Mindfulness-Based Intervention for Pediatric Mild Traumatic Brain Injury

The PedsQL is a reliable and valid measure of quality of life (QoL) in healthy children and adolescents and those with acute and/or chronic health conditions. Parent versions exist for children aged 2 to 18 years (in 4 age groups) and child versions for those aged 5 and over. For this study, only the child's version (ages 8-12 and ages 13-18) will be used. The inventory covers four domains: physical, emotional, social, and school, the sum of which is total QoL. This measure will be used to assess whether early brief MBI can improve total QoL. Higher scores indicate better health related to QoL.

A Validated measure offered in both English and French for the adolescent concussion population that assesses the individual's own perception of hardiness or perceived stress. It is a 10-item rating scale, 5-point Likert scale; the scale is summed and provides a total score (0-40) for the level of resilience. A lower score is attributed to lesser levels of resilience.

Designed to measure fatigue in pediatric patients and comprises the General Fatigue Scale (6 items), Sleep-Rest Fatigue Scale (6 items), and Cognitive Fatigue Scale (6 items). The PedsQL™ Multidimensional Fatigue Scale has demonstrated excellent internal consistency, reliability and validity. For this study, only the child's version (ages 8-12 and ages 13-18) will be used. Higher scores are associated with less fatigue.

This assessment will be used to measure the degree of symptoms, available in both English and French. The HBI is a 20-item self-report questionnaire, Likert scale (0, 1, 2, or 3 points) yielding separate scores for cognitive and somatic symptom scales for a total score range of 0 to 60. Higher scores indicate a higher degree of symptoms. Participants will complete a post-injury measure, while parents will complete a retrospective (pre-injury) measure at an emergency department presentation. Only participants will complete HBI measures at follow-up.

The GAD-7 is a validated, reliable and sensitive to treatment-related changes tool that assesses anxiety symptoms in youth. It is a 7-item scale, 3-point Likert scale, providing a sum score (0-21) of the level of GAD. A higher score indicates a worse outcome. It is available for participants in both English and French.

The CES-D-10 is a 10-item questionnaire assessing how individuals feel during the past week. This is a short version of the 20-item CES-D tool. Graded on a 4-point Likert scale, with items 5 and 8 scored inversely. The final score is the sum of the graded items with higher scores indicating a worse outcome. The CES-D-10 has good internal consistency (Cronbach's α=0.86) and test-retest reliability (I CC=0.85). It is also available in both English and French.

The CAMM is a 10-item validated self-report measure of mindfulness for use with children and adolescents, in both English and French. Responses are scored on a 5-point Likert scale. Lower scores indicate higher tendencies to be mindful in everyday life.

The Pediatric Fear Avoidance Behavior After Traumatic Brain Injury (PFAB-TBI) is a validated measure used in the pediatric population with concussion to measure the degree of fear avoidance as a negative coping style post-injury. It is comprised of 16-item, 4-point Likert scale asking participants to agree with statements that range from 0 ("strongly disagree") through 3 ("strongly agree"). The total item score is out of 48 with higher scores associated with more negative clinical outcomes.(Cairncross et al., 2021). This measure is offered in both English and French.

The AFQ-Y8 is the 8-item short-form version of the original 17-item AFQ-Y, a self-report measure examining psychological inflexibility in youth. This validated measure comprises two constructs of psychological inflexibility: cognitive fusion (the belief that inner thoughts are true and allow them to dominate behaviour) and experiential avoidance (avoidance or suppression of unwanted internal experiences). Participants are asked to agree with statements on a 5-point Likert scale with responsed from not true at all (0) to very true (4). Items are summed to produce a final score between 0 and 32, with a higher score indicating greater psychological inflexibility. Measures are available in both English and French.

A 10-item self-report questionnaire examining an individual's perception of stress. The items are ranked on a 5-point Likert scale, asking participants to respond from Never (1) to very often (5). Items 4, 5 and 7 are positively worded and reverse-scored, then all items are summed. Higher scores indicate that participants are more likely to appraise events as stressful. Participants also have the option to complete the measure in English or French.

A validated 10-item questionnaire used in adolescent populations to measure emotion regulation. The measure consists of 2 subcategories: cognitive reappraisal (6 items) and expressive suppression (4 items). . Responses to items include a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Composite scores for cognitive reappraisal range from 6-30 and 4 to 20 for expressive suppression. Scores are typically interpreted separately. Higher reappraisal scores are associated with positive tendencies to reframe situations to regulate emotions, while higher repressive scores are negatively associated with the tendency to inhibit emotions. This measure can be completed in English of French.

The CEQ is a 6-item questionnaire (9-point Likert scale) assessing credibility and expectancy. The validated questionnaire demonstrates excellent reliability across different populations and is available in both English and French. A higher score indicates more credibility.

This is a validated, reliable, 8-item questionnaire used to measure client satisfaction with a particular program or service. In this case, the questionnaire has been modified to assess participant satisfaction with the app-based intervention. It is available to participants in English or French.

Upon entering the app, participants will be asked daily to self-asses their mood and levels of stress. Self-assessed stress is captured via a visual-point scale and self-assessed emotions are captured via participant selecting their emotions. There is also a daily thought journal included within the app. requiring participants to journal their thoughts in the moment daily and write their positive thoughts.

The GSLTAQ was developed to classify physical activities/exercises performed into three subgroups: strenuous, moderate, and light. The frequency and type of activity/exercise score performed over the past week are used to calculate the physical activity/exercise total score. A higher score corresponds to a higher level of weekly activity/exercise.

The questionnaire is a 5 question, self-administered rating scale for pubertal development without pictorial representations or interviews. Separate forms are used for boys and girls. For Items 1 through 4 on the girls' version and all items on the boys' version, response options are: not yet start (1 point); barely started (2 points); definitely started (3 points); seems complete (4 points); I don't know. Yes, on the menstruation item for girls is 4 points, while No is 1 point. Points are then averaged for all items to give a Pubertal Developmental Scale. Pubertal Category Scores can also be computed.

Participants will be asked if or when they returned to a full day of school, and if or when they have returned to usual levels of physical activity. These questions will be asked at follow-up each week after enrolment