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Background: It is estimated that at least 225,000 children are seen in Emergency Departments (ED) for concussion in the United States each year. Studies have shown that positive coping skills and psychological resilience influence post-concussive symptoms. No work in this limited field has examined the influence of coping skills and psychological resilience in the same study sample. Additional research is warranted to investigate the relationship between these factors and concussion outcomes during the acute recovery period to determine the most appropriate targets for therapy and who may be most likely to benefit. I hypothesized that the problem-focused engagement coping style (PFE) would mediate post-concussive symptoms at both two- and four-weeks post-injury and that pre-injury psychological resilience would moderate concussion symptoms at these timepoints. In addition, I hypothesized a moderated mediation model, such that the influence of PFE would be more evident in individuals with higher levels of pre-injury resilience.Method: 61 adolescents (ages 11-18) who sustained a concussion completed measures of coping (Coping Strategies Inventory-Short Form), and concussion symptoms (Health and Behavior Inventory) beginning in the emergency department and weekly throughout the four-week course of an online intervention study. Resilience (Connor-Davidson Resilience Scale), was measured only in the ED. Multiple imputation with predictive mean matching was utilized to account for missing data. Analyses included the Baron and Kenny procedure for estimating mediation effects and Hierarchical Bayesian methods were used to test any potential mediation effects in both the overall sample and following a mean split to investigate moderated mediation. Multiple regression analyses were used to evaluate moderation effects.Results: Coping and resilience were significantly correlated with concussion symptoms at both timepoints (r(60) ranged from -.37 to -.28 for coping skills; r(60) ranged from -.62 to -.32 for resilience). Findings did not support the hypothesized mediation effects. In regression analyses examining resilience as a moderator of concussion recovery, resilience had main effects on concussion symptoms at two- and four-weeks post injury but did not moderate recovery in symptoms. However, the moderation effect of resilience on concussion recovery trended towards significance (p = .06) at four-weeks post injury. The hypothesized moderated mediation effects were not supported.Discussion: While the proposed mediation and moderation models were not supported, results of the study have potential clinical implications. The predictor and outcome variables were all highly correlated with each other, suggesting that these factors play a role in concussion recovery. The moderation model at week two was not significant. However, it was significant at four weeks post-injury, suggesting that effects may change over time. To my knowledge, this was the first study that examined both coping and resilience in the same statistical models with a pediatric population. This study was limited by a small and heterogeneous sample of adolescents, who were recruited from an ED, which is often a stressful environment. Future work should investigate symptoms beginning in the acute stage and into the prolonged stage of concussion recovery to better understand the relationship of these factors to recovery over time.

Abstract Study Objectives: Investigate whether a realistic “dose” of shortened sleep, relative to a well-rested state, causes a decline in adolescents’ learning and an increase in inattentive and sleepy behaviors in a simulated classroom setting. Methods: Eighty-seven healthy 14.0- to 16.9-year olds underwent a 3-week sleep manipulation protocol, including two 5-night sleep manipulation conditions presented in a randomly counterbalanced within-subjects cross-over design. Wake time was held constant. Bedtimes were set to induce Short Sleep (SS; 6.5 hours in bed) versus Healthy Sleep (HS; 10 hours in bed). During the morning at the end of each condition, participants underwent a simulated classroom procedure in which they viewed lecture-based educational videotapes and completed relevant quizzes. Their behaviors in the simulated classroom were later coded by condition-blind raters for evidence of inattention and sleepiness. Results: Adolescents had a longer average sleep period during HS (9.1 hours) than SS (6.5 hours). Compared to scores during HS, adolescents scored significantly lower on the quiz, showed more behaviors suggestive of inattention and sleepiness in the simulated classroom, and were reported by adolescents themselves and by their parents to be more inattentive and sleepy during SS. However, the impact of the manipulation on quiz scores was not mediated by changes in attention or sleepiness. Conclusions: Although effect sizes were modest, these findings suggest that previously-reported correlations between sleep duration and academic performance reflect true cause–effect relationships. Findings add to the growing evidence that the chronically shortened sleep experienced by many adolescents on school nights adversely impacts their functioning and health.

To identify latent trajectories of IQ over time after pediatric traumatic brain injury (TBI) and examine the predictive value of risk factors within and across recovery trajectories. 206 children ages 3-7 years at injury were included: 87 TBI (23 severe, 21 moderate, 43 complicated mild) and 119 orthopedic injury (OI). We administered intelligence tests shortly after injury (1½ months), 12 months, and 6.8 years postinjury. Latent class growth modeling was used to identify latent subgroups. Separate models examined verbal and nonverbal IQ recovery trajectories following TBI versus OI. Variables included: age at injury, sex, race, socioeconomic status, injury severity, quality of the home environment, family functioning, and parenting style. Both the TBI and OI analyses yielded different growth models for nonverbal ( = 3) and verbal IQ ( = 3). Although all models resulted in 3 latent classes (below average, average, and aboveaverage performance); trajectory shapes, contributors to class membership, and performance within each class varied by injury group and IQ domain. TBI severity was associated with class membership for nonverbal IQ, with less severe injuries associated with higher IQ scores; however, TBI severity did not influence verbal IQ class membership. Parenting style had a more prominent effect on verbal and nonverbal IQ within the TBI than OI trajectories. Findings suggest TBI severity is related to recovery trajectories for nonverbal but not verbal IQ and parenting style has stronger effects on recovery in TBI than OI. Results highlight the importance of parental factors on long-term recovery after TBI.

Objective: To investigate the effects of methylphenidate on long-term executive and neuropsychological functioning in children with attention problems following TBI, as well as the relationship between methylphenidate associated changes in lab-based neuropsychological measures of attentional control, processing speed, and executive functioning and parent- or self-report measures of everyday executive functioning. Method: 26 children aged 6–17 years, who were hospitalized for moderate-to-severe blunt head trauma 6 or more months previously, were recruited from a large children’s hospital medical center. Participants were randomized into a double-masked, placebo-controlled cross-over clinical trial. Participants completed a comprehensive neuropsychological battery and parent- and self-report ratings of everyday executive functioning at baseline, and at 4 weeks and 8 weeks following upward titration of medication to an optimal dose or while administered a placebo. Results: Methylphenidate was associated with significant improvements in processing speed, sustained attention, and both lab-based and everyday executive functioning. Significant treatment-by-period interactions were found on a task of sustained attention. Participants who were randomized to the methylphenidate condition for the first treatment period demonstrated random or erratic responding, with slower and more variable response times when given placebo during the second period. Conclusion: Results indicate that methylphenidate treatment is associated with positive outcomes in processing speed, sustained attention, and both lab-based and everyday measures of executive functioning compared to placebo group. Additionally, results suggest sustained attention worsens when discontinuing medication. (JINS, 2019, 25, 740–749)

Pediatric traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children and adolescents. In 2013, over 300,000 children under the age of 5 years presented to emergency departments with a TBI. Very young children (= 3years old) have double the risk of experiencing a TBI than older children. These very young children are at risk for more severe injuries due to both anatomical and environmental factors. Despite the high prevalence of injury in this population, they have traditionally been understudied. TBI in older children and adolescents is associated with deficits across a wide variety of areas, many of which may not become problematic until children have reached school age and are required to take on additional cognitive load. This, in addition to the fact that TBI can be difficult to identify and that young children are more difficult to assess in general when compared to older children and adolescents, may be one of the factors that has led to the majority of research in TBI to focus on older children. Studies in these older populations have illustrated the importance of the family environment and parental warm responsiveness in influencing both cognitive and behavioral outcomes, while studies in this very young population have demonstrated the importance of more distal environmental factors (e.g., social capital.) The current study investigated the potential moderating effect of caregiver warm responsiveness on adaptive, developmental, and health-related quality of life outcome following TBI in 30 children aged 0-2 years old. After being recruited from the emergency department at CCHMC, families returned 1 and 6 months post-injury for follow up visits. Separate linear mixed models examined moderation effects. An interaction was found between injury severity and parental responsiveness on parent-reported fine motor functioning; children with moderate injury severity scored higher than those with a severe injury at low levels of parental responsiveness. This measure was comparable in both groups at high levels of parental responsiveness. An interaction between injury severity and parental responsiveness on general developmental functioning was also found. However, post-hoc analyses were not significant. Finally, a significant interaction between injury severity and parental responsiveness was found on HRQOL; children with moderate injury severity scored higher than those with a severe injury at low levels of parental responsiveness, a result that trended towards significance. HRQOL was similar in both groups at high levels of parental responsiveness. Within the severe group, HRQOL differed significantly between those with high versus low levels of parental responsiveness, children with responsive parents had significantly higher HRQOL than those with less responsive parents. Results indicate the importance of parental responsiveness in recovery from TBI in very young children. Specifically, results suggest that high levels of parental responsiveness are associated with better outcomes in children with both moderate and severe injuries. Additional research is warranted to continue investigating these outcomes in larger samples. As intervention studies in older populations have shown the impact of parental responsiveness on HRQOL, it is possible that similar interventions could be adapted for younger populations.