NEUROBEHAVIORAL OUTCOME OF HEAD INJURY IN CHILDREN

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。列出的机构是 研究中心，而研究中心不一定是研究者所在的机构。 我们假设，执行功能（EFs）的完整性是至关重要的话语处理，学业成绩和适应行为的发展，而抑制和元认知技能与儿童CHI的精神疾病的结果。 目的1：探讨工作记忆、抑制和元认知技能等特异性EF缺陷与CHI急性严重程度、局灶性脑病变成像和年龄差异之间的关系。 目的2和3代表了一个新的方向，调查如何变异的完整性的工作记忆，抑制和元认知技能相关的话语，学业成绩，适应性行为，和精神的CHI儿童的结果。 具体假设包括： 1.目标1：工作记忆、抑制和元认知技能的发展受损与急性CHI的严重程度和残留前额叶病变的体积直接相关。 与年龄较大的儿童发生严重CHI的结果相比，9岁之前发生的严重CHI对工作记忆、抑制和元认知技能的发展产生更大的不利影响。 2.目标二：话语处理、学习成绩和适应技能方面的问题与儿童头部受伤后工作记忆、抑制和元认知技能的发展不足直接相关。 3.目标3：CHI后抑制和元认知能力受损的儿童患注意力缺陷/多动障碍（ADHD）和相关外化障碍（即，对立违抗和行为障碍）。 创伤后内化障碍与创伤前内化障碍和与创伤相关的心理应激有关。前额叶和/或基底颞叶病变的存在，儿童或父母的损伤前精神疾病史，以及不良的心理社会环境有助于CHI后发展为精神疾病的风险增加。 该项目将认知结构与脑成像和结果领域相结合，包括发展神经精神病学，旨在改善脑损伤儿童的评估和干预。 本研究的目的是：（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闭合性颅脑损伤（CHI）严重程度（格拉斯哥昏迷量表）、脑磁共振成像（MRI）病灶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（包括话语处理、学业成绩和适应行为）的影响;（3）研究创伤后抑制和元认知能力的损害、CHI严重程度和局灶性脑损伤对新的精神障碍发展的影响，并评估家庭环境、创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.