School of Psychology, Deakin University, Geelong, Vic., Australia.
Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.
J Child Psychol Psychiatry. 2021 Sep;62(9):1150-1161. doi: 10.1111/jcpp.13385. Epub 2021 Feb 24.
Despite increasing evidence of a link between early life brain injury and anti-social behavior, very few studies have assessed factors that explain this association in children with traumatic brain injury (TBI). One hypothesis suggests that childhood TBI elevates risk for anti-social behavior via disruption to anatomically distributed neural networks implicated in executive functioning (EF). In this longitudinal prospective study, we employed high-resolution structural neuroimaging to (a) evaluate the impact of childhood TBI on regional morphometry of the central executive network (CEN) and (b) evaluate the prediction that lower EF mediates the prospective relationship between structural differences within the CEN and postinjury anti-social behaviors.
This study involved 155 children, including 112 consecutively recruited, hospital-confirmed cases of mild-severe TBI and 43 typically developing control (TDC) children. T1-weighted brain magnetic resonance imaging (MRI) sequences were acquired sub-acutely in a subset of 137 children [TBI: n = 103; TDC: n = 34]. All participants were evaluated using direct assessment of EF 6 months postinjury, and parents provided ratings of anti-social behavior 12 months postinjury.
Severe TBI was associated with postinjury volumetric differences within the CEN and its putative hub regions. When compared with TD controls, the TBI group had significantly worse EF, which was associated with more frequent anti-social behaviors and abnormal CEN morphometry. Mediation analysis indicated that reduced EF mediated the prospective association between postinjury volumetric differences within the CEN and more frequent anti-social behavior.
Our longitudinal prospective findings suggest that detection of neurostructural abnormalities within the CEN may aid in the early identification of children at elevated risk for postinjury executive dysfunction, which may in turn contribute to chronic anti-social behaviors after early life brain injury. Findings underscore the potential value of early surveillance and preventive measures for children presenting with neurostructural and/or neurocognitive risk factors.
尽管越来越多的证据表明早期脑损伤与反社会行为之间存在关联，但很少有研究评估创伤性脑损伤 (TBI) 儿童中解释这种关联的因素。有一种假设认为，儿童 TBI 通过破坏与执行功能 (EF) 相关的解剖分布神经网络，增加了反社会行为的风险。在这项纵向前瞻性研究中，我们采用高分辨率结构神经影像学来 (a) 评估儿童 TBI 对中央执行网络 (CEN) 区域形态的影响，以及 (b) 评估以下假设：较低的 EF 预测会调节 CEN 内结构差异与损伤后反社会行为之间的前瞻性关系。
本研究涉及 155 名儿童，包括 112 名连续招募的、经医院确诊的轻度至重度 TBI 病例和 43 名典型发育对照 (TDC) 儿童。在 137 名儿童的亚急性阶段采集 T1 加权脑磁共振成像 (MRI) 序列[TBI：n=103；TDC：n=34]。所有参与者在损伤后 6 个月接受直接 EF 评估，父母在损伤后 12 个月对反社会行为进行评分。
严重 TBI 与 CEN 及其假定的中枢区域的损伤后体积差异有关。与 TD 对照组相比，TBI 组的 EF 明显更差，这与更频繁的反社会行为和异常的 CEN 形态有关。中介分析表明，EF 的降低介导了 CEN 内损伤后体积差异与更频繁的反社会行为之间的前瞻性关联。
我们的纵向前瞻性研究结果表明，检测 CEN 内的神经结构异常可能有助于早期识别有发生损伤后执行功能障碍风险的儿童，这反过来可能导致儿童在早期脑损伤后出现慢性反社会行为。研究结果强调了对有神经结构和/或神经认知危险因素的儿童进行早期监测和预防措施的潜在价值。
