Social competence following neonatal and childhood stroke

Authors

  • Warren Lo,

    Corresponding author
    1. Division of Neurology, Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA
    • Correspondence: Warren Lo, Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, EDU 582, 700 Children's Drive, Columbus, OH 43205-2664, USA.

      E-mail: warren.lo@nationwidechildrens.org

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  • Anne Gordon,

    1. Paediatric Occupational Therapy Department, Paediatric Neuroscience, Evelina Children's Hospital, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
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  • Christine Hajek,

    1. Department of Psychology, The Ohio State University, Columbus, OH, USA
    2. Center for Biobehavioral Health, Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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  • Alison Gomes,

    1. Critical Care & Neurosciences Research, Murdoch Children's Research Institute and The Royal Children's Hospital, Melbourne, Victoria, Australia
    2. Psychological Medicine, Monash University, Melbourne, Australia
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  • Mardee Greenham,

    1. Critical Care & Neurosciences Research, Murdoch Children's Research Institute and The Royal Children's Hospital, Melbourne, Victoria, Australia
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  • Elizabeth Perkins,

    1. Division of Neurology, Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA
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  • Nicholas Zumberge,

    1. Department of Radiology, The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA
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  • Vicki Anderson,

    1. Critical Care & Neurosciences Research, Murdoch Children's Research Institute and The Royal Children's Hospital, Melbourne, Victoria, Australia
    2. Department of Psychology, The Royal Children's Hospital, Melbourne, Australia
    3. School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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  • Keith Owen Yeates,

    1. Department of Psychology, The Ohio State University, Columbus, OH, USA
    2. Center for Biobehavioral Health, Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
    3. Division of Psychology, Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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  • Mark T. Mackay

    1. Critical Care & Neurosciences Research, Murdoch Children's Research Institute and The Royal Children's Hospital, Melbourne, Victoria, Australia
    2. Department of Neurology, The Royal Children's Hospital, Melbourne, Australia
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  • Funding: Dr Lo was supported by the Research Institute of the Nationwide Children's Hospital. Dr Yeates is supported by the NIH although no NIH funds were expended in this study. Dr Anderson is supported by the National Health and Medical Research Council of Australia. The remaining authors have no financial disclosures and declare no conflicts of interest.

Abstract

Background

Social functioning encompasses a range of important skills that an individual uses to interact with the social world. Previous studies suggest that social functioning (outcomes) may be impaired after childhood stroke, but research is limited.

Aims

We examined the following: (1) the effect of ischemic stroke upon social outcomes in children; (2) the correlation of cognitive abilities and problem behaviors with social outcomes; and (3) the role of infarct characteristics as predictors of social outcomes.

Methods

We conducted an observational case-controlled study to compare children with neonatal or childhood onset stroke and controls with chronic asthma. Neurological deficits were measured with the Pediatric Stroke Outcome Measure. Cognitive abilities, problem behavior, adaptive behavior, and social outcomes were assessed with standardized measures.

Results

Overall stroke cases were impaired in several areas of adaptive behaviors but not in cognitive ability, problem behaviors, or social outcomes. Children with more severe neurological deficits had impairments in a range of adaptive behaviors, social adjustment, and social participation. Impaired cognitive ability and more problem behaviors correlated with impaired social adjustment, particularly in stroke cases. Larger infarcts correlated with greater neurological impairment, lower IQ, and poorer social participation.

Conclusions

Stroke can result in impaired adaptive and social functioning without apparent deficits in IQ or behavior. Infarct size, residual neurological deficits, impaired cognitive ability, and problem behaviors increase the risk for poor social adjustment and participation. These findings can help the clinician anticipate impaired social functioning after pediatric stroke, which is important because age-specific treatments are available.

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