BACKGROUND:Youth and young adults with spina bifida (SB) are at risk for neurocognitive challenges and face substantial medical needs, including neurogenic bowel management. Little is known about the relationship between neurocognitive functioning and independently managing a bowel program. Understanding these associations could help tailor interventions that promote independence and long-term quality of life. OBJECTIVE:To examine whether performance-based measures of intellectual functioning, academic achievement, and executive functioning are associated with bowel management program (BMP) independence in a clinical sample of youth and young adults with SB. We hypothesized that better neurocognitive and academic functioning would be associated with greater BMP independence. DESIGN:Cross-sectional study using secondary analysis of an institutional clinical registry. Binary logistic regression using weighted least squares mean and variance estimation tested predictors of bowel management independence, including a latent academic functioning factor and observed full-scale IQ, adjusting for age and ambulation status. SETTING:Outpatient hospital pediatric rehabilitation clinic. PARTICIPANTS:A total of 79 individuals with SB (ages 10-25 years; 50.6% female) with data on BMP status and neuropsychological testing. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURE:BMP independence, as measured by a parent-reported (if under 18 years) or self-reported (if older than 18 years) questionnaire. RESULTS:After adjusting for age and ambulation status, higher full-scale IQ (odds ratio [OR] = 1.32 [95% CI, 1.04-1.67], p = .025) and academic functioning (as defined as a latent variable including reading, writing, and math performance) (OR = 1.35 [95% CI, 1.08-1.69], p = .009) were associated with greater BMP independence. Executive functioning (as defined by a latent variable including tasks assessing planning, problem-solving, initiation, and cognitive flexibility) was not a significant predictor. When both full-scale IQ and academic functioning were included in a multivariable model, only full-scale IQ remained a significant independent predictor (OR = 1.45 [95% CI, 1.04-1.68], p = .004), suggesting that overall intellectual ability accounts for much of the variance in self-management. CONCLUSIONS:Higher intellectual functioning is associated with BMP independence in youth and young adults with SB, indicating that key cognitive abilities support self-management. These findings highlight the importance of considering general intellectual ability when designing individualized treatment plans and emphasize the need to address broader contextual barriers to promote successful self-management.

OBJECTIVE:The primary aim of this study was to determine if neighborhood disadvantage predicted internalizing symptoms and body mass index (BMI) in youth with spina bifida (SB), while accounting for several sociodemographic factors. We also explored whether resilience factors helped explain associations between neighborhood disadvantage and internalizing symptoms or neighborhood disadvantage and BMI. METHODS:Participants (n = 69, Mage=14.13, Range: 8-20, 51% biological female, 25% Hispanic/Latinx White, 28% Other/Multiracial, 48% non-Hispanic/Latinx White) were drawn from a retrospective chart review of clinical data, including self-reported resilience factors and internalizing symptoms, collected as part of the standard of care in a multidisciplinary pediatric SB clinic. Neighborhood disadvantage scores were extracted from participant addresses. Using structural equation modeling, we examined whether neighborhood disadvantage predicted BMI and internalizing symptoms. We explored whether these paths were mediated by resilience factors. RESULTS:Higher neighborhood disadvantage predicted higher BMI and lower internalizing symptoms. Higher neighborhood disadvantage predicted higher resilience factors, which predicted lower internalizing symptoms. Higher resilience factors did not predict BMI. CONCLUSIONS:Neighborhood disadvantage may require youth with SB to navigate their way to additional resilience factors to maintain better psychosocial outcomes. However, having more resilience factors may not help offset the physical health costs of disadvantaged neighborhoods.

Objective: We aim to describe health care, vocational, and educational transitions in young adults with pediatric-onset disabilities and to examine the associations with social determinants of health and depressive symptoms. Design: This cross-sectional study used multinomial and binary logistic regression to examine the associations of sociodemographic factors and depressive symptoms with health care, educational, and vocational transitions. Setting: Participants were recruited from outpatient specialty clinics in a rehabilitation medicine department at a quaternary academic children's hospital. Participants: Transition age adults with acquired brain injury (17), spina bifida (10), and neuromuscular disorders (28) participated in this study. Interventions: Not applicable. Main Outcome Measures: Participants provided information about their current health care utilization and educational/vocational status. Results: Twenty-five percent of participants were unsure of their primary resource for preventative health care; this uncertainty was associated with White race/Hispanic ethnicity (P=.004) and public insurance (P=.02). When asked about their primary health care resource if they are sick or have an immediate health-related question, 18% identified the emergency department; this was significantly related to greater neighborhood disadvantage (P=.009). Considering current educational and vocational status, having a job while also going to school was associated with more self-reported depressive symptoms (P=.009) and younger age (P=.02). Conclusions: Outcomes during the transition to adulthood are related to multiple factors, including race and ethnicity, public insurance, neighborhood disadvantage, and depressive symptoms. Targeted interventions to support health care, vocational, and educational transitions in the context of social determinants of health and mental health status are needed. Archives of Physical Medicine and Rehabilitation 2025;106:674-81 (c) 2024 by the American Congress of Rehabilitation Medicine.

PURPOSE/OBJECTIVE:The transition from childhood to adulthood often involves emotional challenges. These problems may be especially prominent for transition-age adults (TAA) with pediatric-onset disabilities, although there are currently few studies that speak to this. The aim of this study is to characterize depressive symptoms and the association with family functioning in a sample of TAA with pediatric-onset disabilities. RESEARCH METHOD/DESIGN:This sample is comprised of 55 TAA (18-28 years of age, M = 20.88, SD = 2.49) who were followed by pediatric rehabilitation medicine clinics. Participants have childhood acquired brain injury (n = 17), spina bifida (n = 10), or neuromuscular disorders (n = 28). Participants completed the Center for Epidemiological Studies-Depression scale and the Family Assessment Device Short Form. RESULTS:Clinically elevated depressive symptoms were endorsed by 65.4% of the sample. Forty-five percent of those with elevated depressive symptoms were not currently receiving psychotherapy services. Poorer family functioning on the Family Assessment Device Short Form and older age were independently associated with more depressive symptoms, controlling for medical condition, mobility status, and other relevant sociodemographic factors. CONCLUSIONS/IMPLICATIONS:Emotional problems are quite common in TAA with a history of acquired brain injury, spina bifida, and neuromuscular disorders, yet are seemingly inadequately managed. In view of the results of this study, TAA with pediatric-onset disabilities are likely to benefit from interventions that bolster emotional well-being and target risk factors related to their family system. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

OBJECTIVE:We examined the associations of executive functioning and social determinants of health with medical self-management skills in transition-age adults (TAA) with pediatric-onset disabilities. METHOD:This cross-sectional pilot study included 47 young adults between the ages of 18-28 and their informants (e.g., parents, partners, siblings). Participants were followed by pediatric rehabilitation clinics for acquired brain injury (ABI = 16), neuromuscular disorders (NMD = 22), or spina bifida (SB = 9). Informants completed the Behavior Rating Inventory of Executive Functions - Adult Version, from which we reported the General Executive Composite. To assess medical self-management, young adult participants completed the Transition Readiness Assessment Questionnaire (TRAQ). RESULTS:Using generalized linear regression with the TRAQ as the dependent measure, better informant-rated executive functioning skills were associated with more favorable ratings of healthcare self-management with a large effect size (β = -0.62, p < .001). With a small effect size, there was also a main effect of participant race and ethnicity (β = 0.27, p = .049). Marginalized identities, specifically identification as of Indigenous and Black races, were associated with poorer ratings of healthcare self-management skills. CONCLUSIONS:Lower executive functioning skills and some marginalized identities are linked to poorer healthcare self-management in this sample of TAA with pediatric-onset disabilities. These findings highlight the value of neuropsychologists in identifying cognitive challenges and implementing targeted interventions in the context of social determinants of health.

BACKGROUND:Premature birth is a risk factor for abusive head trauma (AHT), but no prior studies have compared preterm and term infants with AHT. OBJECTIVE:To assess differences in demographics, family/contextual factors, and outcomes between preterm and term infants with AHT. PARTICIPANTS AND SETTING:403 patients (70 preterm) treated for AHT between 2012 and 2020 at a tertiary care children's hospital. METHODS:Data were collected via chart review. Demographics, family/contextual variables, and a composite score for each Bayley Scales of Infant Development domain were compared between preterm and term patients with independent samples t-tests, chi-square tests, and binary logistic regression. Gestational age (GA) corrected and uncorrected Bayley scores for preterm patients were compared using a repeated measures ANOVA. RESULTS:Preterm infants had significantly lower height (p < .001, d = 0.50) and weight (p < .001, d = 0.44) percentiles, but no other significant demographic or family/contextual differences were found. Preterm children earned numerically higher Bayley scores than term infants with GA correction and lower scores without correction. Corrected Bayley scores were significantly higher than uncorrected for preterm infants in the Cognitive (p < .001, η2p = 0.083), Expressive Language (p = .005, η2p = 0.052), Fine Motor (p = .001, η2p = 0.045), and Gross Motor (p = .008, η2p = 0.031) domains. CONCLUSIONS:While no significant differences in demographics or family/contextual variables were observed, age corrected Bayley scores were significantly higher than uncorrected scores for preterm infants with AHT.

BACKGROUND:There is a lack of consensus on how best to measure injury severity in abusive head trauma in order to predict long-term neurodevelopmental outcomes. OBJECTIVE:We hypothesized that a constellation of injury-related variables along with child and family variables would more accurately predict outcomes in children who have sustained an AHT than the Glasgow Coma Scale (GCS) alone. PARTICIPANTS AND SETTING:In 2012-2020, we enrolled 270 patients (median age 4.6 months) treated for AHT at a large tertiary care children's hospital who survived their injuries and came to a multi-disciplinary follow-up clinic. METHODS:Exploratory analyses examined bivariate relationships of injury severity and child and family variables with neurodevelopmental outcomes, as measured by the Bayley Scales of Infant and Toddler Development, using Pearson correlations, independent samples t-tests, and one-way ANOVAs. These exploratory analyses informed the selection of variables for stepwise multivariate regressions predicting neurodevelopmental outcomes. RESULTS:Stepwise regression revealed that a constellation of injury-related variables including cytotoxic edema, length of intensive care stay, neurosurgical intervention, seizures, intubation, eye injuries, and abnormal spine imaging explained significantly more variance in Bayley scores than GCS alone (14-22 %, all p-values < .01). The largest effect sizes were for measures of hospital course (length of intensive care stay, neurosurgical intervention, seizures, and intubation). Including child and family variables explained an additional 6-10 % of the variance (all p-values < .05). CONCLUSIONS:A constellation of injury-related variables, especially those related to hospital course, was more predictive of neurodevelopment than solely GCS for children with AHT.

PURPOSE:To determine whether caregiver expectation and symptoms of attention deficit/hyperactivity disorder (ADHD) were significantly associated with self-management behavior in a sample of youth and young adults with spina bifida (SB), while accounting for several other condition-related and sociodemographic factors. METHODS:Participants were drawn from clinical cases seen through a multidisciplinary outpatient SB clinic at a children's hospital between 2022 and 2023. Participants included 52 youth and young adults younger than 21 years diagnosed with SB. Caregiver report of youth and young adult self-management behavior and caregiver expectation were obtained using the Kennedy Krieger Independence Scales-Spina Bifida Version (KKIS-SB). Caregiver report of youth and young adult ADHD symptoms were obtained using the National Institute for Children's Health Quality Vanderbilt Assessment Scale-Parent Version. RESULTS:Caregiver expectation and symptoms of ADHD were significantly associated with self-management behaviors in youth and young adults with SB, including the ability to initiate daily self-care and home living routines independently and the ability to use prospective memory to complete tasks that are needed for good health. More ADHD symptoms were associated with poorer ratings of self-management behavior and higher caregiver expectation was associated with better ratings of self-management behavior. CONCLUSION:The findings of this study suggest that caregiver expectations and co-occurring neurocognitive challenges may be influential when considering self-management behaviors in youth and young adults with SB. Family-based interventions that target caregiver perceptions and behaviors and provide psychoeducation about neurocognitive challenges as they relate to self-management behaviors may be an important target for future research.

BACKGROUND:Abusive head trauma (AHT), a leading cause of death from child physical abuse, disproportionately impacts the youngest children. Identifying children at highest risk following AHT has been hampered by the lack of a widely accepted measure of brain injury severity in infants and toddlers. OBJECTIVE:Identify clinical factors associated with mortality from AHT. PARTICIPANTS AND SETTING:403 patients (mean age 10.8 months) treated for AHT between 2012 and 2020 at a tertiary care children's hospital. METHODS:Single-center retrospective chart review. We tested relationships between covariates and mortality with t-tests and chi-square tests; these analyses guided development of a multivariable model using binary logistic regression. RESULTS:Forty-two of 403 children died (10.4 %). In bivariate analyses, mortality was linked to lower Glasgow Coma Scale (GCS; d = 2.07, p < .001), older age (d = -0.55, p = .009), midline shift (Φ = 0.10, p = .04), eye injuries (V = 0.42, p < .001), fractures (Φ = 0.14, p = .004), abdominal/visceral injuries (Φ = 0.14, p = .005), neurosurgical interventions (V = 0.22, p < .001), and intubation (Φ = 0.37, p < .001). Older children were at risk for more severe brain injuries and abdominal/visceral injuries. In the multivariable model, lower GCS (p < .001) and more fractures (p = .02) were associated with mortality. CONCLUSIONS:Our data support the use of GCS in infants and toddlers following AHT. Older children were more likely to die than younger children, with evidence for differing injury patterns by age.

CONTEXT:Pediatric mild traumatic brain injuries (mTBIs) represent an evolving field of interest in youth athletics. Although most players recover within 4 weeks, some have symptoms that last longer. Little is known about youth health-related quality of life (HRQoL) after mTBI. OBJECTIVES:To characterize youth HRQoL after soccer-related mTBI and to identify predictors of individual differences in HRQoL recovery. DESIGN:Prospective cohort study. SETTING:Youth soccer. PARTICIPANTS:Soccer players, aged 8 to 17 years, who sustained an mTBI (n = 23) or orthopaedic injury (OI, n = 24) or remained uninjured (n = 23) during a single season. MAIN OUTCOME MEASURE(S):We assessed HRQoL via the Pediatric Quality of Life Inventory, version 4.0, and postconcussive symptoms via the Health and Behavior Index. Serial assessments occurred at 24 to 48 hours, 7 days, 30 days, and 90 days postinjury via telephone interview. RESULTS:At 7 days postinjury, the mTBI and OI groups had poorer total HRQoL (F2,67 = 11.35, P < .001) than the uninjured control group. At 7 days, the mTBI group had the poorest psychosocial HRQoL, whereas the OI group had the poorest physical HRQoL. Differences between the mTBI and uninjured control groups resolved by 30 days. Within the mTBI group, players with significant postconcussive symptoms at 7 days had poorer total (F1,21 = 23.071, P ≤ .001; F1,21 = 5.798, P = .028), psychosocial (F1,21 = 16.488, P = < .001; F1,21 = 5.050, P = .039), and physical (F1,21 = 21.671, P = < .001; F1,21 = 5.119, P = .038) HRQoL at 7 and 30 days, respectively, than players with minimal symptoms; these differences resolved by 90 days. CONCLUSIONS:As a group, youth soccer players who sustained mTBI had transient impairments in HRQoL that resolved by 30 days. A subset of players with significant postconcussive symptoms at 7 days postinjury had poorer HRQoL for at least 30 days postinjury than those whose postconcussive symptoms had resolved within a week of injury. This suggests ongoing recovery in this subset at 30 days and the potential utility of HRQoL as a measure of recovery.

Social-emotional difficulties are common sequelae of traumatic brain injury (TBI). Children who have experienced inflicted TBI (iTBI) may be at increased risk for social-emotional problems due to the risk factors associated with both early neurologic injury and with child maltreatment. We characterized the associations among injury severity, caregiver type (i.e., biological parents, non-kinship, kinship), and child social-emotional functioning in 41 infants and young children who had sustained iTBI and were seen in a large, regional children's hospital. This study was a retrospective analysis, utilizing data collected from the medical record as part of routine clinical care. Social-emotional functioning was assessed with the Bayley Scales of Infant and Toddler Development-Third Edition. Children with more severe injuries were rated as having worse social-emotional functioning. Caregiver type was associated with child social-emotional scores, above and beyond injury and demographic predictors. Biological parents were more likely to report better social-emotional skills than non-kinship caregivers, with the pattern of results suggesting that rater bias plays a role in this difference. In order to ensure that children are accurately identified for supports, these relationships should be considered when interpreting caregiver report of social-emotional skills.

The primary aim of this study was to characterize Cognitive Disengagement Syndrome (CDS) symptomatology in youth with spina bifida (SB). One hundred and sixty-nine patients aged 5-19 years old were drawn from clinical cases seen through a multidisciplinary outpatient SB clinic at a children's hospital between 2017 and 2019. Parent-reported CDS and inattention were measured using Penny's Sluggish Cognitive Tempo Scale and the Vanderbilt ADHD Rating Scale. Self-reported internalizing symptoms were measured with the 25-item Revised Children's Anxiety and Depression Scale (RCADS-25). We replicated Penny's proposed 3-factor structure of CDS with slow, sleepy, and daydreamer components. The slow component of CDS overlapped heavily with inattention, while the sleepy and daydreamer components were distinct from inattention and internalizing symptoms. Eighteen percent (22 of 122) of the full sample met criteria for elevated CDS, and 39% (9 of 22) of those patients did not meet criteria for elevated inattention. Diagnosis of myelomeningocele and presence of a shunt were associated with greater CDS symptoms. CDS can be measured reliably in youth with SB and can be discriminated from inattention and internalizing symptoms in this population. ADHD rating scale measures fail to identify a substantial portion of the SB population with attention-related challenges. Standard screening for CDS symptoms in SB clinics may be important to help identify clinically impairing symptoms and design targeted treatment plans.

CONTEXT Pediatric mild traumatic brain injuries (mTBI) represent an evolving field of interest in youth athletics. While most players recover within 4 weeks, some have symptoms that last longer. Little is known about youth health-related quality of life (HRQoL) following mTBI. OBJECTIVE To characterize youth HRQoL following soccer-related mTBI and to identify predictors of individual differences in HRQoL recovery. DESIGN Prospective cohort study. SETTING Youth Soccer. PARTICIPANTS Soccer players, ages 8-17 years, who sustained mTBI (n=23), orthopedic injuries (OI, n=24), or remained uninjured (n=23) during a single season. MAIN OUTCOME MEASURES HRQoL was assessed via the Pediatric Quality of Life Version 4.0 and post-concussive symptomatology via the Health and Behavior Index. Serial assessments occurred at 24-48 hours, 7 days, 30 days and 90 days post-injury via telephone interview. RESULTS Seven days post-injury, the mTBI and OI groups had poorer Total HRQoL (F[2,67] =11.35, p<0.001) than uninjured controls. At 7 days, the mTBI group had the poorest Psychosocial HRQoL, while OI had the poorest Physical HRQoL. Differences between the mTBI group and uninjured controls resolved by 30 days. Within the mTBI group, players with significant post-concussive symptoms at 7 days had poorer Total (F[1,21]=23.071, p<=0.001; F[1,21]=5.798, p=0.028), Psychosocial (F[1,21]=16.488, p=<0.001; F[1,21]=5.050, p=0.039), and Physical HRQoL (F[1,21]=21.671, p=<0.001; F[1,21]=5.119, p=0.038) at 7 and 30 days than players with minimal symptoms, and these differences resolved by 90 days. CONCLUSION As a groups, youth soccer players who sustained mTBI had transient impairments in HRQoL that resolved by 30 days. A subset of players with significant post-concussive symptoms at 7 days post-injury have poorer HRQoL for at least 30 days post-injury than those whose post-concussive symptoms had resolved within a week of injury. This suggests ongoing recovery in this subset at 30 days and potential utility of HRQoL as a measure of recovery.

The relationship between the p factor and cognition in youth has largely focused on general cognition (IQ) and executive functions (EF). Another cognitive construct, processing speed (PS), is dissociable from IQ and EF, but has received less research attention despite being related to many different mental health symptoms. The present sample included 795 youth, ages 11–16 from the Colorado Learning Disabilities Research Center (CLDRC) sample. Confirmatory factor analyses tested multiple p factor models, with the primary model being a second-order, multi-reporter p factor. We then tested the correlation between the p factor and a latent PS factor. There was a significant, negative correlation between the p factor and PS (r(87) = -0.42, p < .001), indicating that slower processing speed is associated with higher general mental health symptoms. This association is stronger than previously reported associations with IQ or EF. This finding was robust across models that used different raters (youth and caregiver) and modeling approaches (second-order vs. bifactor). Our findings indicate that PS is related to general psychopathology symptoms. This research points to processing speed as an important transdiagnostic construct that warrants further exploration across development.

The COVID-19 pandemic has changed healthcare utilization patterns and clinical practice, including pediatric mTBI evaluation and management. Providers treating pediatric mTBI, including neuropsychologists, have a unique role in evaluating and managing an already complex injury in the context of the COVID-19 pandemic with limited empirically based guidelines. In the present paper, we review usual, evidence-based pediatric mTBI care, highlight changes experienced by healthcare providers since the onset of the pandemic, and provide possible considerations and solutions. Three primary challenges to usual care are discussed, including changes to post-injury evaluation, management, and treatment of persistent symptoms. Changing patterns of healthcare utilization have created unique differences in mTBI identification and evaluation, including shifting injury frequency and mechanism, reluctance to seek healthcare, and increasing access to telemedicine. Typical injury management has been compromised by limited access to usual systems/activities (i.e., school, sports, social/leisure activities). Patients may be at higher risk for prolonged recovery due to pre-injury baseline elevations in acute and chronic stressors and reduced access to rehabilitative services targeting persistent symptoms. Considerations and solutions for addressing each of the three challenges are discussed. Neuropsychologists and other pediatric healthcare providers will need to continue to flexibly adapt to the changing needs of youth recovering from mTBI through the duration of the pandemic and beyond. Consistent with pre-pandemic consensus statements, neuropsychologists remain uniquely qualified to evaluate and manage mTBI and provide an increasingly integral role as members of multidisciplinary teams in the context of the global pandemic.Abbreviations: AAP: American Academy of Pediatrics; CDC: Centers for Disease Control and Prevention; COVID-19: coronavirus disease 19; ED: emergency department; mTBI: Mild traumatic brain injury.

Objectives: To characterize child, parent, and family adjustment for patients followed in a multidisciplinary spina bifida (SB) clinic. Methods: Participants were drawn from clinical cases seen through a multidisciplinary outpatient SB clinic at a children's hospital between 2017 and 2019. Participants included 209 youth under 19 years old who were diagnosed with SB and their parents. Self-reported internalizing symptoms were measured in youth in grade 3 through 12 using the 25-item Revised Children's Anxiety and Depression Scale-25 (RCADS-25). Self- and parent-reported quality of life and family functioning were obtained using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and Family Impact Modules. Results: A total of 45.7% of children and adolescents reported at-risk psychosocial functioning on the PedsQL. In contrast, only 5% of patients reported clinically elevated internalizing symptoms on the RCADS. Parents' quality of life and family functioning in the study were higher than in most studies of parents of children with other chronic health conditions, children with attention deficit-hyperactivity disorder, and healthy control samples. Conclusion: Our findings indicate that children and adolescents with SB are at risk for poor health-related quality of life (HRQOL); however, poorer HRQOL may not necessarily be associated with more severe psychiatric symptoms in this population. Examining resilience factors that may help to buffer against challenges to HRQOL will be important in informing future interventions.

Purpose: Speech sound disorder (SSD) in conjunction with a language disorder has been associated with poor literacy acquisition; however, no study has evaluated whether articulation, phonological, or sequencing skills are differentially related to reading skills. Therefore, this study examined the relationship between speech error types at ages 5–6 years and literacy at ages 7–9 years. Phonological errors were hypothesized to predict phonological awareness (PA) and literacy even while accounting for other speech error types and language skills. Method: One hundred twenty-three children, 86 with a history of speech impairment, completed a battery of speech, language, and literacy tests at ages 5–6 years and again at ages 7–9 years. Speech production at ages 5–6 years was analyzed, and indices of articulation errors, phonological errors, and sequencing deficits were obtained. The relationships of these error types to concurrent language and preliteracy skills and to later literacy outcomes were assessed. Results: As expected, phonological, but not articulation, errors at ages 5–6 years predicted concurrent PA and letter knowledge, as well as literacy at ages 7–9 years, even while accounting for language skills. Surprisingly, of all the error types, sequencing deficits showed the strongest relationship with PA (ages 5–6 years) and literacy (ages 7–9 years). Conclusions: These results suggest that some components of SSD uniquely predict preliteracy and literacy skills, even when controlling for language ability. Future investigations should examine further the association between sequencing deficits and literacy skills, test whether observed relationships hold at younger ages, and evaluate the efficacy of integrating literacy interventions into speech therapy to reduce later reading difficulties. Supplemental Material: https://doi.org/10.23641/asha.19624020

Despite historical emphasis on "specific" learning disabilities (SLDs), academic skills are strongly correlated across the curriculum. Thus, one can ask how specific SLDs truly are. To answer this question, we used bifactor models to identify variance shared across academic domains (academic g), as well as variance unique to reading, mathematics, and writing. Participants were 686 children ages 8 to 16. Although the sample was overselected for learning disabilities, we intentionally included children across the full range of individual differences in this study in response to growing recognition that a dimensional, quantitative view of SLD is more accurate than a categorical view. Confirmatory factor analysis identified five academic domains (basic reading, reading comprehension, basic math, math problem-solving, and written expression); spelling clustered with basic reading and not writing. In the bifactor model, all measures loaded significantly on academic g. Basic reading and mathematics maintained variance distinct from academic g, consistent with the notion of SLDs in these domains. Writing did not maintain specific variance apart from academic g, and evidence for reading comprehension-specific variance was mixed. Academic g was strongly correlated with cognitive g (r = .72) but not identical to it. Implications for SLD diagnosis are discussed.

Objective: To evaluate the feasibility and potential benefits of a manualized, brief cognitive-behavioral therapy-based intervention program for children and adolescents with persistent postconcussive symptoms. Setting: Two outpatient pediatric concussion programs in the United States. Participants: Patients aged 8 to 17 years who sustained concussions between 2 and 12 months prior to enrollment. Design: Pre-/postretrospective study. Main Measures: SCAT-3; HBI; PedsQL 4.0 Generic Core Scales; and RCADS. Results: Thirty children and adolescents completed the treatment program. Self- and parent-reported postconcussive symptoms, quality of life, and internalizing symptoms significantly improved with treatment. Mixed-effects models revealed a significant decline in self-reported postconcussive symptoms across treatment sessions, a = -2.07, SE = 0.25, P < .001. The largest change occurred between sessions 2 and 3, following the session focusing on concussion psychoeducation and sleep hygiene (estimated mean change between sessions 2 and 3 = -4.72, P < .0001). Conclusions: Our findings indicate that a 6-session manualized cognitive behavioral intervention is feasible to initiate in an outpatient clinic 1 to 12 months following a pediatric mild traumatic brain injury. With a manualized format, clinicians at most levels of training should be able to implement this treatment manual and flexibly adapt as needed when working with children and adolescents who are experiencing delayed symptom recovery following concussion.