Introduction: Girls and boys presenting disruptive behavior disorders (DBDs) display differences in white matter microstructure (WMM) relative to typically developing (TD) sex-matched peers. Boys with DBDs are at increased risk for traumatic brain injuries (TBIs), which are also known to impact WMM. This study aimed to disentangle associations of WMM with DBDs and TBIs, and understand their potential cumulative effect.

Methods: The sample included 673 children with DBDs and 836 TD children, aged 9–10, from the Adolescent Brain Cognitive Development Study. Thirteen white matter bundles previously associated with DBDs were the focus of study. Analyses were undertaken separately by sex, adjusting for callous-unemotional traits, attention-deficit hyperactivity disorder, age, pubertal stage, IQ, ethnicity, and family income.

Results: Boys and girls with DBDs were at higher risk of TBIs compared to TD children. Among children without TBIs, those with DBDs showed sex-specific differences in WMM of several tracts relative to TD children. Among girls and boys with DBDs, those who had sustained TBIs displayed WMM alterations compared to non-injured children with DBDs. These differences were robust to adjustment for all covariates. In contrast, no differences in WMM were apparent when comparing brain-injured against non-injured TD children. Across most DBD/TD comparisons, measures of axonal density were higher among children presenting DBDs.

Discussion: In conclusion, in this community sample of children, we demonstrated unique patterns of WMM alterations associated with the presence of DBDs, TBIs, and the combination of both conditions. Our results suggest that both boys and girls with DBDs are at higher risk of sustaining TBIs, which are associated with additional sex-specific alterations of WMM that further compromise their brain development. Given that TBIs are potentially preventable, and intervention techniques are known to decrease the burden of DBDs, our results have important implications for future targeted interventions.

Objective: The current analysis seeks to model the trajectory of executive functioning (EF) following pediatric TBI through the lens of the International Classification Framework (ICF) to unite the understanding and conceptualization of rehabilitative services for this unique population.

Methods: This study is a secondary analysis of data from a longitudinal project that examines return-to-learn supports for students with TBI. Demographic and injury-related information was collected via caregiver report on REDCap. Executive functioning (EF) was measured through the Behavior Rating Inventory of Executive Functioning-2nd Edition-Parent Form (BRIEF-2). Higher scores on the BRIEF-2 indicate poorer EF. To investigate the relationship between participant’s EF and time post-TBI, group-based trajectory modeling (GBTM) was performed.

Results: This analysis included a total of 400 observations across 139 participants with an average of 2.88 observations per participant. The final validated model from GBTM included four unique groups. More robust information about demographics, model selection and validation will be included in the presentation. Group 1 showed levels of EF that were consistently superior EF compared to the standardization sample. Groups 2 and 3 showed levels of EF that were consistently within normal limits though group 3 did show slight improvement in EF over time. Group 4 showed consistently elevated levels of executive dysfunction. Additional variable means from the international classification (ICF) framework were selected and analyzed across each group including: body functions and structures (injury severity), activity and participation (social skills), environmental and personal domains (Caregiver SES, age at injury, free/reduced lunch, IEP/504 plan, enrollment in structured school programming).The presentation will focus on analyzing the differences in these variables across group 1 (i.e., highest levels of EF) and group 4 (i.e., most elevated levels of executive dysfunction) to discuss individual differences.

Conclusions: Use of GBTM helps identify recovery groups that may not be identifiable through a priori group selection alone. This analytic approach may therefore identify children who are most at-risk for difficulties in later developing cognitive areas like EF. To support rehabilitation and continued development of EFs following TBI, it is essential we are able to direct limited resources to children who need them most. The ICF unites the conceptualization of functioning and disability following TBI and helps guide providers of children with TBI. Use of the ICF framework is valuable to supplement standardized assessments to provide a holistic understanding of academic, social, and health outcomes following pediatric TBI. The analysis from this study supports the use of the ICF framework by demonstrating how a myriad of variables contribute to overall outcomes, particularly when examining EF.

Background: Adolescence represents a unique and dynamic developmental stage where high-level cognitive-communication skills (e.g. problem solving, abstract reasoning, attention, metacognition) undergo refinement and consolidation in an environment of heightened neuroplasticity. An acquired brain injury (ABI) during this critical period can disrupt development and compromise a young person’s social, academic, and vocational outcomes. An emergent body of literature exists to inform speech language pathologists’ choice of evidence-based treatment options following a brain injury in adults. However, comparatively few studies relate to adolescent populations, and fewer still include adolescents with lived experience of ABI as stakeholders in the design of interventions. There is broad consensus among researchers that effective treatment approaches for any age group should be tailored, functional, meaningful, and contextually relevant to the individual.

Objectives: To (1) synthesise the current evidence-base on cognitive-communication interventions for adolescents with an acquired brain injury, (2) examine the extent to which these interventions incorporate adolescents with lived experience of an acquired brain injury as stakeholders in the design process, and (3) identify research gaps.

Methods: This scoping review used Arksey and O’Malley’s five-stage methodological framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Extension for Scoping Reviews). In March 2024, a comprehensive search of 5 databases and grey literature was conducted. Qualitative and quantitative data were extracted, thematically analysed, and interpreted descriptively to identify key patterns related to stakeholder engagement and intervention design.

Results: 59 studies met inclusion criteria after screening 2475 studies and reviewing 186 full texts. Preliminary results indicated that lived experience feedback was sought solely at the end of the intervention design process in the vast majority of studies. Multiple studies reported stakeholder evaluation of an intervention's usability and acceptability, often at the same time as validity and feasibly were evaluated. However, studies seldom included adolescent stakeholders in the early planning and iterative development stages. The inclusion of formal or informal descriptions of the intervention design process were either brief or absent.

Conclusions: Adolescents require tailored intervention approaches that are rewarding, meaningful and contextually relevant. Current intervention design methodologies lack descriptive detail regarding the design process, and preference the collection of retrospective evaluation about an intervention’s usability and acceptability, rather than iterative inclusion of adolescent lived experience perspectives across the lifespan of the design stages (planning, development, delivery, and evaluation). These results will inform the iterative design of a novel cognitive-communication treatment program with adolescents with a brain injury as co-researchers, ensuring their lived experience perspectives inform each stage of the intervention design process.

Acquired brain injuries in pediatric age are frequently associated with cognitive impairments, which may worsen over time and cause difficulties in adjustment, learning, and interpersonal relationships. Although recommendations highlight the need for early rehabilitation for this population, to date there are no specific guidelines for rehabilitation interventions in children. The aim of this randomized controlled trial was to compare two different multi-domain cognitive interventions for children with ABI aged 5 to 17 years in the subacute phase (immediately after the emergence of consciousness), to evaluate whether either format could be more effective than the other. Both interventions addressed the following cognitive domains: attention, visual-constructional abilities, memory and executive functions. Specifically, the first intervention (assigned to Group 1-G1) was based on an individualized and personalized approach, in which each patient was offered increased stimulation of the most impaired cognitive function(s), along with the parallel stimulation of the other cognitive domains. On the other hand, the second intervention (assigned to Group 2-G2), was based on a 'fixed dose' stimulation of each cognitive function in a predefined, sequential order. Both interventions had a duration of 12 weeks and included 3 daily sessions (neuropsychological treatment, speech therapy and psychoeducational treatment) for 5 days a week. Forty patients were randomized into the two study groups and were scheduled for cognitive assessment at baseline (T0) and post-intervention (T1). Immediately after the start of the intervention, one patient was excluded from G2 due to clinical reasons, so a final sample of 39 patients was considered for statistical analyses. Among these 39 patients, 34 completed the assigned intervention, 18 in G1 and 16 in G2. After the intervention, improvements were found in all cognitive domains trained by the interventions. In more detail, the primary cognitive outcome (i.e., visual sustained attention) showed a positive change with a large effect and 14 out of 16 secondary outcomes showed an improvement, of which 13 with a medium-to-large effect. No differences in efficacy between the two intervention groups were found. The absence of a passive control group did not, however, allowed us to discriminate the rehabilitation effect alone from the time effect and children spontaneous maturation. In sum, findings highlight that a personalized rehabilitation approach does not lead to better cognitive gains than a non-tailored intervention in children with ABI in the early recovery stage, in contrast with evidence for the chronic phase. This could be attributable to the numerous cognitive deficits shown by children at an early stage, which could benefit from interventions simultaneously addressing different cognitive domains, irrespective of their format. It could be that individualized and tailored interventions are more beneficial at a subsequent stage, when everyday demands and expectations become stronger.

Concussion is prevalent in young children (i.e., children 8 years old and younger). Using developmentally appropriate measures and methods, studies show that young children experience postconcussive symptoms, just as their older peers do, but that they may manifest in unique ways (Beauchamp et al., 2024, Dupont et al, 2024, Crowe et al, 2019). In some cases, early childhood concussion can have lasting behavioral impacts (Gagner et al., 2021). The ability of caregivers to recognize and detect signs and symptoms of a possible concussion is a cornerstone of concussion diagnosis and management. However, most knowledge mobilisation (KM) initiatives and studies focus on children 8 years and older and on sports and school settings (e.g., Mallory et al., 2022; McKinlay & Buck, 2019). Given the specific challenges in detecting signs and symptoms in this age group due to cognitive and language limitations, unique mechanisms of injury and symptom patterns, and considering the distinct environments in which most young children evolve (e.g., formal daycare, preschool, home), there is a clear need for tailored KM products to inform childcare educators about early childhood concussion.

Objective: This study is part of the COCO (Concussion Communication) KM program and aims to develop and assess the utility of an Educational Kit on early childhood concussion intended for teachers and students in early childhood education programs.

Methods: A collaborative and iterative approach was used to create tailored educational products based on literature, focus groups and consultations with experts and practitioners from various discipline: pediatric emergency medicine, childcare services, neuropsychology, communication and teaching. KM products were tested using in-person training sessions with 69 childcare staff and directors, and future early childhood educators. Surveys and focus groups were used to collect information on appreciation, ease of use, perceived usefulness, knowledge increase and intent to use the KM products in the future.

Results: The COCO Educational Kit consists of a 60 to 90 minutes training kit including a presentation, a detection tool, case studies and a learning assessment. Most perceived the KM products to be of adequate level of difficulty (58%), or easy to very easy (47%). The perceived level of knowledge on concussion increased from 4.2/10 (SD=2.58) before the training to 7.6/10 (SD=1.40) after the training. 92% reported they would use the detection tool in their future practice.

Conclusions: The COCO Educational Kit is a promising tool to empower educators in identifying possible concussions and responding adequately. It could also be of use for other individuals who work with young children (e.g., coaches, teachers, daycamp staff). Next steps include adapting the COCO KM products to various key early childhood actors, and developing an online version to increase access to a larger public.

Background: Families of children with conditions affecting brain development experience child behavioural challenges, yet support remains limited. I-InTERACT-North is a virtual, stepped-care parenting intervention that supports family well-being and targets behavioural concerns for children with brain injuries or conditions affecting neurological development. This study has two main objectives: (1) describe the clinical implementation of I-InTERACT-North at a large children’s hospital in Canada, guided by The Implementation Roadmap (TIR); and (2) evaluate the program’s preliminary acceptability and efficacy in improving child behaviour and parental mental health.

Methods: Guided by TIR, we conducted implementation readiness surveys across 3 clinics at The Hospital for Sick Children, followed by implementation meetings every 3 months. We measured program demand through referral and consent rates. Therapist fidelity checklists were also completed. Preliminary program acceptability and efficacy was measured via program satisfaction, parent-reported child behaviour problems (Eyberg Child Behavior Inventory [ECBI]) and parental mental health (Depression Anxiety Stress Scales [DASS]). Participants included families of children aged 3-9 years who completed I-InTERACT-North (N=51; Mage=6.2 years, SD=1.8; 70.6% male). Children referred to the program had either a medical condition affecting neurological development (52.9%; e.g., congenital heart disease, epilepsy, perinatal stroke), a neurodevelopmental condition (37.3%; e.g., attention-deficit/ hyperactivity disorder, autism spectrum disorder), or both (9.8%).

Results: Readiness surveys indicated a strong alignment of I-InTERACT-North with clinic needs and feasibility across the Neonatal Neurodevelopmental Follow-Up, Epilepsy, and Psychiatry clinics. There was a strong uptake of I-InTERACT-North, with 231 referrals received between February 2022 and September 2024. Of those, 138 families consented to participate (59.7%), 51 completed treatment (36.9%), and 41 are either waitlisted or currently completing treatment (29.7%). The remaining families either declined (14.7%), were ineligible (6.9%), withdrew (3.9%), or could not be reached (14.7%). Therapy session fidelity was high, with 89% adherence to session core objectives. Participant satisfaction with program focus and delivery was also high. Significant reductions were observed in child behaviour problems from pre- (problems: M=63.09, SD=8.36; intensity: M=62.96, SD=6.31) to post- (problems: M=56.41, SD=10.05, t[30]=4.4, p<.001; intensity: M=58.1, SD=6.27, t[30]=4.3, p<.001) intervention. There was also a significant pre- (M=14.41, SD=9.06) to post- (M=11.37, SD=7.55) intervention decrease in parental stress (t[47]=3.1, p<.001). Reductions in parental depression and anxiety were observed but were non-significant.

Conclusions: I-InTERACT-North demonstrates potential for successful program implementation across various clinics within a paediatric hospital setting, meeting clinic-specific needs and feasibility. Likewise, the program offers valuable mental health support to families of children with diverse neurological conditions. TIR provides a systematic approach to effective program implementation, including innovative co-design, ongoing evaluation, and iterative revisions to ensure sustainability. Insights gleaned from this implementation will inform ongoing initiatives to optimize and expand the program’s clinical reach across other paediatric centres in Canada, benefitting more families in need.

Background: Increased behavior problems have previously been reported in children following a mild traumatic brain injury (mTBI). A possible risk factor for this may be the child’s social environment: while the influence of parental factors has been investigated, the role of peer behavior after mTBI remains largely unknown. We investigate if negative peer experiences in the form of perpetration or victimization are associated with the development of behavior problems after mTBI.

Methods: From the Adolescent Brain and Cognitive Development (ABCD) study, we included children who reported an mTBI between the baseline assessment (pre-injury, 9-10 years) and 2-year follow-up (post-injury, 11-12 years) and compared them to the remaining sample without a history of injury (nmTBI = 192, nControl = 3198). First, we examined group differences in post-injury behavior problems (CBCL – parent-report questionnaire) as well as in perpetrator or victim experiences with peers (PEQ – self-report questionnaire). Second, we investigated whether the two kinds of peer experiences would moderate the development of behavior problems following mTBI.

Results: Children with an mTBI within the past 2 years showed higher post-injury behavior problems than controls (p = .006), even when controlling for pre-injury levels. They experienced higher levels of victimization by peers (p = .004) but did not report more perpetrator behavior (p = .864). Perpetrator behavior was predictive of behavior problems (p < .001) but did not moderate the relationship with mTBI. Victim experiences, however, moderated the relationship between mTBI and the development of problem behavior (p < .001).

Conclusion: Following an mTBI, children showed higher behavior problems and reported more victim experiences than children without mTBI. Victim experiences acted as a mediator, suggesting that children who experience aggression from their peers may be especially at risk for behavior problems after mTBI. Perpetrator behavior, on the other hand, was strongly related to behavior problems independently of mTBI. This suggests that a child’s peer environment may be an important factor for worse behavioral outcomes after pediatric mTBI.

Background: Concussion education programs delivered in schools are well-positioned to educate youth athletes and non-athletes about concussions. However, school-based concussion education programs have often been delivered solely to student-athletes and have seldom been evaluated. Accordingly, there is a need to develop and evaluate a school-based concussion education program that can be delivered to the entire student body. The objective of this study was to implement a school-based, peer-led concussion education program (Youth Concussion Awareness Network (You-CAN)) in a sample of Canadian high schools to assess the feasibility, acceptability, and preliminary impacts of the program using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework.

Methods: During the 2021-2022 school year, four Canadian high schools consented to participate in You-CAN. Key components of You-CAN involved: (1) the creation of a student-driven concussion council and (2) the delivery of a school-wide concussion awareness campaign by the concussion council. School-wide surveys were completed at two time points during the school year (n=35 paired). Primary outcomes of interest were the impacts of the concussion awareness campaign on concussion knowledge and intended concussion behaviours (i.e., concussion reporting and provision of social support). Qualitative interviews were held with concussion council members (n=6) and supporting school staff (n=5) and focused on program implementation, acceptability, and feasibility. Quantitative survey data was analyzed using descriptive statistics and qualitative interview data was analyzed using a content analysis. Mixed-methods integration occurred at the interpretation and reporting levels across the dimensions of the RE-AIM Framework.

Results: (Reach) Twelve students were recruited to participate in their school's concussion council. (Effectiveness) Among students who completed the program evaluation, there were mixed findings regarding changes in concussion knowledge and intended behaviours. However, in qualitative interviews, most concussion council members reported that their school's concussion awareness campaign increased their own and their peers' concussion knowledge. (Adoption) Seventy-five percent of schools that consented to participate in the You-CAN program adopted the program in their schools. In qualitative interviews, supporting school staff reported adopting You-CAN because it aligned with school priorities and because they appreciated the peer-led nature of the program. However, their school setting and external factors (e.g., COVID-19) influenced the degree to which the program was adopted. (Implementation) The majority of council members and supporting school staff reported being pleased with their concussion awareness campaigns. However, they noted barriers to implementation, such as feeling rushed to plan their campaigns and struggling to coordinate meetings with council members.

Conclusions: The You-CAN program appears to be a feasible and acceptable way to deliver concussion education within schools. Further studies are required to better understand the program's impact on concussion knowledge and behaviours. The learnings from this study will inform modifications to the program prior to its broader implementation.