1
|
Faralli A, Fucà E, Lazzaro G, Menghini D, Vicari S, Costanzo F. Transcranial Direct Current Stimulation in neurogenetic syndromes: new treatment perspectives for Down syndrome? Front Cell Neurosci 2024; 18:1328963. [PMID: 38456063 PMCID: PMC10917937 DOI: 10.3389/fncel.2024.1328963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/25/2024] [Indexed: 03/09/2024] Open
Abstract
This perspective review aims to explore the potential neurobiological mechanisms involved in the application of transcranial Direct Current Stimulation (tDCS) for Down syndrome (DS), the leading cause of genetically-based intellectual disability. The neural mechanisms underlying tDCS interventions in genetic disorders, typically characterized by cognitive deficits, are grounded in the concept of brain plasticity. We initially present the neurobiological and functional effects elicited by tDCS applications in enhancing neuroplasticity and in regulating the excitatory/inhibitory balance, both associated with cognitive improvement in the general population. The review begins with evidence on tDCS applications in five neurogenetic disorders, including Rett, Prader-Willi, Phelan-McDermid, and Neurofibromatosis 1 syndromes, as well as DS. Available evidence supports tDCS as a potential intervention tool and underscores the importance of advancing neurobiological research into the mechanisms of tDCS action in these conditions. We then discuss the potential of tDCS as a promising non-invasive strategy to mitigate deficits in plasticity and promote fine-tuning of the excitatory/inhibitory balance in DS, exploring implications for cognitive treatment perspectives in this population.
Collapse
Affiliation(s)
- Alessio Faralli
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Elisa Fucà
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Giulia Lazzaro
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Deny Menghini
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
- Life Sciences and Public Health Department, Catholic University of Sacred Heart, Rome, Italy
| | - Floriana Costanzo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| |
Collapse
|
2
|
Pinks ME, Van Deusen K, Prince MA, Esbensen AJ, Thurman AJ, Patel LR, Abbeduto L, Walsh MM, Daunhauer LA, Feigles RT, Nguyen V, Fidler DJ. Psychometric evaluation of a working memory assessment measure in young children with Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 139:104564. [PMID: 37451184 PMCID: PMC10528903 DOI: 10.1016/j.ridd.2023.104564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/14/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Working memory involves the temporary storage and manipulation of information and is frequently an area of challenge for individuals with Down syndrome (DS). Despite the potential benefits of intervention, laboratory assessments of working memory that could capture intervention effects have not undergone rigorous evaluation for use with young children with DS. It is critical to evaluate assessments of working memory in young children with DS to ensure the reliable and accurate measurement of performance. AIM This study evaluated an adapted laboratory measure of working memory for young children with DS 2-8 years old. METHOD A self-ordered pointing task, the Garage Game, was administered to 78 children with DS (mean = 5.17 years; SD = 1.49). Adaptations were made to the task to minimize potential DS phenotype-related language and motor confounds. RESULTS Results indicate that the measure is feasible, scalable, and developmentally sensitive, with minimal floor and practice effects for this population within this chronological and developmental age range. CONCLUSION These findings demonstrate that the Garage Game is promising for use in studies of early working memory and treatment trials that aim to support the development of this critical dimension of executive functioning for children with DS.
Collapse
Affiliation(s)
- Miranda E Pinks
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States
| | - Kaylyn Van Deusen
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States
| | - Mark A Prince
- Department of Psychology, Colorado State University, Fort Collins, CO, United States
| | - Anna J Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Angela John Thurman
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis Health, Sacramento, CA, United States
| | - Lina R Patel
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States
| | - Leonard Abbeduto
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis Health, Sacramento, CA, United States
| | - Madison M Walsh
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States
| | - Lisa A Daunhauer
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States
| | - Robyn Tempero Feigles
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis Health, Sacramento, CA, United States
| | - Vivian Nguyen
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis Health, Sacramento, CA, United States
| | - Deborah J Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States.
| |
Collapse
|
3
|
Wu J, Peng J, Li Z, Deng H, Huang Z, He Y, Tu J, Cao L, Huang J. Multi-domain computerized cognitive training for children with intellectual developmental disorder: A randomized controlled trial. Front Psychol 2023; 13:1059889. [PMID: 36698581 PMCID: PMC9868813 DOI: 10.3389/fpsyg.2022.1059889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/08/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose To verify the effects of multi-domain computerized cognitive training on intellectual function and adaptive functioning in children with intellectual developmental disorder (IDD). Methods Children with IDD were randomized to a multi-domain computerized cognitive training (CCT) group (n = 30) and control group (n = 30). Both groups received a 5-week training program. Intellectual function was assessed by Chinese-Wechsler Young Children scale (C-WYCSI) and adaptive functioning was assessed by the Chinese Vineland Adaptive Behavior Rating Scale (VABS-C), which were used at baseline, post-training, and 3-month follow-up. Results There were significant differences for intellectual function and adaptive functioning between the two groups. The CCT group showed significant improvements in total full-scale intelligence quotient (FSIQ) score the Wechsler Intelligence Scale (F[60] = 31.97, p < 0.01) and its subdomain VIQ score (F[60] = 33.83, p < 0.01). For adaptive functioning, CCT had a better adaptive developmental quotient (ADQ) score (F[60] = 28.05, p < 0.01), and subdomain communication (F[60] = 10.86, p < 0.01) and socialization scores (F[60] = 4.35, p < 0.015). Moreover, there was a positive correlation between FSIQ changes and ADQ changes in the CCT group (rs = 0.74, p < 0.01). A greater increase in VIQ score was associated with a greater increase in adaptive functioning (bootstrapping CI: [0.16, 3.30]) in the CCT group. Conclusion Multi-domain CCT improves the intellectual function and adaptive functioning of children with IDD.
Collapse
|
4
|
Schworer EK, Esbensen AJ, Fidler DJ, Beebe DW, Carle A, Wiley S. Evaluating working memory outcome measures for children with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:195-211. [PMID: 33763953 PMCID: PMC8463631 DOI: 10.1111/jir.12833] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/13/2021] [Accepted: 03/02/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND There is a critical need for the psychometric evaluation of outcome measures to be used in clinical trials targeting cognition in Down syndrome (DS). This study examines a specific cognitive skill that is of particular importance in DS, working memory, and the psychometric properties of a set of standardised measurements to assess working memory in individuals with DS. METHODS Ninety children and adolescents ages 6 to 18 years old with DS were assessed on a selection of verbal and visuospatial working memory subtests of standardised clinical assessments at two time points to examine feasibility, distributional qualities, test-retest reliability and convergent validity against a priori criteria. Caregivers also completed an adaptive behaviour questionnaire to address working memory subtests' associations with broader developmental functioning. RESULTS The Stanford Binet-5 Verbal Working Memory, Differential Ability Scales-2 Recognition of Pictures, Stanford Binet-5 Nonverbal Working Memory and Wechsler Intelligence Scale for Children-5 Picture Span measures met the most psychometric criteria overall across the full age and IQ range of the study. Although Differential Ability Scales-2 Recall of Sequential Order and Differential Ability Scales-2 Recall of Digits Backward met the fewest a priori criteria, follow-up analyses suggested greater feasibility in specific age and IQ ranges. CONCLUSIONS Several working memory measures appear to be psychometrically sound and appropriate for use in clinical trials for children with DS, especially when focusing on raw scores. However, floor effects on standard scores and feasibility of some measures were problematic. Guidelines for use of the working memory subtests with this population are provided.
Collapse
Affiliation(s)
- Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Deborah J. Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Dean W. Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Adam Carle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- James M Anderson Center for Health Systems Excellence, Cincinnati, OH, USA
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
5
|
Torra Moreno M, Canals Sans J, Colomina Fosch MT. Behavioral and Cognitive Interventions With Digital Devices in Subjects With Intellectual Disability: A Systematic Review. Front Psychiatry 2021; 12:647399. [PMID: 33927655 PMCID: PMC8076520 DOI: 10.3389/fpsyt.2021.647399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/17/2021] [Indexed: 01/01/2023] Open
Abstract
In recent years, digital devices have been progressively introduced in rehabilitation programs and have affected skills training methods used with children and adolescents with intellectual disabilities (ID). The objective of this review is to assess the effects of the use of digital devices on the cognitive functions and behavioral skills in this population, and to acknowledge their potential as a therapeutic tool. Electronic databases were analyzed until February 2020 using search formulas with free terms related to ID and the use of digital systems with children or adolescents. The risk of bias in randomized controlled trials was assessed by means of the modified Cochrane Collaboration tool and the quality level of the non-randomized studies was assessed using the Newcastle-Ottawa Scale. Forty-four studies were analyzed, most of which were categorized as low quality. Of the executive function studies analyzed, 60% reported significant improvements, most commonly related to working memory. Within the cognitive skills, 47% of the studies analyzed reported significant improvements, 30% of them in language. Significant improvements in the social (50%) and behavioral domains (30%) were also reported. These results suggest that digital interventions are effective in improving working memory and academic skills, and positively affect both the social and behavioral domains. Little information has been published regarding the duration of the effects, which could be limited in time. Further research is necessary to assess long-term effectiveness, the influence of comorbidities, and the effects on subjects with severe ID. The inclusion of smartphones and special education centers is also necessary.
Collapse
Affiliation(s)
- Marta Torra Moreno
- Jeroni de Moragas Private Fundation, Tarragona, Spain
- Jeroni de Moragas Association, Tarragona, Spain
| | - Josefa Canals Sans
- Department of Psychology, Research Center for Behavioral Assessment (CRAMC), Rovira i Virgili University, Tarragona, Spain
| | - Maria Teresa Colomina Fosch
- Department of Psychology, Research Center for Behavioral Assessment (CRAMC), Rovira i Virgili University, Tarragona, Spain
- Research Group in Neurobehavior and Health (NEUROLAB), Tarragona, Spain
| |
Collapse
|
6
|
Feasibility of a Tablet-Based Program for Training Everyday Planning in Adolescents With Intellectual Disabilities. JOURNAL OF COGNITIVE EDUCATION AND PSYCHOLOGY 2020. [DOI: 10.1891/jcep-d-19-00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundIndividuals with intellectual disabilities (ID) show difficulties with everyday planning. A tablet-based training program for everyday planning may be a suitable intervention, but its feasibility must be evaluated. This study evaluated how behavior changes during training and if individuals with ID can use technology by themselves.MethodThirty-three adolescents with ID and 30 younger children with a typical development were recruited. The participants were instructed to train in school for a total of 300 minutes. After the intervention, the participants were matched on mental age (MA).ResultsOnly 16% of the participants trained for all 300 minutes. Participants in the MA group trained for a longer time than the ID group. Both groups made fewer errors per task at the end compared to the beginning. Individuals with ID started off making less attempts per task and increased their activity during the training. This pattern was not seen in the comparison group.ConclusionsBoth groups used the program independently, without adult supervision. However, a large group of participants in the ID group had a low usage time. Thus, the program might not have been feasible for that subgroup. The ID group increased their activity during the training which might mirror a strategy development of how to use the program. The change in behavior in activity on task attempts can be interpreted such that individuals with ID need a longer time to get familiarized with the technology. Tablet-based training programs are feasible for individuals with ID, but it is necessary to follow up on usage time.
Collapse
|
7
|
Meneghetti C, Toffalini E, Lanfranchi S, Carretti B. Path Learning in Individuals With Down Syndrome: The Floor Matrix Task and the Role of Individual Visuo-Spatial Measures. Front Hum Neurosci 2020; 14:107. [PMID: 32296317 PMCID: PMC7136450 DOI: 10.3389/fnhum.2020.00107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/10/2020] [Indexed: 11/16/2022] Open
Abstract
Environment learning is essential in everyday life. In individuals with Down syndrome (DS), this skill has begun to be examined using virtual exploration. Previous studies showed that individuals with DS can learn and remember paths in terms of sequences of turns and straight stretches, albeit with some difficulty, and this learning is supported by their cognitive abilities. This study further investigates environment learning in the DS population, newly examining their ability to learn a path from actual movements, and to learn increasingly long paths, and how their performance relates to their visuo-spatial abilities and everyday spatial activities. A group of 30 individuals with DS and 30 typically-developing (TD) children matched for receptive vocabulary performed a 4 × 4 Floor Matrix task in a grid comprising 16 squares (total area 2.3 × 2.3 meters). The task involved repeating increasingly long sequences of steps by actually moving in the grid. The sequences were presented in two learning conditions, called Observation (when participants watched the experimenter’s moves), or Map (when they were shown a map reproducing the path). Several visuo-spatial measures were also administered. The results showed a clear difference between the two groups’ performance in the individual visuo-spatial measures. In the Floor Matrix task, after controlling for visuo-spatial reasoning ability, both groups benefited to the same degree from the Observation condition vis-à-vis the Map condition, and no group differences emerged. In the group with DS, visuo-spatial abilities were more predictive of performance in the Floor Matrix task in the Observation condition than in the Map condition. The same was true of the TD group, but this difference was much less clear-cut. The visuo-spatial working memory and visualization tasks were the strongest predictors of Floor Matrix task performance. Finally, the group with DS showed a significant relation between Floor Matrix task performance in the Observation condition and everyday spatial activity. These results enlarge on what we know about path learning in individuals with DS and its relation to their visuo-spatial abilities. These findings are discussed within the frame of spatial cognition and the atypical development domain.
Collapse
Affiliation(s)
| | - Enrico Toffalini
- Department of General Psychology, University of Padua, Padua, Italy
| | - Silvia Lanfranchi
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Barbara Carretti
- Department of General Psychology, University of Padua, Padua, Italy
| |
Collapse
|