2.0 CE Credits - Special Issue: Resilience I
As a result of reading these articles, the learner will be able to:
- Explain the moderating effect of cognitive reserve with regard to the impact of traumatic brain injury (TBI) on children’s intelligence, as assessed with the WISC–V.
- Describe which domains are still most sensitive to severity of TBI, even after accounting for cognitive reserve.
- define resilience and supporting factors following neonatal brain injury according to the parent perspective and
- identify key neurological and psychosocial predictors of early developmental and mental health outcomes following neonatal brain injury.
- define psychological resilience, and
- describe the role of psychological resilience in predicting post-concussive symptoms in children with poor recovery from concussion.
- Describe the construct of wellness
- List what predictors are significantly associated with “wellness” after concussion in children and adolescents
Effect of Cognitive Reserve on Children With Traumatic Brain InjuryAbstract
Objectives: Traumatic brain injury can result in cognitive impairments in children. The objective of this retrospective study was to determine to what extent such outcomes are moderated by cognitive reserve, as indexed by parental education. Methods: Sixty 6- to 16-year-old children completed the Wechsler Intelligence Scale for Children—Fifth Edition (WISC–V) within 30–360 days after having sustained a traumatic brain injury (TBI). Their Full-Scale IQ and factor index scores were compared to those of demographically matched controls. In addition, regression analysis was used to investigate in the TBI group the influence of injury severity in addition to parental education on WISC–V factor index scores. Results: Cognitive reserve moderated the effect of TBI on WISC–V Full Scale IQ, Verbal Comprehension, and Visual Spatial. In the TBI group, it also had a protective effect with regard to performance on the Verbal Comprehension, Visual Spatial, and Fluid Reasoning indices. At the same time, greater injury severity was predictive of lower Visual Spatial and Processing Speed index scores in the TBI group. Conclusions: Cognitive reserve as reflected in parental education has a moderating effect with regard to children’s performance on the WISC–V after TBI, such that higher cognitive reserve is associated with greater preservation of acquired word knowledge and understanding of visual relationships. Measures that emphasize speed of processing remain affected by severity of TBI, even after accounting for the protective effect associated with cognitive reserve. (JINS, 2019, 25, 355–361)
Understanding Early Childhood Resilience Following Neonatal Brain Injury From Parents’ Perspectives Using a Mixed-Method DesignAbstract
Objectives: The current study used a mixed-method design to qualitatively examine parents’ definitions of resilience and factors they believed optimized their child’s early outcome following neonatal brain injury. This was followed by quantitative analyses of early developmental and mental health outcomes and their relation to salient biopsychosocial factors. Methods: Participants were parents of children diagnosed with neonatal brain injury due to stroke or hypoxic-ischemic encephalopathy (N= 51; age range of children 18 months to 8 years). The Parent Experiences Questionnaire (PEQ) was used to qualitatively analyze parents’ open-ended responses about their child’s early experiences and outcome. The Child Behavior Checklist (CBCL) and Scales of Independent Behaviour Early Developmental Form (SIB-ED) parent ratings were used to measure child resilience from a quantitative perspective, identifying “at-risk” and “resilient” children using standard cutoffs. “Resilient” and “at-risk” children were compared on biopsychosocial variables using univariate t tests and chi-square analyses. Results: Parents provided five unique definitions of their child’s positive outcomes, and many children demonstrated resilience based on parent perspectives and quantitative definitions. Supporting factors included close medical follow-up, early intervention, and intrinsic factors within the child and parent. Group comparisons of “resilient” and “at-risk” children highlighted the importance of parent mental health across these early developmental and mental health outcomes. Conclusions: Many children were described as resilient during the early years by parents using qualitative and quantitative approaches. Findings highlighted the importance of parent well-being in promoting optimal early outcomes. (JINS, 2019, 25, 390–402.)
Psychological Resilience as a Predictor of Symptom Severity in Adolescents With Poor Recovery Following ConcussionAbstract
Objectives: Examine the mediating effects of anxiety and depressive symptoms on the relationship between psychological resilience and post-concussive symptoms (PCS) in children with poor recovery following concussion. Participants and Methods: Adolescents (N=93), ages 13 to 18 years, were assessed at a neuropsychology screening clinic at a children’s hospital. They sustained concussions more than 1 month before the clinic visit (median time since injury= 5.1 months; range= 42–473 days) and were seen on the basis of poor recovery (i.e., presence of persistent PCS and complaints of cognitive problems). Self-reported psychological resilience was measured using the 10-item version of the Connor-Davidson Resilience Scale; self- and parent-reported anxiety and depressive symptoms were measured using the Behaviour Assessment System for Children – Second Edition; and self- and parent-reported PCS were measured using the Post-Concussion Symptom Inventory. All variables were measured concurrently. Regression-based mediation analyses were conducted to examine anxiety and depressive symptoms as mediators of the relationship between psychological resilience and PCS. Results: Psychological resilience significantly predicted self-reported PCS. Self-reported anxiety and depressive symptoms significantly mediated the relationship between resilience and self-reported PCS, and parentreported child depressive symptoms significantly mediated the relationship between resilience and self- and parentreported PCS. Conclusions: Psychological resilience plays an important role in recovery from concussion, and this relationship may be mediated by anxiety and depressive symptoms. These results help shed light on the mechanisms of the role of psychological resilience in predicting PCS in children with prolonged symptom recovery. (JINS, 2019, 25, 346–354)
Predicting Wellness After Pediatric ConcussionAbstract
Objective: Concussion in children and adolescents is a prevalent problem with implications for subsequent physical, cognitive, behavioral, and psychological functioning, as well as quality of life. While these consequences warrant attention, most concussed children recover well. This study aimed to determine what pre-injury, demographic, and injury-related factors are associated with optimal outcome (“wellness”) after pediatric concussion. Method: A total of 311 children 6–18 years of age with concussion participated in a longitudinal, prospective cohort study. Pre-morbid conditions and acute injury variables, including post-concussive symptoms (PCS) and cognitive screening (Standardized Assessment of Concussion, SAC), were collected in the emergency department, and a neuropsychological assessment was performed at 4 and 12 weeks post-injury. Wellness, defined by the absence of PCS and cognitive inefficiency and the presence of good quality of life, was the main outcome. Stepwise logistic regression was performed using 19 predictor variables. Results: 41.5% and 52.2% of participants were classified as being well at 4 and 12 weeks postinjury, respectively. The final model indicated that children who were younger, who sustained sports/recreational injuries (vs. other types), who did not have a history of developmental problems, and who had better acute working memory (SAC concentration score) were significantly more likely to be well. Conclusions: Determining the variables associated with wellness after pediatric concussion has the potential to clarify which children are likely to show optimal recovery. Future work focusing on wellness and concussion should include appropriate control groups and document more extensively pre-injury and injury-related factors that could additionally contribute to wellness. (JINS, 2019, 25, 375–389)