Predictors of externalizing behavior outcomes following pediatric stroke

Area of Science:

• Pediatric neurology
• Child psychology
• Neuroscience

Background:

• Pediatric stroke survivors face increased risks for behavioral challenges.
• Understanding executive function deficits is crucial for managing long-term outcomes.

Purpose of the Study:

• To determine the prevalence of externalizing behaviors and executive function problems in children post-stroke.
• To identify neurological predictors of these behavioral issues.

Main Methods:

• Utilized parent-reported data from the Behavioral Assessment System for Children-Second Edition (BASC-2) and Behavior Rating Inventory of Executive Function (BRIEF).
• Included 210 children with pediatric ischemic stroke, analyzing perinatal versus childhood stroke groups.
• Correlated externalizing behaviors with executive function measures and examined predictors like gender.

Main Results:

• No significant differences in externalizing behaviors or executive function between perinatal and childhood stroke groups, except for the 'shift' subscale.
• 10% of stroke survivors exhibited clinically elevated hyperactivity, compared to 2% expected.
• Parents reported higher concerns in behavior regulation and metacognition domains of the BRIEF.
• Externalizing behaviors showed moderate to strong correlations with executive function deficits (r=0.42-0.74).
• Female gender was the only significant predictor of increased hyperactivity (p=0.004), though no gender differences in ADHD diagnosis were found.

Conclusions:

• Children with pediatric stroke, both perinatal and childhood, do not differ in reported externalizing behaviors or executive function.
• Pediatric stroke survivors are significantly more prone to clinically elevated hyperactivity than the general population.
• Findings highlight the increased risk and need for monitoring behavioral and executive function outcomes in pediatric stroke survivors.