The overarching aim of the application is to model multivariate relations between neuroimaging, cognitive, and psychosocial predictors of academic outcomes after traumatic brain injury (TBI). Academic deficits are among the most significant and pervasive areas of deficit after TBI in school-aged children and adolescents. Moderate to severe TBI is associated with deficits in executive processes that influence outcomes in many domains, including academic skill development, academic performance, and child adjustment. Traditional achievement measures grossly underestimate the functional academic deficits of children with TBI as they infrequently examine related components of executive processing. To address these limitations, we developed integrative academic tasks that incorporate more real-world demands for speed and automaticity of symbol manipulation, inferencing, cohesion, strategy use, resistance to distraction, and comprehension monitoring. We will administer a battery of 1) executive processing tasks assessing processing speed, working memory, and inhibitory control, 2) core achievement tasks, 3) integrative academic tasks and 4) measures of child adjustment to characterize post-traumatic deficits impacting academic outcomes. We propose to use multiple quantitative structural neuroimaging methods, including DT-MRI and volumetric analyses of white and gray matter, to characterize microstructural and macrostructural damage to neural systems and to examine brain-behavior relations after TBI. Study 1 prospectively examines academic outcomes 2, 6, 12, and 24 months after moderate to severe TBI in youth ages 6-15 at the time of injury and an orthopedic comparison group. MRI studies will be obtained at 2 and 24 months after injury for both groups. Study 2 will examine extended follow-up 3 to 8 years after moderate to severe TBI in a cohort of children who sustained TBI at 0-14 years of age in relation to healthy controls. Study 2 allows characterization of the impact of indices of diffuse and focal injury on the late consequences of brain injury. Quantitative MRI will examine late changes in diffusion anisotropy as well as global and regional atrophy as they relate to academic outcomes. Our approach to prediction of outcomes is unique as it emphasizes 1) more precise behavioral measures related to executive processes and integrative academic skills, 2) measures of factors affecting child adjustment; and 3) quantitative indices of macrostructural and microstructural brain injury that are linked through a developmental model. ? ?
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