Novel Psychiatric Disorders Following Mild Traumatic Brain Injury in the Second Year of the Adolescent Brain Cognitive Development Study.

Pediatric mild traumatic brain injury (mTBI) is a major public health concern. New psychiatric disorders (NPDs) can arise after mTBI, yet postinjury NPDs in nonclinical samples remain poorly understood. NPDs were prospectively characterized for youths ages 9-11 years who experienced an mTBI in their first year of participation in the Adolescent Brain Cognitive Development study, compared with control groups of orthopedically injured and noninjured individuals; a broad set of preinjury factors was accounted for in analyses. Between baseline (ages 9-10) and year 1 (ages 10-11), 135 youths had an mTBI, with 110 incurring a first lifetime mTBI. The prevalence of NPDs at the year-1 study visit was comparable among the injury groups, and mTBI did not predict NPDs at year 1. Preinjury psychiatric diagnoses significantly predicted NPDs (NPD-current [NPD-C] group: OR=2.18, 95% CI=1.30-3.61, p=0.003; NPD-any [NPD-A] group: OR=1.70, 95% CI=1.16-2.52, p=0.006), and self-reported Hispanic ethnicity was associated with lower odds of NPDs at year 1 (NPD-C group: OR=0.19, 95% CI=0.03-0.78, p=0.018; NPD-A group: OR=0.57, 95% CI=0.31-0.98, p=0.043). These results suggest that for nonclinically selected youths with mTBI, in the first year after late childhood injury, mTBI is not associated with differential odds of NPDs. Preinjury psychiatric history predicted NPDs, and self-reported Hispanic ethnicity predicted lower odds of NPDs at year 1. Future studies are needed to further characterize psychiatric sequelae after pediatric mTBI across adolescence to identify risk and protective factors for targeted prevention and intervention strategies.

BackgroundMild traumatic brain injury (mTBI) is common in children. Long-term cognitive and behavioral outcomes as well as underlying structural brain alterations following pediatric mTBI have yet to be determined. In addition, the effect of age-at-injury on long-term outcomes is largely unknown.MethodsChildren with a history of mTBI (n = 406; Mage = 10 years, SDage = 0.63 years) who participated in the Adolescent Brain Cognitive Development (ABCD) study were matched (1:2 ratio) with typically developing children (TDC; n = 812) and orthopedic injury (OI) controls (n = 812). Task-based executive functioning, parent-rated executive functioning and emotion-regulation, and self-reported impulsivity were assessed cross-sectionally. Regression models were used to examine the effect of mTBI on these domains. The effect of age-at-injury was assessed by comparing children with their first mTBI at either 0-3, 4-7, or 8-10 years to the respective matched TDC controls. Fractional anisotropy (FA) and mean diffusivity (MD), both MRI-based measures of white matter microstructure, were compared between children with mTBI and controls.ResultsChildren with a history of mTBI displayed higher parent-rated executive dysfunction, higher impulsivity, and poorer self-regulation compared to both control groups. At closer investigation, these differences to TDC were only present in one respective age-at-injury group. No alterations were found in task-based executive functioning or white matter microstructure.ConclusionsFindings suggest that everyday executive function, impulsivity, and emotion-regulation are affected years after pediatric mTBI. Outcomes were specific to the age at which the injury occurred, suggesting that functioning is differently affected by pediatric mTBI during vulnerable periods. Groups did not differ in white matter microstructure.

Sleep disturbance is a common symptom of psychiatric and neurodevelopmental disorders and, especially in childhood, can be a precursor to various mental disorders. However, the genetic etiology of mental illness that contributes to sleep disturbance during childhood is poorly understood. We investigated whether the polygenic features of psychiatric and neurodevelopmental disorders are associated with sleep disturbance during childhood. We conducted polygenic risk score (PRS) analyses by utilizing large-scale genome-wide association studies (GWASs) (n = 46,350–500,199) of five major psychiatric and neurodevelopmental disorders (autism spectrum disorder, schizophrenia, attention-deficit/hyperactivity disorder (ADHD), major depressive disorder (MDD), and bipolar disorder) and, additionally, anxiety disorders as base datasets. We used the data of 9- to 10-year-olds from the Adolescent Brain Cognitive Development study (n = 9683) as a target dataset. Sleep disturbance was assessed based on the Sleep Disturbance Scale for Children (SDSC) scores. The effects of PRSs for these psychiatric and neurodevelopmental disorders on the total scores and six subscale scores of the SDSC were investigated. Of the PRSs for the five psychiatric and neurodevelopmental disorders, the PRSs for ADHD and MDD positively correlated with sleep disturbance in children (ADHD: R2 = 0.0033, p = 6.19 × 10−5, MDD: R2 = 0.0042, p = 5.69 × 10−6). Regarding the six subscale scores of the SDSC, the PRSs for ADHD positively correlated with both disorders of initiating and maintaining sleep (R2 = 0.0028, p = 2.31 × 10−4) and excessive somnolence (R2 = 0.0023, p = 8.44 × 10−4). Furthermore, the PRSs for MDD primarily positively correlated with disorders of initiating and maintaining sleep (R2 = 0.0048, p = 1.26 × 10−6), followed by excessive somnolence (R2 = 0.0023, p = 7.74 × 10−4) and sleep hyperhidrosis (R2 = 0.0014, p = 9.55 × 10−3). Despite high genetic overlap between MDD and anxiety disorders, PRSs for anxiety disorders correlated with different types of sleep disturbances such as disorders of arousal or nightmares (R2 = 0.0013, p = 0.011). These findings suggest that greater genetic susceptibility to specific psychiatric and neurodevelopmental disorders, as represented by ADHD, MDD, and anxiety disorders, may contribute to greater sleep problems among children.

Mild traumatic brain injuries (mTBI) are considered self-limiting and full recovery is expected. Recent studies identify deficits persisting years after mTBI. Large-scale prospective data permit testing the hypothesis that mTBI increases incidence of affective and behavioral symptoms after new, past , or new and past mTBI. The study involved secondary analyses of survey responses from the Adolescent Brain Cognitive Development (ABCD) Study. Adolescents in the ABCD Study ( n = 11 869; Wave 1, aged 9-10 years; Wave 2, aged 11-12 years) whose parents reported a new ( n = 157), past ( n = 1318), or new and past ( n = 50) mTBI on the Ohio State University Traumatic Brain Injury Identification Method short form were compared with controls who had no history of mTBI ( n = 9,667). Multivariable binary logistic regression models examined associations between a new, past, or new and past mTBI and current affective (aggression, depression, anxiety) and behavioral (somatic, thought, social, attention, attention deficit hyperactivity disorder, conduct) disorders while controlling for demographic factors and baseline symptoms. The primary measure was parental reports of psychiatric and behavioral symptoms on the Child Behavior Checklist. Girls exhibited no significant effects after a new mTBI, although a past mTBI increased anxiety (adjusted odds ratios [aOR] = 1.83, 95% confidence interval [CI: 1.15-2.90]) and attention (1.89 [1.09-3.28]) problems. Girls with new and past mTBIs reported elevated anxiety (17.90 [4.67-68.7]), aggression (7.37 [1.49-36.3]), social (9.07 [2.47-33.30]), thought (7.58 [2.24-25.60]), and conduct (6.39 [1.25-32.50]) disorders. In boys, new mTBI increased aggression (aOR = 3.83, 95% CI [1.42-10.30]), whereas past mTBI heightened anxiety (1.91 [1.42-2.95]), but new and past mTBIs had no significant effects. Adolescents are at greater risk of affective and behavioral symptoms after an mTBI. These effects differ as a function of gender and time of injury. Extended screening for mTBI history and monitoring of affective and behavioral disorders after mTBI in adolescents are warranted.

Intersectional research on childhood suicidality requires studies with a reliable and valid measure of suicidality, as well as a large sample size that shows some variability of suicidality across sex by race intersectional groups. Objectives: We aimed to investigate the feasibility of intersectionality research on childhood suicidality in the Adolescent Brain Cognitive Development (ABCD) study. We specifically explored the reliability and validity of the measure, sample size, and variability of suicidality across sex by race intersectional groups. Methods: We used cross-sectional data (wave 1) from the ABCD study, which sampled 9013 non-Hispanic white (NHW) or non-Hispanic black (NHB) children between the ages of 9 and 10 between years 2016 and 2018. Four intersectional groups were built based on race and sex: NHW males (n = 3554), NHW females (n = 3158), NHB males (n = 1164), and NHB females (n = 1137). Outcome measure was the count of suicidality symptoms, reflecting all positive history and symptoms of suicidal ideas, plans, and attempts. To validate our measure, we tested the correlation between our suicidality measure and depression and Child Behavior Checklist (CBCL) sub-scores. Cronbach alpha was calculated for reliability across each intersectional group. We also compared groups for suicidality. Results: We observed some suicidality history in observed 3.2% (n = 101) of NHW females, 4.9% (n = 175) of NHW males, 5.4% (n = 61) of NHB females, and 5.8% (n = 68) of NHB males. Our measure’s reliability was acceptable in all race by sex groups (Cronbach alpha higher than 0.70+ in all intersectional groups). Our measure was valid in all intersectional groups, documented by a positive correlation with depression and CBCL sub-scores. We could successfully model suicidality across sex by race groups, using multivariable models. Conclusion: Given the high sample size, reliability, and validity of the suicidality measure, variability of suicidality, it is feasible to investigate correlates of suicidality across race by sex intersections in the ABCD study. We also found evidence of higher suicidality in NHB than NHW children in the ABCD study. The ABCD rich data in domains of social context, self-report, schools, parenting, psychopathology, personality, and brain imaging provides a unique opportunity to study intersectional differences in neural circuits associated with youth suicidality.

Recent advances in neuroimaging modeling highlight the importance of accounting for subgroup heterogeneity in population-based neuroscience research through various investigations in large scale neuroimaging data collection. To integrate survey methodology with neuroscience research, we present an imaging data analysis and yield population generalizability with screened subsets of data. The Adolescent Brain Cognitive Development (ABCD) Study has enrolled a large cohort of participants to reflect the individual variation of the U.S. population in adolescent development. To ensure population representation, the ABCD Study has released the base weights. We estimated the associations between brain activities and cognitive performance using the functional Magnetic Resonance Imaging (fMRI) data from the ABCD Study's N-Back working memory task. Notably, the imaging subsample exhibits differences from the baseline cohort in key child characteristics and such discrepancies cannot be addressed simply by applying the ABCD base weights. We developed new population weights specific to the subsample and included the adjusted weights in the image-on-scalar regression model. We validated the approach through synthetic simulations and applications to fMRI data from the ABCD Study. Our findings demonstrate that population weighting adjustments effectively capture active brain areas associated with cognition, enhancing the validity and generalizability of population neuroscience research.

Pediatric traumatic brain injury (TBI) affects about 475,000 children in the United States annually. Studies from the 1990s showed worse mortality in pediatric TBI patients not transferred to a pediatric trauma center (PTC), but did not examine mild pediatric TBI. Evidence-based guidelines used to identify children with clinically insignificant TBI who do not require head CT were developed by the Pediatric Emergency Care Applied Research Network (PECARN). However, which patients can be safely observed at a non-PTC is not directly addressed. A systematic review of the literature was conducted, focusing on management of pediatric TBI and transfer decisions from 1990 to 2020. Pediatric TBI patients make up a great majority of preventable transfers and admissions, and comprise a significant portion of avoidable costs to the health care system. Majority of mild TBI patients admitted to a PTC following transfer do not require ICU care, surgical intervention, or additional imaging. Studies have shown that as high as 83% of mild pediatric TBI patients are discharged within 24 hrs. An evidence-based clinical practice algorithm was derived through synthesis of the data reviewed to guide transfer decision. The papers discussed in our systematic review largely concluded that transfer and admission was unnecessary and costly in pediatric patients with mild TBI who met the following criteria: blunt, no concern for NAT, low risk on PECARN assessment, or intermediate risk on PECARN with negative imaging or imaging with either isolated, nondisplaced skull fractures without ICH and/or EDH, or SDH <0.3 cm with no midline shift.

Outcomes can be challenging to predict in children with mild traumatic brain injury (TBI). Transcranial Doppler (TCD) ultrasound has become an increasingly useful modality in adult and pediatric TBI by measuring blood flow velocities within the circle of Willis. In children with moderate-to-severe TBI, multiple studies have correlated abnormal TCD measurements and poor outcomes. Additionally, TCD has shown value in assessing adults with mild brain injury. To date, there are no studies that correlate TCD findings and outcomes in children with mild TBI. We hypothesize that altered cerebral blood flow after mild TBI is associated with poor functional outcome using the Glasgow Outcome Scale-Extended, Pediatrics (GOS-E Peds). TCD was performed within 24 h of admission on 60 patients at a tertiary Level 1 children's hospital. A secondary analysis was performed on the subgroup of 28 mild TBI patients. GOS-E Peds was measured at the time of hospital discharge and 4-6 weeks post-discharge. Cerebral blood flow velocities did not show correlation with outcome. At discharge, the right-sided Spearman's correlation coefficient was 0.19 (p value = 0.33) and the left-sided was 0.36 (p = 0.06). At follow up the right-sided coefficient was -0.04 (p = 0.84), the left-sided was -0.25 (p = 0.24). Pulsatility index likewise showed no correlation. Right and left-sided correlation at discharge were -0.25 (p = 0.19) and 0.01 (p = 0.96), respectively. At follow up the right side showed 0.004 (p = 0.99), and the left showed 0.18 (p = 0.41). Although our data did not show correlation, it showed that the investigation could feasibly be done in pediatric patients with mild TBI. The study was limited by small sample size and infrequent outcome of interest. Future studies may help define the role of TCD in the large population of mild pediatric TBI patients.

Association between mild traumatic brain injury, brain structure, and mental health outcomes in the Adolescent Brain Cognitive Development Study

Comprehensive reviews of neurocognitive outcomes following mild, uncomplicated traumatic brain injury (TBI) in children have shown minimal effects on neurocognition, especially in methodologically rigorous studies. In this study, we report longitudinal (1, 6, and 12 months post injury) results in four domains of neurocognitive functioning in a large sample of children with mild TBI (n = 124, ages 8-17 at injury) relative to two demographically matched control groups (other injury: n = 94 and non-injury: n = 106). After accounting for age and parental education, significant main effects of group were observed on 7 of the 10 neurocognitive tests. However, these differences were not unique to the TBI sample but were found between both the TBI and other injury groups relative to the non-injured group, suggesting a general injury effect. Effects were primarily within the domains measuring memory, psychomotor processing speed, and language. This is the largest longitudinal study to date of neurocognitive outcomes at discrete time points in pediatric mild TBI. When controlling for pre-injury factors, there is no evidence of long-term neurocognitive impairment in this group relative to another injury control group. The importance of longitudinal analyses and use of appropriate control groups are discussed in the context of evaluating the effects of mild TBI on cognition.

Minority and socioeconomically disadvantaged populations are disproportionately exposed to elevated levels of air pollution. This environmental injustice exhibits distinct patterns and predictors across regions of the United States, which we investigate by leveraging baseline data (2016-2018) from the Adolescent Brain Cognitive Development (ABCD) Study, the largest longitudinal study of child brain development in the United States. Specifically, we examine within- and between-site variability in exposure to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) among 9- to 10-year-old participants. Using geocoded residential addresses and hybrid spatiotemporal models, air pollution exposure disparities were estimated by site, and by family- and neighborhood-level socioeconomic metrics within each site. Results indicate substantial variation in race/ethnicity- and class-based gaps in air pollution exposure across the 21 ABCD study sites. Overall, Hispanic/Latinx and Black children experienced higher average levels of PM2.5 and NO2 compared to their white counterparts, while children in neighborhoods with lower socioeconomic status exhibited elevated exposure regardless of race or ethnicity. Within-site disparities highlighted local environmental injustices, as well, with notable differences in pollution levels across neighborhoods at different levels of disadvantage. Elevated air pollution exposure in minoritized communities aligns with well-documented systemic inequities in built environment conditions and institutional resources, exacerbating health disparities. This study highlights the importance of integrating environmental justice into public health and policy initiatives, leveraging the multisite design of the ABCD Study to provide insights for promoting health equity in child and adolescent development within and across regions in the United States.

This report provides a primer to delay discounting data in the context of the Adolescent Brain Cognitive Development (ABCD) Study. Delay discounting describes the tendency for organisms to devalue temporally constrained outcomes. This decision-making framework has garnered attention from multiple fields for its association with various behavioral health conditions like substance use disorder. Importantly, the literature on delay discounting describes many approaches to analyzing and interpreting discounting data. To be most beneficial to the broader scientific audience, consistency and reproducibility in how delay discounting data are operationalized, analyzed, and interpreted is key. We describe relevant data analysis methods for use with the ABCD Study, a large-cohort longitudinal study (N = 11,878) examining delay discounting among youth respondents across child and adolescent development. Particular attention is given to data collected from children and younger populations given their relevance to ABCD research and potential merit for unique analytic considerations (e.g., higher rates of atypical responding). We first provide a background on the broad theoretical and conceptual aspects of discounting research. We then review discounting assessment, describing conventional titration tasks and the more novel algorithm-based approaches to generating descriptive metrics. We conclude with recommendations for best practice modeling, data handling and exclusions based on nonsystematic data, and ensuing interpretations. Analytic pipelines and coding are provided for investigator use. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

To examine whether pediatric mild traumatic brain injury (mTBI) is associated with differences in neurocognitive functioning among children. Baseline data from the Adolescent Brain Cognitive Development (ABCD) Study. Children with mTBI were compared to two control groups: children with orthopedic injury (OI) and children with no injury (NI). After excluding those with moderate/severe TBI, 450 children were classified as having mTBI, 1604 with OI, and 9814 with NI. This is a cross-sectional analysis using the baseline data from a longitudinal observational study. Neurocognitive performance was assessed using task-based cognitive tests, including the National Institutes of Health Toolbox Cognition Battery (NIHTBX), Rey Auditory Verbal Learning Test, and the Little Man Task. Multiple imputation was used to address missing data. Linear regression models were used to compare cognitive performance across groups, adjusting for age, sex, race, ethnicity, parental income, parental education, and genetic ancestry. The primary outcomes include the principal component scores representing General Ability, Executive Function , and Learning/Memory . Unadjusted analyses showed children with mTBI had significantly higher scores than NI children on all three principal components. However, no significant differences remained after adjusting for confounders. No differences were found between mTBI and OI groups. Sensitivity analyses further adjusting for behavior and white matter microstructure resulted in same findings. After adjusting for demographic and genetic factors, no significant differences were found between children with mTBI and OI/NI. The findings highlight the importance of accounting for demographic, socioeconomic, and genetic confounders, as well as selecting appropriate control groups, when analyzing cognitive differences of children with mTBI.

Dentate Gyrus Microstructure Is Associated With Resilience After Exposure to Maternal Stress Across Two Human Cohorts

A critical component for accelerating the clinical uptake of research data in the area of pediatric concussion or mild traumatic brain injury (MTBI) pertains to the establishment and utilization of common databases. The objective of the first phase of our CanPedCDE initiative was to agree upon pediatric common data elements (CDEs) that could best characterize children with MTBI over their recovery period. The selection of CDEs for our framework aimed to balance factors such as the comprehensiveness of outcomes collected, their applicability to diverse settings, as well as the costs associated with their use. Selection began by identifying relevant domains of functioning (e.g., post-concussion symptoms, attention, and balance). Two sources were used to make this process more efficient: 1) the World Health Organization International Classification of Functioning (ICF) Traumatic Brain Injury Core Set, and the U.S. National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Common Data Elements, both of which had already suggested relevant domains to include in TBI research. The process was completed in two phases: 1) using an online survey of experts and 2) through an in-person consensus meeting. Measurement tools were also proposed that were best felt to capture these domains. Forty experts in MTBI in children from multiple health-related perspectives (e.g., emergency medicine, pediatrics, neurosurgery, nursing, physiotherapy, and neuroscience), as well as knowledge users, participated in the selection process. The final list of CDEs included 77 distinct areas of functioning, covering all categories of the ICF model. Outcome measures were attached to each element, when applicable. The CanPedCDE initiative addresses a significant limitation in MTBI research to date and may help both researchers and clinicians to organize and standardize their assessment of children and youth post-MTBI in order to move the field in promising directions.