Response Inhibition After Traumatic Brain Injury (TBI) in Children: Impairment and Recovery

Department of Psychiatry, Brain and Behaviour Programme, The Hospital for Sick Children, University of Toronto, Canada.
Developmental Neuropsychology (Impact Factor: 2.24). 02/2005; 28(3):829-48. DOI: 10.1207/s15326942dn2803_5
Source: PubMed


Children who experience traumatic brain injury (TBI) often show cognitive impairments postinjury, some of which recover over time. We examined the recovery of motor response inhibition immediately following TBI and over 2 years. We assessed the role of injury severity, age at injury, and lesion characteristics on initial impairment and recovery while considering the role of pre-injury psychiatric disorder. Participants were 136 children with TBI aged 5-16 years. Latency of motor response inhibition was measured with the stop-signal task within 1 month of the injury and again at 3, 6, 12, and 24 months. The performance of the TBI participants at each measurement occasion was standardized with 117 children of similar age, but without injury. Residualized latency scores were calculated. Growth curve analyses showed an initial impairment in response inhibition and improvement over the 2 years following injury. Younger TBI patients were initially more impaired although they exhibited greater recovery of response inhibition than did older TBI patients. Longer duration of coma, but not reactivity of pupils or Glasgow Coma Scale score, predicted initial deficit. Lesion characteristics or pre-injury attention deficit hyperactivity disorder did not predict initial impairment or recovery. Replication with longitudinal testing of a comparison group of children sustaining extracranial injury is necessary to confirm our findings.

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    • "The pattern of executive control impairment (e.g., response inhibition) also suggests dysfunction of frontalsubcortical circuits (Barkley, 1997; Pennington and Ozonoff, 1996). In addition to its presence in children and adolescents with ADHD, poor inhibitiory control has been a consequence of childhood TBI (Leblanc et al., 2005; Levin et al., 2002). For instance, Ornstein et al. (2013) found that children with P-ADHD and children with TBI but no history of ADHD before or after TBI (termed " TBI-only " from here on) presented with poorer inhibitory control than did typically developing controls. "
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    ABSTRACT: The present study compared executive dysfunction among children with attention-deficit/hyperactivity disorder (ADHD) after traumatic brain injury (TBI), also called secondary ADHD (S-ADHD), pre-injury ADHD and children with TBI only (i.e., no ADHD). Youth aged 6-16 years admitted for TBI to five trauma centers were enrolled (n=177) and evaluated with a semi-structured psychiatric interview scheduled on three occasions (within 2 weeks of TBI, i.e., baseline assessment for pre-injury status; 6-months and 12-months post-TBI). This permitted the determination of 6- and 12-month post-injury classifications of membership in three mutually exclusive groups (S-ADHD; pre-injury ADHD; TBI-only). Several executive control measures were administered. Unremitted S-ADHD was present in 17/141 (12%) children at the 6-month assessment, and in 14/125 (11%) children at 12-months post-injury. The study found that children with S-ADHD exhibited deficient working memory, attention, and psychomotor speed as compared to children with pre-injury ADHD. Furthermore, the children with S-ADHD and the children with TBI-only were impaired compared to the children with pre-injury ADHD with regard to planning. No group differences related to response inhibition emerged. Age, but not injury severity, gender, or adaptive functioning was related to executive function outcome. Neuropsychological sequelae distinguish among children who develop S-ADHD following TBI and those with TBI only. Moreover, there appears to be a different pattern of executive control performance in those who develop S-ADHD than in children with pre-injury ADHD suggesting that differences exist in the underlying neural mechanisms that define each disorder, underscoring the need to identify targeted treatment interventions. (JINS, 2014, 20, 971-981).
    Journal of the International Neuropsychological Society 11/2014; 20(10):971-81. DOI:10.1017/S1355617714000903 · 2.96 Impact Factor
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    • "Cancellation is deficient in children with ADHD (e.g., Schachar et al. 2007; Sinopoli et al. 2011), and also in children who develop de novo symptoms of ADHD following TBI (LeBlanc et al. 2005). In the latter group, less severe cancellation deficits persist (LeBlanc et al. 2005; Sinopoli et al. 2011). Restraining or withholding a response is another form of inhibitory control in which children reach adult levels of competence around age 12 (Levin et al. 1991; Liston et al. 2006). "
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    ABSTRACT: At every point in the lifespan, the brain balances malleable processes representing neural plasticity that promote change with homeostatic processes that promote stability. Whether a child develops typically or with brain injury, his or her neural and behavioral outcome is constructed through transactions between plastic and homeostatic processes and the environment. In clinical research with children in whom the developing brain has been malformed or injured, behavioral outcomes provide an index of the result of plasticity, homeostasis, and environmental transactions. When should we assess outcome in relation to age at brain insult, time since brain insult, and age of the child at testing? What should we measure? Functions involving reacting to the past and predicting the future, as well as social-affective skills, are important. How should we assess outcome? Information from performance variability, direct measures and informants, overt and covert measures, and laboratory and ecological measures should be considered. In whom are we assessing outcome? Assessment should be cognizant of individual differences in gene, socio-economic status (SES), parenting, nutrition, and interpersonal supports, which are moderators that interact with other factors influencing functional outcome.
    Neuropsychology Review 05/2014; 24(4). DOI:10.1007/s11065-014-9261-x · 4.59 Impact Factor
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    • "ress affect and execute controlled , goal - directed behavior ( Shackman et al . , 2011 ) . Recent theoretical models dissociate an automatic social processing of inner feelings from a social processing system under conscious cognitive - inhibitory control ( Satpute & Lieberman 2006 ) . Children with TBI have difficulties with inhibitory control ( Leblanc et al . , 2005 ; Sinopoli , Schachar , & Dennis , 2011 ; Sinopoli & Dennis , 2012 ) that may make it difficult for them to cancel or restrain typical response patterns , and thereby contribute to difficulties in emotive communication . Recent research has investigated the brain regions associated with avoidance and approach motiva - tion ( Berkman & L"

    Journal of the International Neuropsychological Society 02/2013; 19(2):230. DOI:10.1017/S135561771300009X · 2.96 Impact Factor
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