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Functional Plasticity in Childhood Brain Disorders: When, What, How, and Whom to Assess

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Abstract

At every point in the lifespan, the brain balances malleable processes representing neural plasticity that promote change with homeostatic processes that promote stability. Whether a child develops typically or with brain injury, his or her neural and behavioral outcome is constructed through transactions between plastic and homeostatic processes and the environment. In clinical research with children in whom the developing brain has been malformed or injured, behavioral outcomes provide an index of the result of plasticity, homeostasis, and environmental transactions. When should we assess outcome in relation to age at brain insult, time since brain insult, and age of the child at testing? What should we measure? Functions involving reacting to the past and predicting the future, as well as social-affective skills, are important. How should we assess outcome? Information from performance variability, direct measures and informants, overt and covert measures, and laboratory and ecological measures should be considered. In whom are we assessing outcome? Assessment should be cognizant of individual differences in gene, socio-economic status (SES), parenting, nutrition, and interpersonal supports, which are moderators that interact with other factors influencing functional outcome.

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Acknowledgments

Supported in part by National Institute of Child Health and Human Development Grants P01 HD35946 & P01 HD35946-06,“Spina Bifida: Cognitive and Neurobiological Variability” and by National Institutes of Health Grant 1RO1 HD04946, “Social Outcomes in Pediatric Traumatic Brain Injury.” We thank Beverly Andres for help with manuscript preparation and Laura Janzen for assistance with the brain tumor literature.

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Authors and Affiliations

  1. Department of Psychology, Program in Neurosciences and Mental Health, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Maureen Dennis, Nevena Simic & Amy Wilkinson

  2. Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada

    Maureen Dennis

  3. Music and Health Research Collaboratory, Faculty of Music, University of Toronto, Toronto, Canada

    Maureen Dennis

  4. Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada

    Brenda J. Spiegler

  5. Department of Psychology, Division of Neurology, The Hospital for Sick Children, Toronto, Canada

    Katia J. Sinopoli

  6. Department of Pediatrics, The Ohio State University, and The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Keith Owen Yeates

  7. Department of Pediatrics, Case Western Reserve University, and Rainbow Babies & Children’s Hospital, Cleveland, OH, USA

    H. Gerry Taylor

  8. Departments of Psychology and Neuroscience, Brigham Young University, Provo, UT, USA

    Erin D. Bigler

  9. Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

    Erin D. Bigler

  10. Department of Psychology, University of Houston, Houston, TX, USA

    Jack M. Fletcher

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  1. Maureen Dennis
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Correspondence to Maureen Dennis.

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Dennis, M., Spiegler, B.J., Simic, N. et al. Functional Plasticity in Childhood Brain Disorders: When, What, How, and Whom to Assess. Neuropsychol Rev 24, 389–408 (2014). https://doi.org/10.1007/s11065-014-9261-x

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