This proposal extends our previous research concerning the neurobehavioral outcome of closed head injury (CHI) in children by addressing the relationship of frontal lobe lesions to recovery. We postulate that frontal lobe injury increases the likelihood of impaired reasoning and concept formation, disrupts use of mnemonic strategies, reduces productivity on verbal and visuospatial fluency measures, results in disinhibition and interferes with motor sequencing and motor responses which conflict with the examiner's behavior. Moreover, we postulate that frontal lobe lesions result in more severe behavioral disturbance as compared to children sustaining extrafrontal lesions or diffuse injury. Study I is a cross-sectional investigation of three age cohorts (0-4, 5-10, 11-15 years at the time of injury) who had been hospitalized for moderate to severe CHI (n=192) at least three years prior to testing. All patients will undergo magnetic resonance imaging (MRI) to characterize the presence and localization of focal brain lesions. Based on the results of MRI, the patients will be classified as having (1) frontal lobe lesions; (2) extrafrontal lesions; (3) frontal/extrafrontal overlap; (4) diffuse brain insult. Study II is a longitudinal design in which prospective pediatric admissions (n=120) for moderate or severe CHI-are i recruited into 3 age cohorts (5-7 years, 8-10 years, 11-15 years at the time of injury) and the same localization of lesion groups as in Study I. Study II evaluates the relationship between localization of brain lesion (according to MRI at 3 months) and neurobehavioral changes over 3 years as measured in examinations at baseline (i.e., ,,when posttraumatic amnesia resolves), 3, 6, 12, 21, and 36 months postinjury. Children sustaining mild CHI will serve as a comparison group in Studies I (n=60) and II (n=36). All children will undergo testing of problem solving, memory strategy, motor function, fluency and evaluation of discourse in 5 narratives. Several control tests (e.g naming) will be given to evaluate the specificity of deficits associated with frontal lesions. Psychosocial adjustment and behavior will also be studied. Study I data will be analyzed using the General Linear Model (GLM) approach to address the specific aims, including the relationship between frontal lobe lesions and neurobehavioral recovery. The data collected in Study II will be analyzed using a GLM approach as well as multi-level modeling of growth curves to assess changes in development which are related to the localization of brain lesion and age at injury.
| Max, Jeffrey E; Friedman, Keren; Wilde, Elisabeth A et al. (2015) Psychiatric disorders in children and adolescents 24 months after mild traumatic brain injury. J Neuropsychiatry Clin Neurosci 27:112-20 |
| Max, Jeffrey E; Lopez, Aholibama; Wilde, Elisabeth A et al. (2015) Anxiety disorders in children and adolescents in the second six months after traumatic brain injury. J Pediatr Rehabil Med 8:345-55 |
| Max, Jeffrey E; Wilde, Elisabeth A; Bigler, Erin D et al. (2015) Personality Change Due to Traumatic Brain Injury in Children and Adolescents: Neurocognitive Correlates. J Neuropsychiatry Clin Neurosci 27:272-9 |
| Schmidt, Adam T; Li, Xiaoqi; Zhang-Rutledge, Kathy et al. (2014) A history of low birth weight alters recovery following a future head injury: a case series. Child Neuropsychol 20:495-508 |
| Rabinowitz, Amanda R; Levin, Harvey S (2014) Cognitive sequelae of traumatic brain injury. Psychiatr Clin North Am 37:1-11 |
| Lipszyc, Jonathan; Levin, Harvey; Hanten, Gerri et al. (2014) Frontal white matter damage impairs response inhibition in children following traumatic brain injury. Arch Clin Neuropsychol 29:289-99 |
| Ornstein, Tisha J; Sagar, Sanya; Schachar, Russell J et al. (2014) Neuropsychological performance of youth with secondary attention-deficit/hyperactivity disorder 6- and 12-months after traumatic brain injury. J Int Neuropsychol Soc 20:971-81 |
| Rabinowitz, Amanda R; Li, Xiaoqi; Levin, Harvey S (2014) Sport and nonsport etiologies of mild traumatic brain injury: similarities and differences. Annu Rev Psychol 65:301-31 |
| Gonzaga-Jauregui, Claudia; Lotze, Timothy; Jamal, Leila et al. (2013) Mutations in VRK1 associated with complex motor and sensory axonal neuropathy plus microcephaly. JAMA Neurol 70:1491-8 |
| Ornstein, Tisha J; Max, Jeffrey E; Schachar, Russell et al. (2013) Response inhibition in children with and without ADHD after traumatic brain injury. J Neuropsychol 7:1-11 |
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