title: Predictors of longitudinal outcome and recovery of pragmatic language and its relation to externalizing behaviour after pediatric traumatic brain injury.
abstract: The purpose of the present investigation was to evaluate the contribution of age-at-insult and brain pathology on longitudinal outcome and recovery of pragmatic language in a sample of children and adolescents with traumatic brain injury (TBI). Children and adolescents with mild to severe TBI (n=112) were categorized according to timing of brain insult: (i) Middle Childhood (5-9 years; n=41); (ii) Late Childhood (10-11 years; n=39); and (iii) Adolescence (12-15 years; n=32) and group-matched for age, gender and socio-economic status (SES) to a typically developing (TD) control group (n=43). Participants underwent magnetic resonance imaging (MRI) including a susceptibility weighted imaging (SWI) sequence 2-8 weeks after injury and were assessed on measures of pragmatic language and behavioural functioning at 6- and 24-months after injury. Children and adolescents with TBI of all severity levels demonstrated impairments in these domains at 6-months injury before returning to age-expected levels at 2-years post-TBI. However, while adolescent TBI was associated with post-acute disruption to skills that preceded recovery to age-expected levels by 2-years post injury, the middle childhood TBI group demonstrated impairments at 6-months post-injury that were maintained at 2-year follow up. Reduced pragmatic communication was associated with frontal, temporal and corpus callosum lesions, as well as more frequent externalizing behaviour at 24-months post injury. Findings show that persisting pragmatic language impairment after pediatric TBI is related to younger age at brain insult, as well as microhemorrhagic pathology in brain regions that contribute to the anatomically distributed social brain network. Relationships between reduced pragmatic communication and more frequent externalizing behavior underscore the need for context-sensitive rehabilitation programs that aim to increase interpersonal effectiveness and reduce risk for maladaptive behavior trajectories into the long-term post injury.
authors: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia. Electronic address: nicholas.ryan@mcri.edu.au.
authors: Nicholas P
authors: NP
authors: Ryan
authors: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Psychology, Royal Children's Hospital, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia. Electronic address: cathy.catroppa@mcri.edu.au.
authors: Cathy
authors: C
authors: Catroppa
authors: Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, Australia. Electronic address: richard.beare@mcri.edu.au.
authors: Richard
authors: R
authors: Beare
authors: Department of Radiology, Royal Children's Hospital, Melbourne, Australia. Electronic address: lee.coleman@rch.org.au.
authors: Lee
authors: L
authors: Coleman
authors: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia. Electronic address: michael.ditchfield@southernhealth.org.au.
authors: Michael
authors: M
authors: Ditchfield
authors: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia. Electronic address: louise.crossley@mcri.edu.au.
authors: Louise
authors: L
authors: Crossley
authors: Department of Psychology, University of Montreal, Montreal, Canada; Ste-Justine Research Center, Montreal, Quebec, Canada. Electronic address: Miriam.beauchamp@umontreal.ca.
authors: Miriam H
authors: MH
authors: Beauchamp
authors: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Psychology, Royal Children's Hospital, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia. Electronic address: vicki.anderson@rch.org.au.
authors: Vicki A
authors: VA
authors: Anderson
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001930:Brain Injuries / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D002675:Child, Preschool; D003337:Corpus Callosum / Q000293:injuries / Q000503:physiopathology; D005260:Female; D005625:Frontal Lobe / Q000293:injuries / Q000503:physiopathology; D006801:Humans; D007389:Internal-External Control; D007802:Language; D007806:Language Disorders / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D013702:Temporal Lobe / Q000293:injuries / Q000503:physiopathology
keywords: Brain injuries; Child; Magnetic resonance imaging; Neurobiology; Pragmatic language