Pediatric Mild Traumatic Brain Injury and the ABCD Study: A Prospective Behavioral, Psychiatric, Neurocognitive, Imaging, and Genetic Investigation

轻度创伤性脑损伤(MTBI)在美国是一个主要的公共卫生问题。数据来自 青少年大脑认知发展(ABCD)研究为我们的团队提供了一个显著 推进与mTBI相关的行为、精神和神经认知问题的研究 非常有争议。我们将分析自2016年以来从这个十年展望中产生的生物心理社会数据 对11,000多名9/10岁儿童进行了21个地点的纵向全国性研究 随后每年进行一次评估。研究设计允许罕见地分析预测因素和 通过检查儿童和儿童的行为、精神和神经认知结果来研究损伤后行为、精神和神经认知结果的机制 收集了237名受伤前和受伤后的儿童的家庭变量，这些儿童到目前为止已经遭受了mTBI 注册后的几年。MTBI组将与两组儿童进行比较1) 入选后意外骨折(骨科损伤；OI)；2)终生“无损伤”(NI)组。 将确定其他患有mTBI的儿童，并将其与OI和NI对照进行比较 研究的第一个月，以及五年研究的第二年末和第四年年中。 这项拟议的研究有三个独特的方面。1)受伤前和受伤后的顺序 结构和功能神经成像数据有助于预测和调节行为分析， 使用个体受伤前和受伤后的变化和群体的精神和神经认知结果 大脑成熟轨迹的差异。2)遗传数据允许进行预测性和适度性分析 结果使用一种新的系统生物学方法，而不是基于候选基因。3)建议的研究 评估mTBI前后的多个神经认知域。 这项研究将检验三个主要假设：(1)行为测量的变化和 神经认知功能将具有更大的规模，新发的精神障碍将在 与OI和NI儿童相比，mTBI儿童的发病率明显更高。(2)行为改变； 新发的精神障碍和儿童神经认知功能的变化将通过损伤前进行预测 儿童变量(性别、适应功能、学习和认知功能、终生精神障碍、 行为分级、脑结构和功能核磁共振测量，以及遗传因素)，以及受伤前家庭 患有mTBI、OI和NI的儿童的变量(社会经济地位、家庭功能、家庭精神病史)。 (3)行为改变、新发精神障碍和神经认知障碍的发生和模式 功能变化将由儿童大脑变量(大脑成熟轨迹)、损伤后家庭进行调节 变量(功能和应激源)和损伤变量(受伤时的年龄、受伤后的时间、严重程度、是否存在 脑损伤和弥漫性轴索损伤的程度)，并受儿童基因结构(遗传因素)的调节 患有mTBI、OI和NI的儿童。

Mild traumatic brain injury (mTBI) is a major public health problem in the United States. Data from the Adolescent Brain Cognitive Development (ABCD) study afford our team an opportunity to significantly advance the study of mTBI-associated behavioral, psychiatric, and neurocognitive problems which are very controversial. We shall analyze biopsychosocial data generated since 2016 from this ten-year prospective longitudinal 21-site national study of an enrolled cohort of over 11,000 nine/ten-year old children who have been subsequently evaluated annually. The study design permits a rare analysis of predictive factors and mechanisms of post-injury behavioral, psychiatric, and neurocognitive outcomes by examining child and family variables collected pre-injury and post-injury in the 237 children who have so far suffered a mTBI in the years subsequent to enrollment. The mTBI group will be compared with two groups of children 1) with a post-enrollment accidental bone fracture (orthopedic injury; OI); and 2) a lifetime “no injury” (NI) group. Additional children who have had a mTBI will be identified and will be compared with OI and NI controls in the first month of the study, and at the end of year 2 and middle of year 4 of the five-year study. There are three unique aspects of the proposed study. 1) Pre-injury and post-injury sequential structural and functional neuroimaging data facilitate predictive and mediation analyses of behavioral, psychiatric, and neurocognitive outcomes using individual pre- versus post-injury changes and group differences in brain maturation trajectories. 2) Genetic data permit predictive and moderation analyses of outcomes using a novel systems biology approach not based on candidate genes. 3) The proposed study evaluates multiple neurocognitive domains before and after mTBI. The study will examine 3 major hypotheses: (1) Change in behavioral measures and changes in neurocognitive function will be of greater magnitude, and new-onset psychiatric disorders will occur at a significantly higher rate, in children with mTBI compared with children with OI and NI. (2) Behavioral changes, new-onset psychiatric disorders, and neurocognitive function changes in children will be predicted by pre-injury child variables (sex, adaptive function, academic and cognitive function, lifetime psychiatric disorders, behavioral ratings, brain structure and functional MRI measures, and genetic factors), and pre-injury family variables (socioeconomic status, family function, family psychiatric history) in children with mTBI, OI, and NI. (3) The occurrence and pattern of behavioral changes, new-onset psychiatric disorders, and neurocognitive function changes will be mediated by child brain variables (trajectory of brain maturation), post-injury family variables (functioning and stressors), and injury variables (age at injury, time-since-injury, severity, presence of a brain lesion, and extent of diffuse axonal injury) and moderated by child gene structure (genetic factors), in children with mTBI, OI, and NI.