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）是美国的一个主要公共卫生问题。的数据 青少年大脑认知发展（ABCD）研究为我们的团队提供了一个机会， 推进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年以来产生的生物心理社会数据， 一项对11,000多名9/10岁儿童进行的21个地点的全国性纵向研究， 随后每年进行评估。研究设计允许对预测因素进行罕见的分析， 损伤后行为，精神和神经认知结果的机制，通过检查儿童和 家庭变量收集了受伤前和受伤后的237名儿童谁到目前为止遭受了mTBI， 入组后的几年。mTBI组将与两组儿童进行比较：1） 入组后意外骨折（骨科损伤; OI）; 2）终身“无损伤”（NI）组。 将确定患有mTBI的其他儿童，并将其与OI和NI对照组进行比较。 研究的第一个月，以及5年研究的第2年年底和第4年中期。 拟议的研究有三个独特的方面。1)伤前伤后序贯 结构和功能神经成像数据有助于行为， 精神和神经认知结果，使用个体损伤前与损伤后的变化和组 大脑成熟轨迹的差异。2)遗传数据允许预测和适度分析， 使用新的系统生物学方法，而不是基于候选基因的结果。3)拟定研究 评估mTBI前后的多个神经认知领域。 本研究将检验3个主要假设：（1）行为测量的变化和 神经认知功能将变得更重要，新发精神疾病将发生在 与OI和NI儿童相比，mTBI儿童的发生率显著更高。(2)行为改变， 新发精神疾病和神经认知功能的变化，在儿童将预测由损伤前 儿童变量（性别、适应功能、学术和认知功能、终身精神疾病， 行为评级、脑结构和功能性MRI测量以及遗传因素），以及损伤前家庭 变量（社会经济地位，家庭功能，家庭精神病史）与mTBI，OI和NI的儿童。 (3)行为改变、新发精神障碍和神经认知障碍的发生和模式 功能变化将通过儿童大脑变量（大脑成熟的轨迹），损伤后家庭 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， mTBI、OI和NI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.