Social competence following pediatric stroke: Contributions of brain insult and family environment

Abstract

Limited information is available regarding predictors of psychosocial difficulties in children following stroke. This study aimed to (i) compare social competence of children with arterial ischemic stroke (AIS) to those with chronic illness and healthy controls and (ii) investigate the contribution of stroke pathology, neurological outcome and environment. Thirty-six children with AIS > 12 months prior to recruitment were compared with children with chronic illness (asthma) (n = 15) and healthy controls (n = 43). Children underwent intellectual assessment, and children and parents completed questionnaires to assess social competence. Children with AIS underwent MRI scan and neurological evaluation. Child AIS was associated with poorer social adjustment and participation, and children with AIS were rated as having more social problems than controls. Lesion volume was not associated with social outcome, but subcortical stroke was linked to reduced social participation and younger stroke onset predicted better social interaction and higher self-esteem. Family function was the sole predictor of social adjustment. Findings highlight the risk of social impairment following pediatric stroke, with both stroke and environmental factors influencing children's social competence in the chronic stages of recovery. They indicate the potential for intervention targeting support at the family level.

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

“…Studies found that younger age at stroke onset was significantly associated with poorer QoL in the domains of physical functioning and neurological outcome [13], long-term clinical outcomes and independence in daily activities [44,46], adaptive functioning skills [47], and overall outcome [16]. In contrast, younger age at stroke was associated with better overall well-being and quality of life [20] and better self-rated self-esteem and social participation [21] in other studies. Older age at stroke was associated with more behavioural difficulties in another study [29].…”

“…One study found that use of seizure medication was the strongest predictor of poorer functional outcome [47]. Lesion volume was not associated with social outcome but subcortical stroke and poorer neurological outcome was associated with less social participation [21]. In another study, neurological severity and larger infarcts were found to be associated with impaired social participation [26].…”

“…Many studies considered normal or mild deficits as a "good" outcome. However, the findings from this review indicate that even mild physical and functional deficits can result in recurring experiences of difficulties in adaptive behaviour and keeping up with peers [13,38,26] [9,21]. Following stroke, children and young people were reported to be impaired on adaptive behaviour, indicating ongoing functional concerns in the areas of self-care, play, school and leisure and frequently required more assistance and time with activities of daily living, practical tasks, mobility, school and social domains [33,45,19,22,40,32,26,50].…”

“…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].…”