The goals of this project are to evaluate neurobehavioral outcomes in multiple domains: cognitive, behavioral, and motoric, for children who sustain traumatic brain injury (TBI). The hypothesis is that the nature and extent of injury to the frontal lobes account for significant variability in outcome beyond age and injury severity. Based on MRI findings, the relationship of focal brain lesions to cognitive sequelae, particularly functions such as working memory, are investigated. Progress: As we enter the seventh and final year of funding, the longitudinal study is winding down. We are no longer recruiting new subjects. All of the subjects in post perspective study are at least one year post-injury. Most of the effort over this past year has been devoted towards the competing continuation renewal for this grant. In this respect, a competing continuation was written and submitted to the National Institutes of Health for the November 1, 1997 deadline. In this application, we proposed to continue the present research. Specifically, we proposed to focus specifically on our finding that there is a raised incident of Attention Deficit/Hyperactivity Disorder in our sample. This was observed through the administration of the Diagnostic Inventory for Children and Adolescents to the child and parents of a subset of the children in our study. These children, who were at least one year post- injury, reported symptomatology consistent with a variety of DSM-IV diagnoses. However, the most common DSM-IV disorder was Attention Deficit/Hyperactivity Disorder. This was apparent in both in Dallas and Houston cohorts. These data are now being prepared for publication. However, they also represent a major aim of the proposed competing continuation. In other components of the competing continuation, we proposed to follow our previous findings showing significant relationships between frontal lobe injury and the variety of executive functions. A new battery of executive function measures have been developed and piloted for the competing continuation. These measures include assessments of a variety of metacognitive skills, impulse control, self-regulation, and further assessments of adaptive behavior. We are hoping to expand the assessment of potential frontal lobe functions in children, basing much of the newly proposed research on analyses of the previous data. The final component provides more systematic assessments of school functioning, including new achievement measures, teacher reports, and other assessments designed to elucidate relationships of deficiencies in executive functions, adaptive behavior, and school outcomes. The significance of traumatic injury is the leading cause of death in children and a major contributor to handicap and disability in children. By understanding the mechanisms underlying recovery of function after pediatric traumatic brain injury, we hope to eventually develop interventions that will reduce morbidity. Of potential interest is the possibility of treating symptoms such as those associated with attentional disorders that we have observed in our cohorts. In addition, children with traumatic brain injury are commonly handicapped because of problems that involve executive functions: planning, organization, self-regulation, and attention. By developing assessment methods in these areas, and by understanding the relationship of injury severity in frontal lobe injury to the presence of deficits on these tasks, we hope to develop alternative interventions in these areas. This may be directly related to the deficits in academic functions as well as the emergence of new psychiatric disorders after traumatic brain injury. Plan: Our plans are to await funding decisions on the competing continuation, which will be reviewed in the spring of 1998. We will be preparing papers for publication that involve our psychiatric assessments and some of the pilot data accrued in developing the competing continuation. We will also continue to analyze the previously collected data. At this point, follow-up of those children previously enrolled in the post perspective component of the study will be continued.
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