Children With Mild TBI at Risk for Behavioral and Emotional Problems

the to study covered in this summary was posted on medRxiv.org as a preliminary version and has not yet been peer-reviewed.

key takeaways

• mild traumatic brain injury (mTBI) and possible mTBI are associated with an increased risk of poor mental and behavioral health outcomes in adolescents.

• An unexpected finding was the association of mTBI with decreased cerebrospinal fluid volume, although the authors say caution is warranted in interpreting these results.

why this is important

• In 2014, emergency departments in the United States handled more than 812,000 cases of TBI in children.

• In mTBI, which accounts for 75% of all TBI cases, symptoms persist for 1 to 3 months in most children, but in about 14%, the injury leads to disability requiring specialized medical and educational care. .

• Children who experience an mTBI are at risk for neural changes that can lead to mental health problems.

• Psychotic-like experiences (PLE) have been associated with different structural and neural changes in the brain; a greater understanding of how events such as TBIs may be related to PLEs is needed.

Study design

• The authors used a mixed-effects model to perform a longitudinal analysis of baseline (n = 11,876), year 1 (n = 11,225), and year 2 (n = 10,414) data from the Cognitive Development of the Adolescent Brain study. (ABCD).

• The ABCD study is a prospective longitudinal study of 11,876 children who were enrolled between the ages of 9 and 10 years and who were followed up annually with in-person visits, participant and parent questionnaires, and baseline and year 2 MRIs.

• Bayesian methods were used in a multilevel analysis to investigate the potential mediation of structural brain metrics (including total cortical volume, cortical thickness, and sulcus depth) between mTBI and mental health outcomes.

• The study sample included 199 children with mTBI and another 527 with possible mTBI at all three time points.

Key results

• The study supports previous findings of the association between mTBI and impaired mental health: children with mTBI or possible mTBI had a 16% and 7% increased risk, respectively, of experiencing behavioral and emotional problems compared to those no BIT.

• Associations were significant after adjustment for participant and family characteristics (including age, gender, race/ethnicity, perceptions of neighborhood safety, parental education and marital status, and household income) and multiple imputation for the missing data.

• People with possible mTBI had a 17% increased risk of experiencing distress after a PLE.

• Structural brain metrics and MRI intensity measures (gray-white matter contrast) failed to show evidence of significant mediation between mTBI and mental health outcomes.

Limitations

• The sample included a disproportionately low number of black children with mTBI, perhaps reflecting the known underreporting of head injuries among minority populations.

• Due to a gap in data collection and concerns about recall bias, the authors did not assess the longitudinal relationship of structural brain metrics with TBI and mental health outcomes, limiting claims of causal inference.

• The ABCD study is ongoing and will collect more MRI data to examine longitudinal associations.

Disclosures

• The study received funding from the National Institute of Drugs abusethe Eunice Kennedy Shriver National Institute of Child Health and Human Development, among others.

• The authors have declared that they have no relevant financial or commercial conflicts of interest.

This is a summary of a preprint investigation study“Association between mild traumatic brain injuryBrain Structure, and Mental Health Outcomes in the Adolescent Brain Cognitive Development Study,” written by Daniel A. López of the Laboratory of Cognitive Neurophysiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, and colleagues. The study was published on medRxiv.org and provided by Medscape. The study has not yet been peer-reviewed. The full text can be found on medRxiv.org.

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Cite this: Children with Mild TBI at Risk for Behavioral and Emotional Problems – Medscape – September 23, 2022.