Paediatrics (RCH) - Theses

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    Working Memory and Decision-Making following Childhood Traumatic Brain Injury: Tool Development, Clinical Trial, and Mediation
    Sood, Nikita ( 2021)
    Background Children with traumatic brain injury (TBI) often present with deficits in working memory and decision-making. As these are considered core executive function skills, children with impairments in working memory and decision-making are more likely to exhibit secondary deficits in academic performance, adaptive behaviour, social skills, and overall quality of life. However, there is a lack of research assessing decision-making skills, or the rehabilitation of working memory and decision-making in this clinical population. The current study aimed to develop a novel measure of decision-making, using a randomised controlled trial to implement and evaluate the efficacy of a computerised working memory intervention (Cogmed), and investigate the contribution of decision-making as a mediator in childhood TBI and dysregulation profile. Method The study was conducted in Victoria, Australia. Participants in the decision-making tool development, and the mediation study comprised two groups, the TBI group (n=49), and the typically developing healthy control group (n=22). Children were assessed directly on standardised measures of executive function such as working memory, and parent reports were obtained via questionnaires of adaptive behaviour and dysregulation. Participants in the clinical trial were children with TBI (n=31) who presented with difficulties in executive function and/or working memory on screening. Child assessments and parent reports were obtained at three time points: baseline, immediately post intervention, and at 6 months follow-up. Results and Conclusion This study was the first study to develop and validate a novel measure of decision-making in children following TBI, thereby providing preliminary evidence of the clinical utility of this measure. This study was the second study to investigate Cogmed in this clinical population, with the results of the clinical trial suggesting minimal evidence for Cogmed’s efficacy in improving working memory, decision-making, and functional outcomes. Finally, this study was the first to report on the role of decision-making as a mediator between childhood TBI and dysregulation, with results suggesting decision-making underpins problems of dysregulation in children following TBI.