Social Outcomes in Pediatric Traumatic Brain Injury

描述(由申请人提供)：本提案的总体目标是对儿童创伤性脑损伤(TBI)的社会后果进行综合的、多层次的研究。这项研究基于社会认知神经科学新兴领域和发展心理学/精神病理学中关于社会能力的研究的模型和方法。这项研究的具体目的是：(1)表征脑外伤儿童的社会互动和适应；(2)考察脑损伤儿童的社会信息加工；(3)确定脑损伤易受脑损伤影响并与社会信息加工有关的大脑区域和结构的完整性；(4)研究脑结构、社会信息处理、社会行为和适应之间的联系。这项研究将涉及8至12岁的儿童，其中150名患有中到重度颅脑损伤，150名患有不涉及头部的骨科损伤，采用横断面并行队列研究设计。参与者将完成几项评估：(1)结构磁共振成像，以测量与社会认知有关的区域的大脑异常；(2)社会信息处理的测量；(3)直接观察与朋友和陌生同龄人的互动；(4)由参与者及其朋友、同学、父母和老师报告的感知社会适应的测量；以及(5)环境变量的测量，例如家庭功能和育儿方式，这些变量可能在调节脑外伤对社会发展的影响方面扮演风险或弹性因素的角色。数据分析将涉及组间比较，以测试与目标1-3相关的假设，以及对组内关联进行结构方程建模，以测试与目标4相关的假设。该项目将代表对儿童脑外伤结果的现有知识库的重大扩展，并将提供对社会行为的神经和认知-情感基础的更广泛的洞察。它的方法和发现将适用于中枢神经系统受到其他侮辱的儿童，以及健康的儿童。因此，该项目将有助于我们理解正常和异常的社会发展。从实践上讲，这项研究将进一步发展衡量脑外伤儿童的损害和残疾的方法，从长远来看，应该有助于确定残留的缺陷和设计干预措施，以促进儿童脑损伤后更好的社会结果。公共卫生相关性：创伤性脑损伤(TBI)是15岁以下青少年死亡和残疾的主要原因，因此是一个重大的公共卫生问题。不良的社会结局是儿童脑外伤相关发病率的一个重要方面。通过帮助更好地了解儿童脑损伤后的社会结果，该研究的发现可能会提出一些方法，以促进儿童对脑损伤后经常发生的功能丧失和残疾的行为适应。

DESCRIPTION (provided by applicant): The overall goal of this proposal is to undertake an integrative, multi-level study of the social outcomes of childhood traumatic brain injury (TBI). The study is grounded in models and methods drawn from both the emerging field of social cognitive neuroscience and the study of social competence in developmental psychology/psychopathology. The study's specific aims are to: (1) characterize the social interactions and adjustment of children with TBI; (2) examine social information processing in children with TBI; (3) determine the integrity of brain regions and structures known to be vulnerable to TBI and implicated in social information processing; and (4) study the linkages among brain structures, social information processing, and social behavior and adjustment among children with TBI. The study will involve 8 to 12 year old children, 150 with moderate to severe TBI and 150 with orthopedic injuries not involving the head, in a cross-sectional, concurrent cohort research design. Participants will complete several assessments: (1) structural magnetic resonance imaging, to enable measurement of brain abnormalities in regions implicated in social cognition; (2) measures of social information processing; (3) direct observations of interactions with friends and unfamiliar peers; (4) measures of perceived social adjustment, as reported both by the participants and by their friends, classmates, parents, and teachers; and (5) measures of environmental variables, such as family functioning and parenting practices, that may act as risk or resilience factors in moderating the effects of TBI on social development. Data analyses will involve between-group comparisons to test hypotheses linked to Aims 1-3, and structural equation modeling of within-group associations to test hypotheses linked to Aim 4. The project will represent a major expansion of the existing knowledge base about the outcomes of childhood TBI, and will also provide insights into the neural and cognitive-affective substrates of social behavior more generally. Its methods and findings will be applicable to children with other insults to the central nervous system, as well as to healthy children. Thus, the project will contribute to our understanding of both normal and aberrant social development. Practically speaking, the study will further the development of methods for measuring impairments and disabilities in children with TBI, and in the long run should assist in identifying residual deficits and designing interventions to promote better social outcomes following childhood TBI. Public health relevance: Traumatic brain injury (TBI) is a leading cause of death and disability in youth under the age of 15, and therefore represents a major public health problem. Poor social outcomes are an important aspect of the morbidity associated with pediatric TBI. By helping to better understand social outcomes after childhood TBI, the study's findings may suggest ways to promote children's behavioral adaptation to the functional losses and disabilities that frequently occur after TBI.