Risk for engagement in nonsuicidal self-injury in children and adolescents

Although NSSI engagement is a growing public health concern, little research has documented the developmental precursors to NSSI in longitudinal studies using youth samples. This study aimed to expand upon previous research on groups of NSSI engagement in a population-based sample of youth using multi-wave data. Moreover, this study examined whether chronic peer and romantic stress, the serotonin transporter gene (5-HTTLPR), parenting behaviors, and negative attributional style predicted the NSSI group membership as well as the role of sex and grade. Participants were 549 youth in beginning in the 3rd, 6th, and 9th grades at the baseline assessment. NSSI was assessed across 7 waves of data. Chronic peer and romantic stress, 5-HTTLPR, parenting behaviors, and negative attributional style were assessed at baseline. Growth mixture models, conducted to test the latent trajectory of NSSI groups did not converge. Three NSSI groups were manually created according to classifications that were determined a priori. NSSI groups included: no NSSI (85.1%), episodic NSSI (8.5%), and repeated NSSI (6.4%). Chronic peer and romantic stress, sex, and grade differentiated the no NSSI vs. repeated NSSI groups and the episodic NSSI vs. repeated NSSI groups. Specifically, higher levels of stress, being female, and being in higher grades related to repeated NSSI. 5-HTTLPR differentiated the no NSSI vs. repeated NSSI groups, such that carrying the short allele of 5-HTTLPR related to repeated NSSI. Exploratory analyses revealed that the relationship between attributional style and NSSI group was moderated by grade. This study suggests chronic interpersonal peer and romantic stress is an important factor placing youth at greater risk for repeatedly engaging in NSSI.

The Utility of the CVLT-C as an Embedded Validity Indicator After Pediatric Mild Traumatic Brain Injury.

Results of neuropsychological examinations depend on valid data. Whereas clinicians previously believed that clinical skill was sufficient to identify non-credible performance by examinees on standard tests, research demonstrates otherwise. Consequently, studies on measures to detect suspect effort in adults have received tremendous attention in the previous twenty years, and incorporation of validity indicators into neuropsychological examinations is now seen as integral. Few studies exist that validate methods appropriate for the measurement of effort in pediatric populations. Of extant studies, most evaluate standalone measures originally developed for use with adults. The present study examined the utility of indices from the California Verbal Learning Test – Children's Version (CVLT-C) as embedded validity indicators in a pediatric sample. Participants were 225 outpatients aged 8 to 16 years old referred for clinical assessment after mild traumatic brain injury (mTBI). Non-credible performance (n = 39) was defined as failure of the Medical Symptom Validity Test (MSVT). Logistic regression demonstrated that only the Recognition Discriminability index was predictive of MSVT failure (OR = 2.88, p < .001). A cutoff of z ≤ -1.0 was associated with sensitivity of 51% and specificity of 91%. In the current study, CVLT-C Recognition Discriminability was useful in the identification of non-credible performance in a sample of relatively high-functioning pediatric outpatients with mTBI. Thus, this index can be added to the short list of embedded validity indicators appropriate for pediatric neuropsychological assessment.

Recovery from Pediatric Brain Injury: A Preliminary Comparison of Longitudinal Data on Psychological Symptomology and Mental Health Treatment

Objective: To document the course of psychological symptomology, mental health treatment, and unmet psychological needs using caregiver reports in the first 18 months following pediatric brain injury (BI). Method: Participants included 28 children (aged 1-18 years) who were hospitalized at a children's hospital's rehabilitation unit. Caregiver reports of children's psychological symptoms, receipt of mental health treatment, and unmet psychological needs were assessed at one month, six months, 12 months, and 18 months post-BI. Results: Caregivers reported a general increase in psychological symptoms and receipt of mental health treatment over the 18 months following BI; however, there was a substantial gap between the high rate of reported symptoms and low rate of reported treatment. Across all four follow-up time points there were substantial unmet psychological needs (at least 60% of sample). Conclusions: Findings suggest that there are substantial unmet psychological needs among children during the first 18 months after BI. Barriers to mental health treatment for this population need to be addressed.

Development of the DORI-TBI: An Investigation to Develop a New Screening Measure to Determine Consultation with a School-Based Brain Injury Resource Team

Brain injury is the leading cause of disability and death in children in the United States. Student re-entry into the school setting following a traumatic brain injury is crucial to student success. Multidisciplinary teams within the school district comprised of individuals with expertise in brain injury are ideal in implementing student specific treatment plans given their specialized training and wide range of expertise addressing student needs. Therefore, the purpose of this study is to develop and initially validate a quantitative instrument that school personnel can use to determine if a student, identified as having a traumatic brain injury, will benefit from district-level consultation from a brain injury team. Three studies were designed to investigate the research questions. In study one, the planning and construction of the DORI-TBI was completed. Study two addressed the content validity of the DORI-TBI through a comparison analysis with other referral forms, content review with experts in the field of TBI, and cognitive interviews with professionals to test the usability of the new screening tool. In study three, a field administration was conducted using vignettes to measure construct validity. Results produced a valid and reliable new screening instrument that can aid school-based teams to more efficiently utilize district level consultation with a brain injury support team.