NEUROBEHAVIORAL OUTCOME OF HEAD INJURY IN CHILDREN

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 我们假设，执行功能的完整性对儿童话语加工、学习成绩和适应行为的发展至关重要，而抑制和元认知技能与儿童CHI的精神结局有关。目的1探讨涉及工作记忆、抑制和元认知技能的特定EF缺陷与CHI的急性严重程度、局灶性脑损伤的成像和年龄差异的关系。目标2和目标3代表了一个新的方向，研究工作记忆、抑制和元认知技能完整性的变异性与儿童CHI的话语、学习成绩、适应行为和精神结果之间的关系。 具体假设包括以下几点： 1.目的1：工作记忆、抑制和元认知技能的发育受损与急性脑缺血的严重程度和额叶残留病变的体积直接相关。与年龄较大的儿童发生的严重CHI相比，9岁之前发生的严重CHI对工作记忆、抑制和元认知技能发展的不利影响更大。 2.目标2：儿童颅脑损伤后的工作记忆、抑制和元认知技能发展不足与话语加工、学业成绩和适应技能的发展直接相关。 3.目的3：CHI后抑制和元认知技能受损的儿童患注意力缺陷/多动障碍(ADHD)和相关的外化障碍(即对立违抗障碍和品行障碍)的风险增加。创伤后内化障碍与伤前内化障碍和与创伤相关的心理应激有关。前额叶和/或基底额叶损害的存在、儿童或父母受伤前精神障碍的病史，以及不利的心理社会环境，都会增加CHI后发展为精神障碍的风险。 该项目将认知结构与脑成像和结果领域相结合，包括发育神经精神病学，目的是改善对脑损伤儿童的评估和干预。这项研究的目标是：(1)阐明基本认知过程的损害，包括工作记忆、抑制和元认知技能与格拉斯哥昏迷量表定义的闭合性脑损伤(CHI)的严重程度、磁共振成像描绘的局灶性脑损伤和受伤时年龄的关系；(2)评估工作记忆、抑制和元认知技能缺陷对结果领域的影响，包括话语处理、学习成绩和适应行为；(3)探讨创伤后抑制和元认知能力障碍、CHI严重程度和局灶性脑损害对新的精神障碍发生的影响，并评估家庭环境、伤前精神病史和心理应激作为影响因素的作用。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. We hypothesize that the integrity of executive functions (EFs) is crucial to the development of discourse processing, academic achievement, and adaptive behavior while inhibition and metacognitive skills are related to the psychiatric outcome of CHI in children. Aim 1 addresses the relationship of specific EF deficits involving working memory, inhibition, and metacognitive skills to the acute severity of CHI, imaging of focal brain lesions, and age differences. Aims 2 and 3 represent a new direction which investigates how variability in the integrity of working memory, inhibition, and metacognitive skills is related to discourse, academic achievement, adaptive behavior, and psychiatric outcomes of CHI in children. Specific hypotheses include the following: 1. Aim 1: Impaired development of working memory, inhibition, and metacognitive skills is directly related to the severity of acute CHI and the volume of residual prefrontal lesions. Development of working memory, inhibition, and metacognitive skills is more adversely affected by severe CHI occurring before age 9 years as compared to the outcome of severe CHI occurring in older children. 2. Aim 2: Problems in discourse processing, scholastic achievement, and adaptive skills are directly related to deficient development of working memory, inhibition, and metacognitive skills following head injury in children. 3. Aim 3: Children whose inhibition and metacognitive skills are impaired following CHI are at increased risk for developing attention-deficit/hyperactivity disorder (ADHD), and related externalizing disorders (i.e., Oppositional-Defiant and Conduct Disorders). Posttraumatic internalizing disorders are related to preinjury internalizing disorders and the psychological stress associated with the injury. The presence of prefrontal and/or basotemporal lesions, history of a preinjury psychiatric disorder in the child or parents, and adverse psychosocial environment contribute to the increased risk of developing a psychiatric disorder following CHI. This project integrates cognitive constructs with brain imaging and outcome domains which include developmental neuropsychiatry with the goal of improving assessment and interventions for brain injured children. The goals of the proposed research are: (1) to elucidate impairments of fundamental cognitive processes, including working memory, inhibition, and metacognitive skills in relation to the severity of closed head injury (CHI) defined by the Glasgow Coma Scale, focal brain lesions depicted by magnetic resonance imaging, and age at injury; (2) to evaluate the impact of deficits in working memory, inhibition, and metacognitive skills on outcome domains, including discourse processing, academic achievement, and adaptive behavior; and, (3) to examine the effects of posttraumatic impairments of inhibition and metacognitive skills, CHI severity, and focal brain lesions on the development of new psychiatric disorder, and assess the role of family environment, preinjury psychiatric history, and psychological stress as effect modifiers.