In Melbourne, Australia, strict ‘lockdowns’ were implemented in 2020 to suppress COVID-19, significantly disrupting daily life. Young people (<18 years) with medical conditions have an elevated risk of mental health problems and may have been disproportionately affected by the distress associated with the COVID-19 restrictions. To investigate this, we conducted a single-site, longitudinal cohort study involving the parents of 135 children and adolescents with medical conditions. Using an adapted version of the CoRonavIruS Health Impact Survey (CRISIS), parents rated their child’s mental health, activities and healthcare experiences pre-COVID-19 (retrospectively), during lockdown and 6 months post-lockdown. General linear mixed models revealed that mental health symptoms, including anxiety, fatigue, distractibility, sadness, irritability, loneliness and worry, were higher during lockdown compared to pre-COVID-19. Notably, anxiety, sadness and loneliness remained elevated 6 months post-lockdown. Covariates such as older child age, increased parent stress and child screen time contributed to greater mental health difficulties. While most mental health symptoms resolved post-lockdown, the persistence of anxiety, sadness and loneliness highlights the need for ongoing clinical monitoring for young people with medical conditions during periods of community stress and restrictions.

To investigate the presence of specific family functioning trajectories in the 7-10 years after pediatric traumatic brain injury (TBI) and explore predictors associated with these trajectories. One hundred and thirty-seven families of children aged 1-12 years who experienced traumatic brain injury were prospectively recruited from a single site, statewide tertiary pediatric hospital. Assessments of family functioning were undertaken using the Intimacy, Conflict and Parenting Style: Family Functioning Scale at preinjury, 6-months, 12-months, 30-months, and 7-10 years. Group-based trajectory modeling was used to identify latent trajectories of functioning. Associations with child, family, and injury characteristics were explored. We identified four distinct family intimacy profiles, four conflict profiles, and three parenting style profiles. Profiles were characterized by their level of functioning, which remained mostly stable from pre-injury levels across the 7-10 years post-injury. Trajectory membership was not reliably related to characteristics of the child, family, or injury. These findings suggest that, while families operate at different levels of intimacy, conflict, and parenting flexibility, these do not change after a child's TBI. Given the established role of family functioning in shaping recovery outcomes, assessments of pre-injury family functioning may enable identification of families with children at risk for poorer outcomes post-TBI.

ObjectiveTo identify differential trajectories of neurocognitive outcomes following pediatric concussion and investigate predictors associated with patterns of recovery up to 3 months.Methods74 participants aged 8-17 years completed attention/working memory, processing speed, and executive function measures at 2 weeks, 1 month, and 3 months post-injury. We used principal component analysis to generate a composite of information processing. Group-based trajectory modeling identified latent trajectories. Multinominal logistic regression was used to examine associations between risk factors and trajectory groups.ResultsWe identified three trajectories of neurocognitive outcomes. The medium (54.6%) and high improving groups (35.8%) showed ongoing increase in information processing, while the low persistent group showed limited change 3 months post-injury. This group recorded below average scores on Digit Span Forward and Backward at 3 months. History of pre-injury headache was significantly associated with the persistent low scoring group, relative to the medium improving (p = 0.03) but not the high improving group (p = 0.09).ConclusionsThis study indicates variability in neurocognitive outcomes according to three differential trajectories, with groups partially distinguished by preexisting child factors (history of frequent headaches). Modelling that accounts for heterogeneity in individual outcomes is essential to identify clinically meaningful indices that are indicative of children requiring intervention.

Importance: Understanding how post-concussive symptoms (PCS) evolve across multiple domains and how these patterns relate to biopsychosocial factors is critical for identifying children at risk of prolonged recovery following concussion. Objective: To identify clinically meaningful recovery groups characterized by shared trajectories of cognitive, physical, emotional, and fatigue PCS over 3 months post-injury, and to examine associations between trajectory group membership and pre-injury, injury-related, and biopsychosocial factors. Design, Setting, and Participants: This prospective longitudinal cohort study was conducted at the Royal Children’s Hospital, Victoria, Australia. Participants were children aged 5–18 years presenting to the emergency department (ED) with concussion. Main Outcomes and Measures: Cognitive, physical, emotional, and fatigue PCS above pre-injury baseline were assessed via parent report using the Postconcussion Symptom Inventory at ED presentation and at 2–4 days, 2 weeks, 1 month, and 3 months post-injury. Group-based multi-trajectory modeling identified recovery groups. Associations with pre-injury, injury-related, psychosocial, and child factors were examined. Results: Among 326 children (231 males [70.9%]; mean [SD] age, 11.6 [3.2] years), five recovery trajectories were identified: resilient ( n = 45, 14%), early recovery ( n = 28, 9%), typical recovery ( n = 146, 45%), delayed symptom exacerbation ( n = 24, 7%), and persistently high symptom endorsement ( n = 83, 25%). Exploratory comparisons suggested that persisting trajectories were associated with prior child mental health history and greater post-injury psychosocial difficulties. Conclusions and Relevance: Pediatric concussion symptom domains followed broadly similar time courses for most children; however, among children with delayed or persisting symptoms, some domains differed in the shape and timing of change. Recovery profiles characterized by persisting symptom endorsement were more strongly associated with psychosocial and mental health factors than with injury-related characteristics, underscoring the importance of early psychosocial screening and ongoing monitoring.