Introduction: Previous research has broadly documented that emotional and behavioral difficulties are seen after pediatric stroke; however, global ratings are generally reported without comparison to age-based norms. Additionally, little is known about the discrete symptomatology exhibited by these children. Thus, the goal of the present study was to evaluate specific psychological symptoms following childhood arterial ischemic stroke (AIS).
Hypothesis: Children with AIS were predicted to have increased difficulties in both internalizing and externalizing symptoms compared to the normative sample. Age at AIS was anticipated to influence the presence of psychological symptoms, with internalizing symptoms occurring at higher levels when the AIS occurred at a later age.
Methods: Participants were children (n = 50, mean age = 12.1 years) who suffered an AIS during childhood (range = 1 month to 17.1 years). Parents completed the Child Behavior Checklist at least 10 months post-AIS (mean = 4.1 years). Children were divided into groups by age at AIS: early (<6 years), middle (6-10 years), or late (>10 years) childhood. Data were analyzed using one-sample t-tests and ANOVA.
Results: Children with AIS had significantly greater problems on the following DSM-oriented scales compared to the normative sample (all p-values < 0.01): Affective Problems, Anxiety Problems, Somatic Problems, Oppositional Defiant Problems, and Conduct Problems. There was a significant age-at-AIS effect on the Anxiety Problems subscale, F(2, 49) = 3.31, p = 0.05, such that the early childhood group had significantly higher levels of anxiety compared to the late childhood group.
Conclusions: Increased internalizing and externalizing symptoms were seen in children with AIS compared to the normative sample, and a higher percentage of children with AIS exceeded a clinically significant threshold in each domain. Contrary to expectations, children who had AIS at an earlier age showed greater number of anxiety symptoms relative to same-age peers. Possible mechanisms for the latter may include changes in family dynamics when young children suffer a neurological injury. These results support the need for careful psychological follow-up in this vulnerable population.