Environmental Contributions to Social and Mental Health Outcomes Following Pediatric Stroke

Abstract

Mental health and social outcomes following acquired brain injury (ABI) in children are often considered to be due to brain insult, but other factors, such as environment, may also play a role. We assessed mental health and social function in children with chronic illness, with and without stroke (a form of ABI), and typically developing (TD) controls to examine environmental influences on these outcomes. We recruited 36 children diagnosed with stroke, 15 with chronic asthma, and 43 TD controls. Children and parents completed questionnaires rating child mental health and social function and distal and proximal environment. TD children had significantly less internalizing and social problems than stroke and asthma groups, and engaged in more social activities than children with stroke. Poorer parent mental health predicted more internalizing and social problems and lower social participation. Family dysfunction was associated with internalizing problems. Lower parent education contributed to children's social function. Children with chronic illness are at elevated risk of poorer mental health and social function. Addition of brain insult leads to poorer social participation. Quality of home environment contributes to children's outcomes, suggesting that supporting parent and family function provides an opportunity to optimize child mental health and social outcomes.

Psychosocial outcome and quality of life following childhood stroke – A systematic review

“…A significant influence of family functioning and parent mental health on psychosocial outcome was identified [8]. A strong association between executive components of attention and social function was also identified [28].…”

“…Nine studies highlight the risk of a range of social difficulties following childhood stroke, such as poorer social adjustment, participation, difficulties with their peers, or changed friendships [8,21,26,27,28,29,35,41,48].…”

“…Twenty-six studies did not recruit a control group but compared scores to published normative population data. Of the remaining ten that did recruit control participants, these included typically developing children as controls [20,8,21]; children with other non-neurological health conditions, such as orthopaedic and chronic asthma controls [22,23,24,25,26,21,8]; and some children with other neurodevelopmental conditions but without stroke, such as sickle cell disease controls [27] or malformations of cortical development [28]. The participant sample sizes in the studies ranged from fourteen children [28] to 163 children [2].…”

“…Although potentially the most concerning for children and families, there is a recognised dearth in research around the functional, behavioural and psychosocial outcome following stroke in childhood [12,18,3,8]. Looking specifically at social interaction, participation, cognition and psychological function, Gomes et al [18] concluded that childhood stroke is associated with increased risk of psychosocial impairment.…”

“…Variations in the aetiology of stroke in childhood, in addition to variation in lesion location and volume can lead to a diverse range of physical and cognitive deficits, and secondary functional impairments [8]. Prognostic signs of a poor outcome have been identified as seizures at the onset of stroke and stroke in infancy [9].…”