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Aim  To determine the levels of anxiety and depression in young people with spinal cord injuries (SCI) and their associated factors and outcomes. Method  Children and adolescents aged 7 to 17 years at interview who had sustained SCI at least 1 year before the study were assessed using the Children’s Depression Inventory, the Revised Children’s Manifest Anxiety Scale, the Pediatric Quality of Life Inventory, the Children’s Assessment of Participation and Enjoyment, and a demographic questionnaire designed for the study. Results  The 118 participants (61 males, 57 females) had a mean age of 12 years 4 months, SD 3y 1mo, range 7‐17y. Mean age at injury was 5 years 11 months, SD 4y 11m, range 0‐16y; 89 participants (75%) had paraplegia and 29 (25%) had tetraplegia. Fifty‐seven (52%) had complete injuries and 52 (48%) had incomplete injuries according to the American Spinal Injury Association impairment scale. Thirteen participants (13%) reported significant symptoms of anxiety, and seven (6%) reported significant levels of depression, which were comparable to the normative population. Age, race, and sex were not associated with anxiety or depression, but participants with shorter duration of injury were more likely to be anxious, and those with less functional independence were more likely to be depressed. Only one dimension of participation was associated with anxiety and depression, but all aspects of quality of life were decreased among those with anxiety or depression. Interpretation  The levels of anxiety and depression in young people with SCI are comparable to the normative range. When anxiety and depression occur they are associated with reduced levels of quality of life.

AIM To determine patterns of participation and levels of enjoyment in young people with spinal cord injuries (SCI) and to assess how informal and formal participation varies across child, injuryrelated, household, and community variables.METHOD One hundred and ninety-four participants (106 males, 88 females; mean age 13y 2mo, SD 3y 8mo, range 6-18y) with SCI and their primary caregivers completed a demographics questionnaire and a standardized measure of participation (the Children's Assessment of Participation and Enjoyment, [CAPE]) at three pediatric SCI centers in a single hospital system in the United States. Their mean age at injury was 7 years 2 months (SD 5y 8mo, range 0-17y); 71% had paraplegia, and 58% had complete injuries.RESULTS Young people participated more often in informal activities (t (174) =29.84, p<0.001) and reported higher enjoyment with these (t (174) =2.01, p=0.046). However, when engaging in formal activities, they participated with a more diverse group (t (174) =)16.26, p<0.001) and further from home (t (174) =)16.08, p<0.001). Aspects of informal participation were related to the child's age, sex, and injury level, and formal participation to the child's age and caregiver education. Caregiver education was more critical to formal participation among young people with tetraplegia than among those with paraplegia (F (4,151) =2.67, p=0.034).INTERPRETATION Points of intervention include providing more participation opportunities for young people with tetraplegia and giving caregivers the resources necessary to enhance their children's formal participation.A spinal cord injury (SCI) is a life-changing event and is particularly devastating when it occurs during childhood. Many unique challenges exist for children with SCI as a result of both the injury and the dynamic growth and development issues that occur during childhood.1 One area of particular concern is that of participation. The World Health Organization 2 defines participation as 'involvement in a life situation' and the result of peer interaction within an individual's social and physical environment. Researchers have found that involvement, particularly in physical recreation and sports, is highly related to overall health, disease prevention, maintenance of functional independence, 3 and life satisfaction. Despite this, rates of participation tend to be lower among young people with disabilities. 5 In the present study, we explored participation among young people with SCI.Participation is essential to the development of children. It is often through participation that children learn about societal expectations, develop communication skills, build friendships, and conquer important milestones while gaining skills and knowledge imperative to success at home and in the community. 6 Children with disabilities are at risk of decreased participation.5 A disability creates a major disruption in children's ability to play and interact with their environment. 7 This disruption may adversely affect the developmental process, as lack of so...

Spinal cord injuries are devastating events, and they are particularly tragic when they affect children or adolescents who have barely had an opportunity to experience life. Of the approximately 10,000 individuals who sustain spinal cord injury each year in the United States, 3% to 5% occur in individuals younger than 15 years of age and approximately 20% occur in those younger than 20 years of age (Nobunaga, Go, & Karunas, 1999). Because of the growth and development inherent in children and adolescents and the unique manifestations and complications associated with spinal cord injuries, management must be developmentally based and directed to the individual's special needs (Vogel, 1997). The many unique facets of pediatric spinal cord injuries are addressed in this article. They clearly delineate the need for care that is responsive to the dynamic changes that occur with growth and development. The multidisciplinary team, combined with a focus on family-centered care, is essential in pediatric spinal cord injuries.

Youth from small towns, those injured younger, those with incomplete injuries, and those experiencing recent medical complications may need additional supports and resources to maximize participation. Clinicians should work with caregivers to identify and problem-solve obstacles to youth participation.