Longitudinal magnetic resonance imaging reveals differences in cortical expansion in fetuses with congenital heart defects.

Pediatric traumatic brain injury (TBI) has a worldwide impact on public health, affecting approximately 3 million children each year []. Although the majority of pediatric TBIs are classified as mild injuries, sustaining a TBI during childhood and adolescence during significant brain development can result in long-term, lasting effects [, ]. Symptoms can include acute and chronic deficits in cognition, emotional regulation, behavior, physical activity, and sleep [–]. Across all levels of severity, symptoms can affect daily functioning in the home and at school, resulting in an increased demand for rehabilitation services and recovery support [, , , ]. More than 14% of children with mild TBI and 61% of children with moderate-to-severe TBI require new services one year post-injury [, ]. Due to the wide range of negative long-term outcomes for children with TBI [] and the increased need for post-injury supports [], monitoring the effectiveness of service delivery for children with TBI is essential. School is an important area of service delivery and support for children with TBI. The need for accommodations and special education services for students with TBI is common, as the consequences of TBI can complicate academic success [, ]. In the US, these services vary widely and include informal, short-term accommodations in classrooms; formal, federal accommodations like Section 504 plans; and/or eligibility for special education under the Individuals with Disabilities Education Act (IDEA) []. Longitudinal studies have noted the persistent need for academic services averaging six years post-injury and that these needs can continue to be identified and change over time [, –]. Such studies emphasize the importance of appropriate, longitudinal identification of the barriers to educational services and the challenges experienced by students with TBI upon their return to school [, ]. The COVID-19 pandemic was a recent unforeseen challenge to special education delivery. With many students in the US abruptly transitioning to remote or hybrid (mix of in-person and virtual/remote) learning in the spring of 2020, understanding the impact of these transitions on at-risk populations, especially children with pre-existing neurodevelopmental disorders and learning deficits, is imperative []. Particularly of concern is the reported decrease in the amount and/or intensity of special education services and accommodations received by children with chronic conditions [–]. A recent study of adolescents with attention-deficit/hyperactivity disorder (ADHD) noted that only 59% of school-based services and 39% of academic tutoring services were still being received after the transition to remote learning []. Other reported challenges faced by students due to the COVID-19 pandemic and school closures included negative effects on mental health, changes to routine, and changes in social support [, ]. Children with TBI are already at higher risk for requiring more support in these specific areas [], making them especially vulnerable to pandemic-related schooling disruptions.