cérébral (TCC) pédiatrique représente l'une des causes principales de handicap chez les enfants à travers le monde. Parmi la gamme de conséquences documentées suite au TCC ...pédiatrique, les problèmes de comportement seraient très répandus et toucheraient particulièrement les enfants blessés à un jeune âge. En effet, le cerveau en plein développement pourrait s'avérer hautement vulnérable aux effets d'une atteinte cérébrale. Cependant, en ce qui concerne les formes plus légères de TCC (TCC léger; TCCL ou " commotion cérébrale "), les évidences restent mitigées. Alors que certaines études montrent peu, voire aucune manifestation comportementale du TCCL chez le jeune enfant, d'autres études révèlent des difficultés plus significatives et persistantes. L'objectif principal de la présente thèse était de caractériser les conséquences comportementales du TCCL chez l'enfant d'âge préscolaire (≤ 5 ans).;
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La thèse est composée de trois articles empiriques. L'objectif du premier article était d'investiguer la présence de comportements internalisés et externalisés chez l'enfant six mois post-TCCL. Un deuxième objectif était d'identifier les caractéristiques préexistantes de l'enfant et de sa famille, ainsi que les variables liées à la blessure, susceptibles de prédire la présence de difficultés comportementales post-TCCL. L'échantillon comprenait 229 enfants âgés entre 18 et 60 mois, répartis en trois groupes : enfants ayant subi un TCCL (n = 86), enfants avec une blessure orthopédique (n = 62) et enfants contrôles en bonne santé (n = 81). Les résultats révèlent que les enfants d'âge préscolaire ayant subi un TCCL présentent davantage de comportements internalisés et externalisés que leurs pairs six mois après l'accident. En outre, la présence de difficultés comportementales pré-morbides, de même qu'un niveau plus élevé de détresse maternelle, prédisent davantage de difficultés comportementales six mois post-TCCL. ;
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Le deuxième article visait à caractériser les changements longitudinaux de ces comportements internalisés et externalisés observés à six mois post-TCCL. Les résultats indiquent que les difficultés comportementales observées à six mois post-TCCL persistent jusqu'à 30 mois après la blessure. Bien qu'à l'échelle du groupe, les résultats demeurent dans les limites des normes attendues pour l'âge, il existe un sous-groupe d'enfants ayant subi un TCCL qui présente des difficultés qui sont cliniquement significatives et qui persistent au long cours.;
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Le troisième article visait à explorer l'association entre la présence d'un polymorphisme commun du gène BDNF (Val66Met), impliqué dans les mécanismes de plasticité cérébrale, et la présence de comportements internalisés et externalisés post-TCCL, au sein de cette même cohorte d'enfants d'âge préscolaire. Les résultats indiquent un effet protecteur du polymorphisme Val66Met sur les comportements internalisés observés six mois après l'accident, spécifique au groupe d'enfants ayant subi un TCCL. ;
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Les résultats issus de cette thèse permettent de mieux comprendre les conséquences comportementales du TCCL préscolaire, la trajectoire longitudinale des manifestations comportementales et la contribution de certains facteurs propres à l'enfant et à son environnement familial. Ultimement, cette thèse pourrait contribuer à préciser les orientations ministérielles concernant la prise en charge clinique du TCCL chez le jeune enfant et à mieux outiller les cliniciens œuvrant auprès de cette population vulnérable.
Pediatric traumatic brain injury (TBI) is a leading cause of long-term disability in children and adolescents worldwide. Amongst the wide array of consequences known to occur after pediatric TBI, behavioral impairments are among the most widespread and may particularly affect children who sustain injury early in the course of development (i.e., before the age of 6 years). Indeed, recent evidence suggest that the developing brain could be highly vulnerable to injury due to neurobiological and developmental particularities. When it comes to pediatric mild TBI (mTBI or "concussion"), which represents the vast majority of TBI cases in children, there is mixed evidence regarding the extent and chronicity of behavioral consequences. While some studies show little or no evidence of behavioral changes after mTBI sustained in the early years of life, others document persistent behavioral consequences. There is a paucity of studies focusing on early TBI, which likely contributes to the heterogeneity of findings. The overarching aim of this thesis was to characterize behavioral consequences of mTBI sustained in early childhood (i.e., between 18 and 60 months old).;
The thesis is composed of three empirical articles. The aim of the first article was to document the presence of internalizing and externalizing behavior problems six months after preschool mTBI. A second objective was to identify pre-existing child and family characteristics, as well as injury-related variables that could predict behavioral outcome. The sample consisted of 229 children recruited to one of three participant groups: mild TBI (mTBI; n = 86), orthopedic injury (OI; n = 62) and typically developing children (TDC; n = 81). The results indicate that children who sustain preschool mTBI exhibit more internalizing and externalizing problems than their peers six months post-injury. Results also show that pre-injury behavioral problems, as well as higher levels of maternal distress, predict poorer post-TBI behavioral functioning. ;
The second article intended to characterize longitudinal changes in behavioral outcome over 30 months post-injury in the same cohort of preschoolers. Results indicate that the higher rates of internalizing and externalizing symptoms observed in the mTBI group at six months post-injury persist up to 30 months post-injury. Although at the group level, results remain within the expected age norms, there is evidence of a subgroup of children with mTBI who present clinically significant behavioral symptoms, even in the long-term.;
The third article aimed to explore the association between the presence of a common and naturally occurring polymorphism of the BDNF gene (Val66Met), known to be involved in neuroplasticity mechanisms, and behavioral problems after preschool mTBI. Results indicate a protective effect of the Val66Met polymorphism on internalizing symptoms observed at six months post-injury, specific to the mTBI group. ;
Taken together, these findings further our understanding of the behavioral consequences of mTBI in early childhood, the trajectory of recovery and factors that are associated with behavioral difficulties after early TBI. Ultimately, this thesis could contribute to the development of ministerial guidelines for the clinical management of mTBI in young children and support the efforts of clinicians working with this vulnerable population.
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