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Functional plasticity in childhood brain disorders: when, what, how, and whom to assess
Maureen Dennis1, Brenda J Spiegler, Nevena Simic
1Department of Psychology, Program in Neurosciences and Mental Health, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada, maureen.dennis@sickkids.ca.
Insights
The developing brain balances plasticity and homeostasis. Behavioral outcomes in children with brain injury reflect these processes and environmental interactions, guiding assessment timing and methods.
Area of Science:
- Neuroscience
- Developmental Psychology
- Clinical Research
Background:
- The brain constantly balances neural plasticity (change) and homeostasis (stability) throughout life.
- Child development, typical or with brain injury, results from interactions between these brain processes and the environment.
Purpose of the Study:
- To explore optimal assessment strategies for behavioral outcomes in children with brain malformations or injuries.
- To determine when to assess, what to measure, and how to assess outcomes in pediatric brain injury.
Main Methods:
- Reviewing principles of neural plasticity and homeostatic processes in development.
- Considering factors influencing functional outcomes, including age at insult, time since insult, and age at testing.
- Examining various assessment approaches: performance variability, direct/informant measures, overt/covert measures, lab/ecological settings.
Main Results:
- Key functions for assessment include reacting to the past, predicting the future, and social-affective skills.
- Assessment should integrate diverse data sources and methods for a comprehensive view.
- Individual differences (gene, SES, parenting, nutrition, support) significantly moderate outcomes.
Conclusions:
- Timing, content, and methods of outcome assessment are critical for understanding pediatric brain injury.
- Recognizing individual differences is essential for accurate and meaningful outcome evaluation.
- A holistic approach considering biological and environmental factors is necessary for effective intervention and support.
Abstract:
At every point in the lifespan, the brain balances malleable processes representing neural plasticity that promote change with homeostatic processes that promote stability. Whether a child develops typically or with brain injury, his or her neural and behavioral outcome is constructed through transactions between plastic and homeostatic processes and the environment. In clinical research with children in whom the developing brain has been malformed or injured, behavioral outcomes provide an index of the result of plasticity, homeostasis, and environmental transactions. When should we assess outcome in relation to age at brain insult, time since brain insult, and age of the child at testing? What should we measure? Functions involving reacting to the past and predicting the future, as well as social-affective skills, are important. How should we assess outcome? Information from performance variability, direct measures and informants, overt and covert measures, and laboratory and ecological measures should be considered. In whom are we assessing outcome? Assessment should be cognizant of individual differences in gene, socio-economic status (SES), parenting, nutrition, and interpersonal supports, which are moderators that interact with other factors influencing functional outcome.
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