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Zaksaite T, Loveday C, Edginton T, Spiers HJ, Smith AD. Hydrocephalus: A neuropsychological and theoretical primer. Cortex 2023; 160:67-99. [PMID: 36773394 DOI: 10.1016/j.cortex.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/09/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
Hydrocephalus is a common neurological condition, the hallmark feature of which is an excess in production, or accumulation, of cerebrospinal fluid in the ventricles. Although it is associated with diffuse damage to paraventricular brain areas, patients are broadly typified by a particular pattern of cognitive impairments that include deficits in working memory, attention, and spatial abilities. There have, however, been relatively few neuropsychological accounts of the condition. Moreover, theories of the relationship between aetiology and impairment appear to have emerged in isolation of each other, and proffer fundamentally different accounts. In this primer, we aim to provide a comprehensive and contemporary overview of hydrocephalus for the neuropsychologist, covering cognitive sequelae and theoretical interpretations of their origins. We review clinical and neuropsychological assays of cognitive profiles, along with the few studies that have addressed more integrative behaviours. In particular, we explore the distinction between congenital or early-onset hydrocephalus with a normal-pressure variant that can be acquired later in life. The relationship between these two populations is a singularly interesting one in neuropsychology since it can allow for the examination of typical and atypical developmental trajectories, and their interaction with chronic and acute impairment, within the same broad neurological condition. We reflect on the ramifications of this for our subject and suggest avenues for future research.
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Affiliation(s)
- Tara Zaksaite
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - Catherine Loveday
- School of Social Sciences, University of Westminster, 115 New Cavendish St, London W1W 6UW, UK
| | - Trudi Edginton
- Department of Psychology, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Hugo J Spiers
- Department of Experimental Psychology, Division of Psychology and Language Sciences, University College London, 26 Bedford Way, London, WC1H 0AP, UK
| | - Alastair D Smith
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK; Brain Research and Imaging Centre, University of Plymouth, 7 Derriford Rd, Plymouth, PL6 8BU, UK.
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Lindquist B, Jacobsson H, Strinnholm M, Peny‐Dahlstrand M. A scoping review of cognition in spina bifida and its consequences for activity and participation throughout life. Acta Paediatr 2022; 111:1682-1694. [PMID: 35608513 PMCID: PMC9546308 DOI: 10.1111/apa.16420] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
Aim The aim of this scoping review was to summarise findings concerning cognitive characteristics in people with spina bifida and explain how cognitive factors influence activities and participation in different areas and stages of life. Methods PubMed, Psych INFO, ERIC, Scopus, CINAHL and the Cochrane Library were searched for English language papers published in 2000–2018. A total of 92 papers were selected and quality was assessed according to the McMaster criteria. The results were presented related to body functions, activity and participation from the International Classification of Function and Health, ICF. Results People with spina bifida tended to have a lower IQ than those without. The majority also had cognitive difficulties manifested in problems with language, perception, memory, executive and attentional functions. Those difficulties affected activity and participation in all life domains in ICF. This may affect medical adherence and responsibility and by extension the prevention of secondary complications. Conclusion It is important for caregivers, professionals and especially individuals with spina bifida themselves to understand and handle both physical and cognitive consequences in all life circumstances. Having insight into one’s own assets and difficulties paves the way to managing life challenges, which could enhance health, self‐management and participation in society.
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Affiliation(s)
- Barbro Lindquist
- Department of Habilitation Halmstad County Hospital Halmstad Sweden
| | | | - Margareta Strinnholm
- Folke Bernadotte Regional Habilitation Center University Children´s Hospital Uppsala Sweden
| | - Marie Peny‐Dahlstrand
- Regional Rehabilitation Centre Queen Silvia Children´s Hospital Sahlgrenska University Hospital Gothenburg Sweden
- Sweden Institute of Neuroscience and Physiology at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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Foss S, Flanders TM, Heuer GG, Schreiber JE. Neurobehavioral outcomes in patients with myelomeningocele. Neurosurg Focus 2020; 47:E6. [PMID: 31574480 DOI: 10.3171/2019.7.focus19445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/25/2019] [Indexed: 01/26/2023]
Abstract
This paper describes some of the more common patterns in neurobehavioral deficits and their underlying neuroanatomical basis in myelomeningocele (MMC). Patients with MMC can face a lifetime of specific organ system dysfunction, chief among them spinal cord malformations, orthopedic issues, hydrocephalus, and urological disabilities. In addition, patients can experience specific patterns of neurobehavioral difficulties due to the changes in neuroanatomy associated with the open spinal defect. Although there is variability in these patterns, some trends have been described among MMC patients. It is thought that early recognition of these potential neurobehavioral deficits by treating neurosurgeons and other members of the treatment team could lead to earlier intervention and positively impact the overall outcome for patients. Neurodevelopmental and neurobehavioral follow-up assessments are recommended to help guide planning for relevant treatments or accommodations.
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Affiliation(s)
- Sophie Foss
- 1Department of Child and Adolescent Psychiatry and Behavioral Sciences, and Divisions of
| | | | - Gregory G Heuer
- 2Neurosurgery and.,3Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Pennsylvania
| | - Jane E Schreiber
- 1Department of Child and Adolescent Psychiatry and Behavioral Sciences, and Divisions of.,3Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Pennsylvania
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Wasserman RM, Stoner AM, Stern A, Holmbeck GN. ADHD and Attention Problems in Children With and Without Spina Bifida. Top Spinal Cord Inj Rehabil 2018; 22:253-259. [PMID: 29339866 DOI: 10.1310/sci2204-253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objectives: To identify differences in the diagnosis and treatment of attention deficit/hyperactivity disorder (ADHD) between typically developing children and children with spina bifida. Method: Sixty-eight children with spina bifida and 68 demographically matched, typically developing children participated in a larger, longitudinal study. Rates of maternal, paternal, and teacher reports of attention problems, as well as rates of maternal reports of ADHD diagnosis, diagnosing provider, pharmaceutical treatment, mental health treatment, and academic accommodations were obtained at 5 time points over a period of 8 years and were compared across groups. Results: Children with spina bifida were more likely to have an ADHD diagnosis and attention problems. Attention problems and ADHD diagnoses were first reported at earlier time points for children with spina bifida than typically developing children. Among children with ADHD or attention problems, children with spina bifida were more likely to be treated with medication, but they were just as likely to use mental health services and receive resource services at school. Conclusions: Children with spina bifida were diagnosed with ADHD and identified as having attention problems more frequently and at an earlier age. This finding could be due to earlier symptom development, greater parental awareness, or more contact with providers. Among those with ADHD or attention problems, stimulant medication was more likely to be prescribed to children with spina bifida, despite research that suggests it may not be as beneficial for them. Further research on the effectiveness of ADHD pharmacological treatment for children with spina bifida is recommended.
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Affiliation(s)
- Rachel M Wasserman
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, Texas
| | - Alison M Stoner
- Department of Psychiatry and Behavioral Medicine, Children's Hospital of Wisconsin, Milwaukee
| | - Alexa Stern
- Department of Psychology, Loyola University Chicago
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Azab WA, Mijalcic RM, Nakhi SB, Mohammad MH. Ventricular volume and neurocognitive outcome after endoscopic third ventriculostomy: is shunting a better option? A review. Childs Nerv Syst 2016; 32:775-80. [PMID: 26861009 DOI: 10.1007/s00381-016-3032-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Shunts are generally associated with a smaller post-treatment ventricular size in comparison to endoscopic third ventriculostomy (ETV). METHODS To determine whether such a difference in ventricular size has neurocognitive implications, we reviewed the current literature pertaining to the (1) neurocognitive sequelae of hydrocephalus, (2) neurocognitive outcome after ETV, (3) extent of reversal of neurocognitive changes associated with hydrocephalus after shunting, and (4) data on correlation between post-treatment ventricular volume and neurocognitive outcome after ETV. RESULTS Collectively, the results of the available studies should call into question the correlation between the residual postoperative ventricular volume and neurocognitive outcome. CONCLUSION The available literature is so far in support of ETV as a valid and effective treatment modality in hydrocephalic patients. No sufficient evidence is available to justify resorting to shunting on the premise that it is associated with a better neurocognitive outcome.
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Affiliation(s)
- Waleed A Azab
- Department of Neurosurgery, Ibn Sina Hospital, P. O Box 25427, Safat, 13115, Kuwait City, Kuwait.
| | - Radovan M Mijalcic
- Department of Neurosurgery, Ibn Sina Hospital, P. O Box 25427, Safat, 13115, Kuwait City, Kuwait.,Clinical Centre of Serbia, Clinic for Neurosurgery, University Medical School, Belgrade, Serbia
| | - Saleh Ben Nakhi
- Department of Neurosurgery, Ibn Sina Hospital, P. O Box 25427, Safat, 13115, Kuwait City, Kuwait
| | - Mohammad H Mohammad
- Department of Neurosurgery, Ibn Sina Hospital, P. O Box 25427, Safat, 13115, Kuwait City, Kuwait
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Raghubar KP, Barnes MA, Dennis M, Cirino PT, Taylor H, Landry S. Neurocognitive predictors of mathematical processing in school-aged children with spina bifida and their typically developing peers: Attention, working memory, and fine motor skills. Neuropsychology 2015; 29:861-73. [PMID: 26011113 PMCID: PMC4641019 DOI: 10.1037/neu0000196] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Math and attention are related in neurobiological and behavioral models of mathematical cognition. This study employed model-driven assessments of attention and math in children with spina bifida myelomeningocele (SBM), who have known math difficulties and specific attentional deficits, to more directly examine putative relations between attention and mathematical processing. The relation of other domain general abilities and math was also investigated. METHOD Participants were 9.5-year-old children with SBM (n = 44) and typically developing children (n = 50). Participants were administered experimental exact and approximate arithmetic tasks, and standardized measures of math fluency and calculation. Cognitive measures included the Attention Network Test (ANT), and standardized measures of fine motor skills, verbal working memory (WM), and visual-spatial WM. RESULTS Children with SBM performed similarly to peers on exact arithmetic, but more poorly on approximate and standardized arithmetic measures. On the ANT, children with SBM differed from controls on orienting attention, but not on alerting and executive attention. Multiple mediation models showed that fine motor skills and verbal WM mediated the relation of group to approximate arithmetic; fine motor skills and visual-spatial WM mediated the relation of group to math fluency; and verbal and visual-spatial WM mediated the relation of group to math calculation. Attention was not a significant mediator of the effects of group for any aspect of math in this study. CONCLUSION Results are discussed with reference to models of attention, WM, and mathematical cognition.
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Affiliation(s)
| | | | - Maureen Dennis
- The Hospital for Sick Children and The University of Toronto, Ontario
| | - Paul T. Cirino
- Department of Psychology, University of Houston, Houston, Texas
| | | | - Susan Landry
- Department of Pediatrics, University of Texas Health Science Center-Houston, Houston, Texas
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Dennis M, Cirino PT, Simic N, Juranek J, Taylor WP, Fletcher JM. White and grey matter relations to simple, choice, and cognitive reaction time in spina bifida. Brain Imaging Behav 2015; 10:238-51. [DOI: 10.1007/s11682-015-9388-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kulesz PA, Treble-Barna A, Williams VJ, Juranek J, Cirino PT, Dennis M, Fletcher JM. Attention in spina bifida myelomeningocele: Relations with brain volume and integrity. NEUROIMAGE-CLINICAL 2015; 8:72-8. [PMID: 26106529 PMCID: PMC4473288 DOI: 10.1016/j.nicl.2015.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 12/02/2022]
Abstract
This study investigated the relations of tectal volume and superior parietal cortex, as well as alterations in tectocortical white matter connectivity, with the orienting and executive control attention networks in individuals with spina bifida myelomeningocele (SBM). Probabilistic diffusion tractography and quantification of tectal and superior parietal cortical volume were performed on 74 individuals aged 8–29 with SBM and a history of hydrocephalus. Behavioral assessments measured posterior (covert orienting) and anterior (conflict resolution, attentional control) attention network functions. Reduced tectal volume was associated with slower covert orienting; reduced superior parietal cortical volume was associated with slower conflict resolution; and increased axial diffusivity and radial diffusivity along both frontal and parietal tectocortical pathways were associated with reduced attentional control. Results suggest that components of both the orienting and executive control attention networks are impaired in SBM. Neuroanatomical disruption to the orienting network appears more robust and a direct consequence of characteristic midbrain dysmorphology; whereas, executive control difficulties may emerge from parietal cortical anomalies and reduced frontal and parietal cortical–subcortical white matter pathways susceptible to the pathophysiological effects of congenital hydrocephalus. We use robust correlations to model structure–function relations. We use a large sample of individuals with spina bifida myelomeningocele. Reduced tectal volume is associated with slower covert orienting. Reduced superior parietal cortical volume is associated with slower conflict resolution. Tectocortical pathways are associated with reduced attentional control.
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Affiliation(s)
- Paulina A Kulesz
- Department of Psychology, University of Houston, USA ; Texas Institute for Measurement, Evaluation and Statistics, University of Houston, USA
| | - Amery Treble-Barna
- Department of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, USA
| | - Victoria J Williams
- Department of Psychology, University of Houston, USA ; Texas Institute for Measurement, Evaluation and Statistics, University of Houston, USA
| | - Jenifer Juranek
- Department of Pediatrics, University of Texas Health Science Center, USA
| | - Paul T Cirino
- Department of Psychology, University of Houston, USA ; Texas Institute for Measurement, Evaluation and Statistics, University of Houston, USA
| | - Maureen Dennis
- Department Of Surgery And Psychology, University Of Toronto, Canada
| | - Jack M Fletcher
- Department of Psychology, University of Houston, USA ; Texas Institute for Measurement, Evaluation and Statistics, University of Houston, USA
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Kulesz PA, Tian S, Juranek J, Fletcher JM, Francis DJ. Relations between volumetric measures of brain structure and attentional function in spina bifida: utilization of robust statistical approaches. Neuropsychology 2014; 29:212-25. [PMID: 25495830 DOI: 10.1037/neu0000166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Weak structure-function relations for brain and behavior may stem from problems in estimating these relations in small clinical samples with frequently occurring outliers. In the current project, we focused on the utility of using alternative statistics to estimate these relations. METHOD Fifty-four children with spina bifida meningomyelocele performed attention tasks and received MRI of the brain. Using a bootstrap sampling process, the Pearson product-moment correlation was compared with 4 robust correlations: the percentage bend correlation, the Winsorized correlation, the skipped correlation using the Donoho-Gasko median, and the skipped correlation using the minimum volume ellipsoid estimator. RESULTS All methods yielded similar estimates of the relations between measures of brain volume and attention performance. The similarity of estimates across correlation methods suggested that the weak structure-function relations previously found in many studies are not readily attributable to the presence of outlying observations and other factors that violate the assumptions behind the Pearson correlation. CONCLUSIONS Given the difficulty of assembling large samples for brain-behavior studies, estimating correlations using multiple, robust methods may enhance the statistical conclusion validity of studies yielding small, but often clinically significant, correlations.
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Affiliation(s)
| | - Siva Tian
- Department of Psychology, University of Houston
| | - Jenifer Juranek
- Children's Learning Institute, University of Texas-Houston Health Science
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Covert orienting in three etiologies of congenital hydrocephalus: the effect of midbrain and posterior fossa dysmorphology. J Int Neuropsychol Soc 2014; 20:268-77. [PMID: 24528548 DOI: 10.1017/s1355617713001501] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Covert orienting is related to the integrity of the midbrain, but the specificity of the relation is unclear. We compared covert orienting in three etiologies of congenital hydrocephalus (aqueductal stenosis [AS], Dandy-Walker malformation [DWM], and spina bifida myelomeningocele [SBM]--with and without tectal beaking) to explore the effects of midbrain and posterior fossa malformations. We hypothesized a stepwise order of group performance reflecting the degree of midbrain tectum dysmorphology. Performance on an exogenously cued covert orienting task was compared using repeated measures analysis of covariance, controlling for age. Individuals with SBM and tectal beaking demonstrated the greatest disengagement cost in the vertical plane, whereas individuals with AS performed as well as a typically developing (TD) group. Individuals with SBM but no tectal beaking and individuals with DWM showed greater disengagement costs in the vertical plane relative to the TD group, but better performance relative to the group with SBM and tectal beaking. Individuals with AS, DWM, and SBM and tectal beaking demonstrated poorer inhibition of return than TD individuals. Impairments in attentional disengagement in SBM are not attributable to the general effects of hydrocephalus, but are instead associated with specific midbrain anomalies that are part of the Chiari II malformation.
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Wong LM, Goodrich-Hunsaker NJ, McLennan YA, Tassone F, Rivera SM, Simon TJ. A cross-sectional analysis of orienting of visuospatial attention in child and adult carriers of the fragile X premutation. J Neurodev Disord 2014; 6:45. [PMID: 25937844 PMCID: PMC4416306 DOI: 10.1186/1866-1955-6-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 11/15/2014] [Indexed: 11/13/2022] Open
Abstract
Background Fragile X premutation carriers (fXPCs) have an expansion of 55–200 CGG repeats in the FMR1 gene. Male fXPCs are at risk for developing a neurodegenerative motor disorder (fragile X-associated tremor/ataxia syndrome (FXTAS)) often accompanied by cognitive decline. Several broad domains are implicated as core systems of dysfunction in fXPCs, including perceptual processing of spatial information, orienting of attention to space, and inhibiting attention to irrelevant distractors. We tested whether orienting of spatial attention is impaired in fXPCs. Methods Participants were fXPCs or healthy controls (HCs) asymptomatic for FXTAS. In experiment 1, they were male and female children and adults (aged 7–45 years). They oriented attention in response to volitional (endogenous) and reflexive (exogenous) cues. In experiment 2, the participants were men (aged 18–48 years). They oriented attention in an endogenous cueing task that manipulated the amount of information in the cue. Results In women, fXPCs exhibited slower reaction times than HCs in both the endogenous and exogenous conditions. In men, fXPCs exhibited slower reaction times than HCs in the exogenous condition and in the challenging endogenous cueing task with probabilistic cues. In children, fXPCs did not differ from HCs. Conclusions Because adult fXPCs were slower even when controlling for psychomotor speed, results support the interpretation that a core dysfunction in fXPCs is the allocation of spatial attention, while perceptual processing and attention orienting are intact. These findings indicate the importance of considering age and sex when interpreting and generalizing studies of fXPCs.
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Affiliation(s)
- Ling M Wong
- Davis Medical Center, MIND Institute, University of California, Sacramento, CA 95817 USA ; War Related Illness and Injury Study Center, Veterans Affairs Medical Center, Washington, DC 20422 USA
| | | | - Yingratana A McLennan
- Davis Medical Center, MIND Institute, University of California, Sacramento, CA 95817 USA
| | - Flora Tassone
- Davis Medical Center, MIND Institute, University of California, Sacramento, CA 95817 USA ; Department of Biochemistry and Molecular Medicine, University of California, Davis Medical Center, Sacramento, CA 95817 USA
| | - Susan M Rivera
- Davis Medical Center, MIND Institute, University of California, Sacramento, CA 95817 USA ; Department of Psychology, University of California, Davis, CA 95616 USA ; Center for Mind and Brain, University of California, Davis, CA 95616 USA
| | - Tony J Simon
- Davis Medical Center, MIND Institute, University of California, Sacramento, CA 95817 USA ; Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA 95817 USA
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12
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Lehmann J, Jansen P. Mental rotation performance in children with hydrocephalus both with and without spina bifida. Dev Neuropsychol 2013; 38:433-44. [PMID: 24138214 DOI: 10.1080/87565641.2013.820304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The mental rotation ability in children with hydrocephalus and those with both hydrocephalus and spina bifida in comparison to healthy controls was investigated in this study. All groups performed a chronometric mental rotation test. Compared to children with hydrocephalus, children with both spina bifida and hydrocephalus showed an impaired mental rotation performance, demonstrated by slower reaction times. No significant performance difference was found between children with spina bifida and healthy controls. Error rates were comparable between groups indicating that the impaired mental rotation performance in children with both spina bifida and hydrocephalus is primarily due to motor impairment.
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Affiliation(s)
- Jennifer Lehmann
- a Institute of Sport Science, University of Regensburg , Regensburg , Germany
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Williams VJ, Juranek J, Stuebing K, Cirino PT, Dennis M, Fletcher JM. Examination of frontal and parietal tectocortical attention pathways in spina bifida meningomyelocele using probabilistic diffusion tractography. Brain Connect 2013; 3:512-22. [PMID: 23937233 DOI: 10.1089/brain.2013.0171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abnormalities of the midbrain tectum are common but variable malformations in spina bifida meningomyelocele (SBM) and have been linked to neuropsychological deficits in attention orienting. The degree to which variations in tectum structure influence white matter (WM) connectivity to cortical regions is unknown. To assess the relationship of tectal structure and connectivity to frontal and parietal cortical regions, probabilistic diffusion tractography was performed on 106 individuals (80 SBM, 26 typically developing [TD]) to isolate anterior versus posterior tectocortical WM pathways. Results showed that those with SBM exhibited significantly reduced tectal volume, along with decreased fractional anisotropy (FA) in posterior but not anterior tectocortical WM pathways when compared with TD individuals. The group with SBM also showed greater within-subject discrepancies between frontal and parietal WM integrity compared with the TD group. Of those with SBM, qualitative classification of tectal beaking based on radiological review was associated with increased axial diffusivity across both anterior and posterior tectocortical pathways, relative to individuals with SBM and a normal appearing tectum. These results support previous volumetric findings of greater impairment to posterior versus anterior brain regions in SBM, and quantifiably relate tectal volume, tectocortical WM integrity, and tectal malformations in this population.
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Taylor HB, Barnes MA, Landry SH, Swank P, Fletcher JM, Huang F. Motor contingency learning and infants with Spina Bifida. J Int Neuropsychol Soc 2013; 19:206-15. [PMID: 23298791 PMCID: PMC4067977 DOI: 10.1017/s1355617712001233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Infants with Spina Bifida (SB) were compared to typically developing infants (TD) using a conjugate reinforcement paradigm at 6 months-of-age (n = 98) to evaluate learning, and retention of a sensory-motor contingency. Analyses evaluated infant arm-waving rates at baseline (wrist not tethered to mobile), during acquisition of the sensory-motor contingency (wrist tethered), and immediately after the acquisition phase and then after a delay (wrist not tethered), controlling for arm reaching ability, gestational age, and socioeconomic status. Although both groups responded to the contingency with increased arm-waving from baseline to acquisition, 15% to 29% fewer infants with SB than TD were found to learn the contingency depending on the criterion used to determine contingency learning. In addition, infants with SB who had learned the contingency had more difficulty retaining the contingency over time when sensory feedback was absent. The findings suggest that infants with SB do not learn motor contingencies as easily or at the same rate as TD infants, and are more likely to decrease motor responses when sensory feedback is absent. Results are discussed with reference to research on contingency learning in infants with and without neurodevelopmental disorders, and with reference to motor learning in school-age children with SB.
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Affiliation(s)
- Heather B Taylor
- Department of Pediatrics, University of Texas Health Science Center, Houston, TX 77030, USA.
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Caspersen ID, Habekost T. Selective and sustained attention in children with spina bifida myelomeningocele. Child Neuropsychol 2013; 19:55-77. [DOI: 10.1080/09297049.2011.639753] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Spellicy CJ, Northrup H, Fletcher JM, Cirino PT, Dennis M, Morrison AC, Martinez CA, Au KS. Folate metabolism gene 5,10-methylenetetrahydrofolate reductase (MTHFR) is associated with ADHD in myelomeningocele patients. PLoS One 2012; 7:e51330. [PMID: 23227261 PMCID: PMC3515551 DOI: 10.1371/journal.pone.0051330] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 11/07/2012] [Indexed: 02/06/2023] Open
Abstract
The objective of this study was to examine the relation between the 5, 10-methylenetetrahydrofolate reductase (MTHFR) gene and behaviors related to attention- deficit/hyperactivity disorder (ADHD) in individuals with myelomeningocele. The rationale for the study was twofold: folate metabolizing genes, (e.g. MTHFR), are important not only in the etiology of neural tube defects but are also critical to cognitive function; and individuals with myelomeningocele have an elevated incidence of ADHD. Here, we tested 478 individuals with myelomeningocele for attention-deficit hyperactivity disorder behavior using the Swanson Nolan Achenbach Pelham-IV ADHD rating scale. Myelomeningocele participants in this group for whom DNAs were available were genotyped for seven single nucleotide polymorphisms (SNPs) in the MTHFR gene. The SNPs were evaluated for an association with manifestation of the ADHD phenotype in children with myelomeningocele. The data show that 28.7% of myelomeningocele participants exhibit rating scale elevations consistent with ADHD; of these 70.1% had scores consistent with the predominantly inattentive subtype. In addition, we also show a positive association between the SNP rs4846049 in the 3'-untranslated region of the MTHFR gene and the attention-deficit hyperactivity disorder phenotype in myelomeningocele participants. These results lend further support to the finding that behavior related to ADHD is more prevalent in patients with myelomeningocele than in the general population. These data also indicate the potential importance of the MTHFR gene in the etiology of the ADHD phenotype.
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Affiliation(s)
- Catherine J. Spellicy
- Department of Pediatrics, University of Texas Medical School at Houston, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Hope Northrup
- Department of Pediatrics, University of Texas Medical School at Houston, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- Shriners Hospital for Children, Houston, Texas, United States of America
| | - Jack M. Fletcher
- Department of Psychology, University of Houston, Houston, Texas, United States of America
| | - Paul T. Cirino
- Department of Psychology and Texas Institute for Measurement, Evaluation, and Statistics (TIMES), University of Houston, Houston, Texas, United States of America
| | - Maureen Dennis
- Department of Surgery, University of Toronto, and Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada
| | - Alanna C. Morrison
- Human Genetics Center, Division of Epidemiology, Human Genetics and Environmental Science, School of Public Health, University of Texas Health Sciences Center at Houston, Houston, Texas, United States of America
| | - Carla A. Martinez
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center, El Paso, Texas, United States of America
| | - Kit Sing Au
- Department of Pediatrics, University of Texas Medical School at Houston, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
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17
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Yang Z, Yeo RA, Pena A, Ling JM, Klimaj S, Campbell R, Doezema D, Mayer AR. An FMRI study of auditory orienting and inhibition of return in pediatric mild traumatic brain injury. J Neurotrauma 2012; 29:2124-36. [PMID: 22533632 PMCID: PMC3419846 DOI: 10.1089/neu.2012.2395] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Studies in adult mild traumatic brain injury (mTBI) have shown that two key measures of attention, spatial reorienting and inhibition of return (IOR), are impaired during the first few weeks of injury. However, it is currently unknown whether similar deficits exist following pediatric mTBI. The current study used functional magnetic resonance imaging (fMRI) to investigate the effects of semi-acute mTBI (<3 weeks post-injury) on auditory orienting in 14 pediatric mTBI patients (age 13.50±1.83 years; education: 6.86±1.88 years), and 14 healthy controls (age 13.29±2.09 years; education: 7.21±2.08 years), matched for age and years of education. The results indicated that patients with mTBI showed subtle (i.e., moderate effect sizes) but non-significant deficits on formal neuropsychological testing and during IOR. In contrast, functional imaging results indicated that patients with mTBI demonstrated significantly decreased activation within the bilateral posterior cingulate gyrus, thalamus, basal ganglia, midbrain nuclei, and cerebellum. The spatial topography of hypoactivation was very similar to our previous study in adults, suggesting that subcortical structures may be particularly affected by the initial biomechanical forces in mTBI. Current results also suggest that fMRI may be a more sensitive tool for identifying semi-acute effects of mTBI than the procedures currently used in clinical practice, such as neuropsychological testing and structural scans. fMRI findings could potentially serve as a biomarker for measuring the subtle injury caused by mTBI, and documenting the course of recovery.
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Affiliation(s)
- Zhen Yang
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Ronald A. Yeo
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Amanda Pena
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Josef M. Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Stefan Klimaj
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Richard Campbell
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - David Doezema
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
- Neurology Department, University of New Mexico School of Medicine, Albuquerque, New Mexico
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18
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Gold AB, Ewing-Cobbs L, Cirino P, Fuchs LS, Stuebing KK, Fletcher JM. Cognitive and behavioral attention in children with math difficulties. Child Neuropsychol 2012; 19:420-37. [PMID: 22686370 PMCID: PMC4155495 DOI: 10.1080/09297049.2012.690371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cognitive assessments and behavioral ratings of attention were used to examine the relation of inattention to math performance in children. Third grade students with math difficulties (MD; n = 17) and math and reading difficulties (MDRD; n = 35) were administered the Attentional Network Test (ANT), as well as achievement and intelligence measures. Strengths and Weaknesses of ADHD-Symptoms and Normal-Behavior-IV (SWAN-IV) Inattention ratings were collected from teachers. Two comparison groups were also recruited: a typically achieving group (n = 23) and a group that responded to a math-tutoring intervention (responders; n = 54). On the ANT, children with MD and MDRD did not perform significantly different than typically achieving children or responders on measures of alerting and orienting attention and executive control. All subgroups did demonstrate performance patterns that were expected on the ANT. However, performance across blocks of the task was inconsistent, suggesting poor reliability. There were no relations between ANT performance and SWAN-IV behavioral inattention scores, though behavioral ratings of inattention correlated significantly with math performance. Children with MD and MDRD may have more difficulty with distraction and attention to detail in contextual situations, as opposed to impulsive responding in these settings. The lack of relation between cognitive attention and math performance may suggest that either the ANT does not assess the relevant attention constructs associated with math difficulties or may parallel studies of attention deficit/hyperactivity disorder (ADHD) in which cognitive and behavioral assessments are weakly related.
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Affiliation(s)
- Alanna B Gold
- Department of Psychology, University of Houston, Houston, TX 77204, USA.
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19
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A cross-sectional study of the development of volitional control of spatial attention in children with chromosome 22q11.2 deletion syndrome. J Neurodev Disord 2012; 4:5. [PMID: 22958432 PMCID: PMC3374293 DOI: 10.1186/1866-1955-4-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 02/15/2012] [Indexed: 11/10/2022] Open
Abstract
Background Chromosome 22q11.2 deletion syndrome (22q11.2DS) results from a 1.5- to 3-megabase deletion on the long arm of chromosome 22 and occurs in approximately 1 in 4000 live births. Previous studies indicate that children with 22q11.2DS are impaired on tasks involving spatial attention. However, the degree to which these impairments are due to volitionally generated (endogenous) or reflexive (exogenous) orienting of attention is unclear. Additionally, the efficacy of these component attention processes throughout child development in 22q11.2DS has yet to be examined. Methods Here we compared the performance of a wide age range (7 to 14 years) of children with 22q11.2DS to typically developing (TD) children on a comprehensive visual cueing paradigm to dissociate the contributions of endogenous and exogenous attentional impairments. Paired and two-sample t-tests were used to compare outcome measures within a group or between groups. Additionally, repeated measures regression models were fit to the data in order to examine effects of age on performance. Results We found that children with 22q11.2DS were impaired on a cueing task with an endogenous cue, but not on the same task with an exogenous cue. Additionally, it was younger children exclusively who were impaired on endogenous cueing when compared to age-matched TD children. Older children with 22q11.2DS performed comparably to age-matched TD peers on the endogenous cueing task. Conclusions These results suggest that endogenous but not exogenous orienting of attention is selectively impaired in children with 22q11.2DS. Additionally, the age effect on cueing in children with 22q11.2DS suggests a possible altered developmental trajectory of endogenous cueing.
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20
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Lacy M, Baldassarre M, Nader T, Frim D. Parent ratings of executive functioning in children with shunted hydrocephalus. Pediatr Neurosurg 2012; 48:73-9. [PMID: 23037887 DOI: 10.1159/000339313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 05/07/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The present study examined the executive functioning of a group of children with a history of communicating hydrocephalus and how their level of functioning was correlated with parent ratings of executive functioning. METHODS The study examined the executive functioning of 39 shunted children with a history of hydrocephalus and 20 healthy peers. Additionally, parents of both groups of children completed the Behavior Rating Inventory of Executive Function (BRIEF) to assess the parents' perceptions of their children's executive functioning. Finally, the study investigated the relationship between the shunted hydrocephalus children's executive functioning and the parent ratings of their executive functioning. RESULTS Overall, the children with a history of shunted hydrocephalus displayed more executive dysfunction than their healthy peers. These children were rated by their parents as having more executive dysfunction than their healthy peers and displaying working memory, initiation, mental flexibility and self-monitoring difficulties, which appear to increase with age among the shunted hydrocephalus group. While parent ratings as measured by the BRIEF indices did not correlate with all executive tasks within the shunted hydrocephalus group, the cognitive tests assessing mental flexibility may be sensitive to the problems noted by parents at home. CONCLUSIONS The children with a history of shunted hydrocephalus displayed executive functioning deficits on formal examination. The parents of children with a history of shunted hydrocephalus report ongoing executive difficulties which may increase with age.
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Affiliation(s)
- Maureen Lacy
- Sections of Neuropsychology and Neurosurgery, Departments of Psychiatry and Surgery, The University of Chicago Medical Center, Chicago, Ill., USA
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21
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Taylor HB, Landry SH, Barnes M, Swank P, Cohen LB, Fletcher J. Early information processing among infants with and without spina bifida. Infant Behav Dev 2010; 33:365-72. [PMID: 20488543 PMCID: PMC2956001 DOI: 10.1016/j.infbeh.2010.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 11/05/2009] [Accepted: 03/19/2010] [Indexed: 11/19/2022]
Abstract
This study focuses on the development of early visual information processing among infants with spina bifida (SB) compared to typically developing infants using the habituation-dishabituation paradigm. Analyses were conducted in two stages. First infants were evaluated to determine if 18-month old infants (SB=47; Control=40) differed in their ability to shift attention and habituate to two female faces, as well as their responses to composite and novel stimuli. Second, relations between these variables and infant motor and mental functioning were evaluated. The results of the study indicated that difficulties with visual attention skills can be detected as early as 18 months of age among infants with SB. Infants with SB differed significantly from controls on attention getting. Although there were no differences found on habituation and composite tasks, infants with SB differed significantly from controls on their ability to dishabituate. Implications are discussed.
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Affiliation(s)
- Heather B Taylor
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
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22
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Dennis M, Barnes MA. The cognitive phenotype of spina bifida meningomyelocele. ACTA ACUST UNITED AC 2010; 16:31-9. [PMID: 20419769 DOI: 10.1002/ddrr.89] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A cognitive phenotype is a product of both assets and deficits that specifies what individuals with spina bifida meningomyelocele (SBM) can and cannot do and why they can or cannot do it. In this article, we review the cognitive phenotype of SBM and describe the processing assets and deficits that cut within and across content domains, sensory modality, and material, including studies from our laboratory and other investigations. We discuss some implications of the SBM cognitive phenotype for assessment, rehabilitation, and research.
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Affiliation(s)
- Maureen Dennis
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.
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23
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Abstract
Children with injury to the central nervous system (CNS) exhibit a variety of language disorders that have been described by members of different disciplines, in different journals, using different descriptors and taxonomies. This paper is an overview of language deficits in children with CNS injury, whether congenital or acquired after a period of normal development. It first reviews the principal CNS conditions associated with language disorders in childhood. It then describes a functional taxonomy of language, with examples of the phenomenology and neurobiology of clinical deficits in children with CNS insults. Finally, it attempts to situate language in the broader realm of cognition and in current theoretical accounts of embodied cognition.
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Affiliation(s)
- Maureen Dennis
- Program in Neurosciences and Mental Health, Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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24
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Effects of reading goals on reading comprehension, reading rate, and allocation of working memory in children and adolescents with spina bifida meningomyelocele. J Int Neuropsychol Soc 2010; 16:517-25. [PMID: 20338082 PMCID: PMC3050058 DOI: 10.1017/s1355617710000123] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spina bifida meningomyelocele (SBM) is a neurodevelopmental disorder associated with intact word decoding and deficient text and discourse comprehension. This study investigated the ability to adjust reading in accordance with specified reading goals in 79 children and adolescents with SBM (9-19 years of age) and 39 controls (8-17 years of age). Both groups demonstrated slower reading times and enhanced comprehension when reading to study or to come up with a title than when reading for specific information or for entertainment. For both groups, verbal working memory contributed to comprehension performance in those reading conditions hypothesized to require more cognitive effort. Despite their sensitivity to the goals of reading, the group with SBM answered fewer comprehension questions correctly across all reading goal conditions. The results are discussed in relation to the hypothesized cognitive underpinnings of comprehension deficits in SBM and to current models of text comprehension.
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25
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Lindquist B, Uvebrant P, Rehn E, Carlsson G. Cognitive functions in children with myelomeningocele without hydrocephalus. Childs Nerv Syst 2009; 25:969-75. [PMID: 19263057 DOI: 10.1007/s00381-009-0843-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to explore the separate effects of myelomeningocele (MMC) and hydrocephalus on intelligence and neuropsychological functions in a population-based series of children. MATERIAL AND METHODS Of the 69 children with MMC born in 1992-1999 in western Sweden, nine did not develop hydrocephalus. Eight of them participated in this study and were compared with age- and gender-matched children with MMC in combination with hydrocephalus and with controls. RESULTS Children with only MMC had an IQ of 103 compared with 75 in those with hydrocephalus added to the MMC and they had significantly better immediate and long-term memory and executive functions. When compared with controls, they had difficulty with learning and executive functions, but when the two children with an IQ of <70 were excluded, those with only MMC performed just as well as the controls. CONCLUSION Hydrocephalus rather than MMC in itself appeared to cause the cognitive deficits found in children with MMC.
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Affiliation(s)
- Barbro Lindquist
- Department of Habilitation, Halmstad County Hospital, Halmstad, Sweden
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26
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Abstract
IQ scores are volatile indices of global functional outcome, the final common path of an individual's genes, biology, cognition, education, and experiences. In studying neurocognitive outcomes in children with neurodevelopmental disorders, it is commonly assumed that IQ can and should be partialed out of statistical relations or used as a covariate for specific measures of cognitive outcome. We propose that it is misguided and generally unjustified to attempt to control for IQ differences by matching procedures or, more commonly, by using IQ scores as covariates. We offer logical, statistical, and methodological arguments, with examples from three neurodevelopmental disorders (spina bifida meningomyelocele, learning disabilities, and attention deficit hyperactivity disorder) that: (1) a historical reification of general intelligence, g, as a causal construct that measures aptitude and potential rather than achievement and performance has fostered the idea that IQ has special status and that in studying neurocognitive function in neurodevelopmental disorders; (2) IQ does not meet the requirements for a covariate; and (3) using IQ as a matching variable or covariate has produced overcorrected, anomalous, and counterintuitive findings about neurocognitive function.
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27
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English LH, Barnes MA, Taylor HB, Landry SH. Mathematical development in spina bifida. DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 2009; 15:28-34. [PMID: 19213013 PMCID: PMC3047453 DOI: 10.1002/ddrr.48] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Spina bifida (SB) is a neural tube defect diagnosed before or at birth that is associated with a high incidence of math disability often without co-occurring difficulties in reading. SB provides an interesting population within which to examine the development of mathematical abilities and disability across the lifespan and in relation to the deficits in visual-spatial processing that are also associated with the disorder. An overview of math and its cognitive correlates in preschoolers, school-age children and adults with SB is presented including the findings from a longitudinal study linking early executive functions in infancy to the development of later preschool and school age math skills. These findings are discussed in relation to socio-historical perspectives on math education and implications for intervention and directions for further research are presented.
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Affiliation(s)
| | - Marcia A. Barnes
- Children’s Learning Institute, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
| | - Heather B. Taylor
- Children’s Learning Institute, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
| | - Susan H. Landry
- Children’s Learning Institute, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
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28
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Swartwout MD, Cirino PT, Hampson AW, Fletcher JM, Brandt ME, Dennis M. Sustained attention in children with two etiologies of early hydrocephalus. Neuropsychology 2008; 22:765-75. [PMID: 18999350 PMCID: PMC2593153 DOI: 10.1037/a0013373] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Several studies have shown that children with spina bifida meningomyelocele (SBM) and hydrocephalus have attention problems on parent ratings and difficulties in stimulus orienting associated with a posterior brain attention system. Less is known about response control and inhibition associated with an anterior brain attention system. Using the Gordon Vigilance Task (Gordon, 1983), we studied error rate, reaction time, and performance over time for sustained attention, a key anterior attention function, in 101 children with SBM, 17 with aqueductal stenosis (AS; another condition involving congenital hydrocephalus), and 40 typically developing controls (NC). In SBM, we investigated the relation between cognitive attention and parent ratings of inattention and hyperactivity and explored the impact of medical variables. Children with SBM did not differ from AS or NC groups on measures of sustained attention, but they committed more errors and responded more slowly. Approximately one-third of the SBM group had attention symptoms, although parent attention ratings were not associated with task performance. Hydrocephalus does not account for the attention profile of children with SBM, which also reflects the distinctive brain dysmorphologies associated with this condition.
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Affiliation(s)
- Maegan D Swartwout
- Department of Psychology, University of Houston, Houston, TX 77204-5355, USA.
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29
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Au KS, Tran PX, Tsai CC, O’Byrne MR, Lin JI, Morrison AC, Hampson AW, Cirino P, Fletcher JM, Ostermaier KK, Tyerman GH, Doebel S, Northrup H. Characteristics of a spina bifida population including North American Caucasian and Hispanic individuals. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2008; 82:692-700. [PMID: 18937358 PMCID: PMC2597629 DOI: 10.1002/bdra.20499] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Meningomyelocele (MM) is a common human birth defect. MM is a disorder of neural development caused by contributions from genes and environmental factors that result in the NTD and lead to a spectrum of physical and neurocognitive phenotypes. METHODS A multidisciplinary approach has been taken to develop a comprehensive understanding of MM through collaborative efforts from investigators specializing in genetics, development, brain imaging, and neurocognitive outcome. Patients have been recruited from five different sites: Houston and the Texas-Mexico border area; Toronto, Canada; Los Angeles, California; and Lexington, Kentucky. Genetic risk factors for MM have been assessed by genotyping and association testing using the transmission disequilibrium test. RESULTS A total of 509 affected child/parent trios and 309 affected child/parent duos have been enrolled to date for genetic association studies. Subsets of the patients have also been enrolled for studies assessing development, brain imaging, and neurocognitive outcomes. The study recruited two major ethnic groups, with 45.9% Hispanics of Mexican descent and 36.2% North American Caucasians of European descent. The remaining patients are African-American, South and Central American, Native American, and Asian. Studies of this group of patients have already discovered distinct corpus callosum morphology and neurocognitive deficits that associate with MM. We have identified maternal MTHFR 667T allele as a risk factor for MM. In addition, we also found that several genes for glucose transport and metabolism are potential risk factors for MM. CONCLUSIONS The enrolled patient population provides a valuable resource for elucidating the disease characteristics and mechanisms for MM development.
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Affiliation(s)
- Kit Sing Au
- Department of Pediatrics, The University of Texas Medical School at Houston, Houston, TX
| | - Phong X. Tran
- Department of Pediatrics, The University of Texas Medical School at Houston, Houston, TX
| | - Chester C. Tsai
- Department of Pediatrics, The University of Texas Medical School at Houston, Houston, TX
| | - Michelle R. O’Byrne
- Department of Pediatrics, The University of Texas Medical School at Houston, Houston, TX
| | - Jone-Ing Lin
- Human Genetics Center, The University of Texas School of Public Health, Houston, TX
| | - Alanna C. Morrison
- Human Genetics Center, The University of Texas School of Public Health, Houston, TX
| | - Amy W. Hampson
- Department of Psychology, University of Houston, Houston, TX
| | - Paul Cirino
- Department of Psychology, University of Houston, Houston, TX
| | | | | | | | - Sabine Doebel
- The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Hope Northrup
- Department of Pediatrics, The University of Texas Medical School at Houston, Houston, TX
- Shriners Hospital for Children, Houston, TX
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30
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Dennis M, Sinopoli KJ, Fletcher JM, Schachar R. Puppets, robots, critics, and actors within a taxonomy of attention for developmental disorders. J Int Neuropsychol Soc 2008; 14:673-90. [PMID: 18764966 PMCID: PMC2593155 DOI: 10.1017/s1355617708080983] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This review proposes a new taxonomy of automatic and controlled attention. The taxonomy distinguishes among the role of the attendee (puppet and robot, critic and actor), the attention process (stimulus orienting vs. response control), and the attention operation (activation vs. inhibition vs. adjustment), and identifies cognitive phenotypes by which attention is overtly expressed. We apply the taxonomy to four childhood attention disorders: attention deficit hyperactivity disorder, spina bifida meningomyelocele, traumatic brain injury, and acute lymphoblastic leukemia. Variations in attention are related to specific brain regions that support normal attention processes when intact, and produce disordered attention when impaired. The taxonomy explains group differences in behavioral inattention, hyperactivity, and impulsiveness, as well as medication response. We also discuss issues relevant to theories of the cognitive and neural architecture of attention: functional dissociations within and between automatic and controlled attention; the relative importance of type of brain damage and developmental timing to attention profile; cognitive-energetic models of attention and white matter damage; temporal processing deficits, attention deficits and cerebellar damage; and the issue of cognitive phenotypes as candidate endophenotypes.
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Affiliation(s)
- Maureen Dennis
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada.
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31
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Hasan KM, Sankar A, Halphen C, Kramer LA, Ewing-Cobbs L, Dennis M, Fletcher JM. Quantitative diffusion tensor imaging and intellectual outcomes in spina bifida: laboratory investigation. J Neurosurg Pediatr 2008; 2:75-82. [PMID: 18590401 PMCID: PMC3046025 DOI: 10.3171/ped/2008/2/7/075] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Patients with spina bifida (SB) have variable intellectual outcomes. The authors used diffusion tensor (DT) imaging to quantify whole-brain volumes of gray matter, white matter, and cerebrospinal fluid (CSF), and perform regional quantitative microstructural assessments of gray matter nuclei and white matter tracts in relation to intellectual outcomes in patients with SB. METHODS Twenty-nine children with myelomeningoceles and 20 age- and sex-matched children with normal neural tube development underwent MR imaging with DT image acquisition and assessments of intelligence. The DT imaging-derived metrics were the fractional anisotropy (FA), axial (parallel), and transverse (perpendicular) diffusivities. These metrics were also used to segment the brain into white matter, gray matter, and CSF. A region-of-interest analysis was conducted of the white and gray matter structures implicated in hydrocephalus. RESULTS The amount of whole-brain gray matter was decreased in patients with SB, with a corresponding increase in CSF (p < 0.0001). Regional transverse diffusivity in the caudate nucleus was decreased (p < 0.0001), and the corresponding FA was increased (p < 0.0001), suggesting reduced dendritic branching and connectivity. Fractional anisotropy in the posterior limb of the internal capsule increased in the myelomeningocele group (p = 0.02), suggesting elimination of some divergent fascicles; in contrast, the FA in several white matter structures (such as the corpus callosum genu [p < 0.001] and arcuate fasciculus) was reduced, suggesting disruption of myelination. Diffusion tensor imaging-metrics involving gray matter volume and the caudate nucleus, but not other structures, predicted variations in IQ (r = 0.37-0.50; p < 0.05). CONCLUSIONS Diffusion tensor imaging-derived metrics provide noninvasive neuronal surrogate markers of the pathogenesis of SB and predict variations in general intellectual outcomes in children with this condition.
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Affiliation(s)
- Khader M. Hasan
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston
| | - Ambika Sankar
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston
| | - Christopher Halphen
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston
| | - Larry A. Kramer
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston
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32
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Brown TM, Ris MD, Beebe D, Ammerman RT, Oppenheimer SG, Yeates KO, Enrile BG. Factors of biological risk and reserve associated with executive behaviors in children and adolescents with spina bifida myelomeningocele. Child Neuropsychol 2008; 14:118-34. [PMID: 18306076 DOI: 10.1080/09297040601147605] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study examined differences between healthy children (n = 35) and those with spina bifida myelomeningocele (SBM; n = 42) on the Behavior Rating Inventory of Executive Function (BRIEF), a measure of executive function behaviors. It also examined whether aspects of biological risk associated with SBM and reserve factors within the family could account for variability in BRIEF scores for children and adolescents with SBM. Patients in the SBM group exhibited more problems than both published norms and a local comparison group of healthy children in metacognition but not behavior regulation. Behavior regulation problems in children with SBM were predicted by parent psychological distress. More shunt-related surgeries and history of seizures predicted poorer metacognitive abilities.
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Affiliation(s)
- Tanya Maines Brown
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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33
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Verb generation in children with spina bifida. J Int Neuropsychol Soc 2008; 14:181-91. [PMID: 18282316 PMCID: PMC2592551 DOI: 10.1017/s1355617708080181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 08/29/2007] [Accepted: 08/29/2007] [Indexed: 11/06/2022]
Abstract
We investigated verb generation in children with spina bifida meningomyelocele (SBM; n = 55) and in typically developing controls (n = 32). Participants completed 6 blocks (40 trials each) of a task requiring them to produce a semantically related verb in response to a target noun and an additional 40 trials on which they were simply required to read target nouns aloud. After controlling for reading response time, groups did not differ significantly in verb generation response time or learning. Children with SBM produced more non-verb errors than controls and tended to repeat their mistakes over blocks. Verb generation performance was associated with brain volume measures in participants with SBM. Congenital cerebellar dysmorphology is associated with impaired performance in verb generation accuracy, although not with increased response times to produce verbs
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Hrabok M, Kerns KA, Müller U. The Vigilance, Orienting, and Executive Attention Networks in 4-Year-Old Children. Child Neuropsychol 2007; 13:408-21. [PMID: 17805994 DOI: 10.1080/13825580600977224] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The present study examined the development of lower and higher order forms of attention during the preschool years. Lower forms of attention were assessed with tasks that primarily engaged the attention functions of vigilance and orienting. Higher, executive forms of attention were assessed with tasks that involved inhibition and working memory. The findings revealed that performance improved significantly with age on measures of inhibition and orienting. Results are discussed in the context of the development of attentional networks.
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Affiliation(s)
- Marianne Hrabok
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada.
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Dennis M, Jewell D, Drake J, Misakyan T, Spiegler B, Hetherington R, Gentili F, Barnes M. Prospective, declarative, and nondeclarative memory in young adults with spina bifida. J Int Neuropsychol Soc 2007; 13:312-23. [PMID: 17286888 DOI: 10.1017/s1355617707070336] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Revised: 09/29/2006] [Accepted: 10/18/2006] [Indexed: 11/07/2022]
Abstract
The consequences of congenital brain disorders for adult cognitive function are poorly understood. We studied different forms of memory in 29 young adults with spina bifida meningomyelocele (SBM), a common and severely disabling neural tube defect. Nondeclarative and semantic memory functions were intact. Working memory was intact with low maintenance and manipulation requirements, but impaired on tasks demanding high information maintenance or manipulation load. Prospective memory for intentions to be executed in the future was impaired. Immediate and delayed episodic memory were poor. Memory deficits were exacerbated by an increased number of lifetime shunt revisions, a marker for unstable hydrocephalus. Memory status was positively correlated with functional independence, an important component of quality of life.
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Affiliation(s)
- Maureen Dennis
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada.
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Dennis M, Landry SH, Barnes M, Fletcher JM. A model of neurocognitive function in spina bifida over the life span. J Int Neuropsychol Soc 2006; 12:285-96. [PMID: 16573862 DOI: 10.1017/s1355617706060371] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 11/07/2005] [Accepted: 11/10/2005] [Indexed: 11/06/2022]
Abstract
Spina bifida myelomeningocele (SBM), a neural tube defect that is the product of a complex pattern of gene-environment interactions, is associated with naturally occurring, systematic variability in the neural phenotype and in environmental factors that lead to systematic variability in the cognitive phenotype. We characterize the basis for variability in the cognitive phenotype of children with SBM with reference to a model of key biological, cognitive, and environmental events unfolding over the course of development from infancy to middle age. The cognitive phenotype is not domain-specific, but represents manifestations of unobservable constructs involving associative and assembled processing, the latter directly reflecting the impact of the neural phenotype on core deficits involving movement, timing, and attention orienting. The expression of the cognitive phenotype is variable, being moderated by features of the neural phenotype involving secondary CNS insults (such as hydrocephalus) that impair assembled processing, as well as by environmental factors (such as poverty, parenting, and education) that impair associative processing. The preservation of strengths in associative processing depends in part on the severity of the CNS deficits in SBM and the impact of the environment.
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Affiliation(s)
- Maureen Dennis
- Brain and Behavior Program, The Hospital for Sick Children and the University of Toronto, 555 University Avenue, Rm. 6278A, Ontario, Ontario M5G 1X8, Canada.
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Dennis M, Edelstein K, Frederick J, Copeland K, Francis D, Blaser SE, Kramer LA, Drake JM, Brandt M, Hetherington R, Fletcher JM. Peripersonal spatial attention in children with spina bifida: associations between horizontal and vertical line bisection and congenital malformations of the corpus callosum, midbrain, and posterior cortex. Neuropsychologia 2006; 43:2000-10. [PMID: 15893777 DOI: 10.1016/j.neuropsychologia.2004.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2003] [Revised: 08/25/2004] [Accepted: 10/26/2004] [Indexed: 11/22/2022]
Abstract
Horizontal and vertical line bisection was studied in 129 children and adolescents between 8 and 19 years of age, one group (n=32) of typically developing controls and one group (n=97) with spina bifida (SBM), a neurodevelopmental disorder associated with dysmorphology of the corpus callosum, posterior cortex, and midbrain. For each participant, structural brain MRIs were analyzed qualitatively to identify beaking of the midbrain tectum and corpus callosum agenesis and hypoplasia and quantitatively by segmentation and volumetric analyses of regional cortical white and gray matter. Each group showed the line length effect, whereby greater estimation errors are made with longer lines. The group with SBM differed from controls in terms of both accuracy and variability of line bisection. Children with SBM showed pseudoneglect, attending more than controls to left hemispace. The extent of rightward bisection bias was unrelated to right posterior brain volumes, although an intact corpus callosum during development moderated and normalized the exaggerated leftward line bisection bias. More children with SBM than controls attended to inferior hemispace. A normal midbrain and greater posterior cortex volume during development moderated and normalized the downward bias. Children with SBM showed more intra-subject variability than controls. Line bisection in children with SBM reflects three deficits: an exaggerated attentional bias to left hemispace, an abnormal attentional bias to inferior hemispace; and a larger zone of subjective uncertainty in bisection judgments.
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Affiliation(s)
- Maureen Dennis
- Brain and Behaviour Program, Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ont., Canada M5G 1X8.
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Liptak GS, Fried R, Baltus-Hebert E, Eyer Tierney S, Fucile S, Doremus TL. Do grip and pinch strength predict neurologic complications in children with spina bifida and hydrocephalus? Pediatr Neurosurg 2006; 42:208-13. [PMID: 16714860 DOI: 10.1159/000092356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Accepted: 10/02/2005] [Indexed: 01/07/2023]
Abstract
BACKGROUND Neurological complications occur commonly in children with meningomyelocele and can cause significant morbidity and mortality. An earlier study suggested that acute changes in grip and pinch strength could be used to identify individuals at increased risk for developing a neurological complication. OBJECTIVE To evaluate the use of grip and pinch measurements to screen for neurological problems in children with spina bifida and hydrocephalus. DESIGN A prospective evaluation of screening tests. PATIENTS 92 children, born since 1976, who had meningomyelocele and hydrocephalus and were treated at the University of Rochester Medical Center. METHODS Grip and pinch strength were measured between July, 1991, and June, 2003. RESULTS Mean grip and pinch strengths were similar to those found in previous studies of children with meningomyelocele; 58 neurological events occurred in 39 (40%) individuals. These included 31 episodes of ventricular shunt failure and 22 symptomatic tethered cord occurrences. Specificity, sensitivity and likelihood ratios were calculated in multiple ways using different criteria for loss of grip or pinch strength and for interval to neurological event. Sensitivities were low (<0.35) and the highest positive likelihood ratio found, using fall in either lateral pinch with 6 months to neurological event, was 2.3. CONCLUSIONS Despite previous recommendations, grip and pinch measurements were not helpful when used as a routine screening test for neurological dysfunction for children with meningomyelocele and hydrocephalus.
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Affiliation(s)
- Gregory S Liptak
- Andrew J. Kirch Developmental Services Center, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Dennis M, Edelstein K, Copeland K, Frederick JA, Francis DJ, Hetherington R, Blaser SE, Kramer LA, Drake JM, Brandt ME, Fletcher JM. Space-Based Inhibition of Return in Children With Spina Bifida. Neuropsychology 2005; 19:456-65. [PMID: 16060820 DOI: 10.1037/0894-4105.19.4.456] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Inhibition of return (IOR) refers to an increase in time to react to a target in a previously attended location. Children with spina bifida meningomyelocele (SBM) and hydrocephalus have congenital dysmorphology of the midbrain, a brain region associated with the control of covert orienting in general and with IOR in particular. The authors studied exogenously cued covert orienting in 8- to 19-year-old children and adolescents (84 with SBM and 37 age-matched, typically developing controls). The exogenous cue was a luminance change in a peripheral box that was 50% valid for the upcoming target location. Compared with controls, children with SBM showed attenuated IOR in the vertical plane, a deficit that was associated with midbrain dysmorphology in the form of tectal beaking but not with posterior brain volume loss. The data add to the emerging evidence for SBM deficits in attentional orienting to salient information.
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Affiliation(s)
- Maureen Dennis
- Brain and Behaviour Program, The Hospital for Sick Children, Toronto, ON, Canada.
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