Neurocognitive Network Organization in Children with Traumatic Brain Injury

Pediatric traumatic brain injury (TBI) is the leading cause of acquired disability in children, potentially leading to neurocognitive deficits that affect daily functioning. This study explored the impact of pediatric TBI on neurocognitive network organization and its relation to intelligence and behavior problems. This observational multicenter study prospectively included 113 children with mild to severe TBI and 113 neurologically healthy (NH) children, matched for sex, age and socio-economic status. Six months post-TBI, neurocognitive functioning was assessed using computerized tests, intelligence outcome was assessed with Wechsler tests, and behavior problems were assessed through questionnaires. Conventional analysis of neurocognitive data involved calculating test performance scores, while network analysis involved the use of graph theory on individual neurocognitive data to explore neurocognitive network organization. Results of the conventional analysis showed that children with TBI had lower performance than NH children in Speed, Stability, Attention & Control, Verbal Working Memory, and Visual Working Memory (0.009 ≤ <i>p</i> ≤ 0.047, -0.42 ≤ <i>d</i> ≤ -0.29, small effect sizes). Network analysis showed lower <i>centralization</i> in the neurocognitive network organization of children with TBI compared to NH children (<i>p</i> = 0.04, <i>d</i> = -0.38). No differences were found in other network parameters (<i>p</i> ≥ 0.20). Neurocognitive network organization in children with TBI was related to intelligence (<i>R</i>² = 29.7%) and internalizing behavior problems (<i>R</i>² = 6.0%). Neurocognitive network organization was related stronger to externalizing behavior problems (<i>R</i>² = 21.6%, 95% CI = 13.7-34.6%) than measures of conventional neurocognitive performance (<i>R</i>² = 9.4%). This study indicates that pediatric TBI disrupts the neurocognitive network and is characterized by a less centralized organization compared to peers. Neurocognitive network organization may contribute to our understanding of outcomes following TBI, particularly regarding externalizing behavior problems.