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Brugnaro BH, Lima CRG, Costa IGRDA, Fernandes G, Campos ACDE, Rosenbaum P, Pavão SL, Rocha NACF. Personal and environmental factors and household assistance in Down syndrome: cross-sectional study. AN ACAD BRAS CIENC 2024; 96:e20230558. [PMID: 39258691 DOI: 10.1590/0001-3765202420230558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/29/2024] [Indexed: 09/12/2024] Open
Abstract
According to a biopsychosocial framework, personal and environmental factors might be mediators or facilitators/barriers, respectively, to functioning. However, it is not known how these factors can impact independence in household chores in children/adolescents with Down syndrome (DS). This study explored whether and how personal/environmental factors are associated with the independence level in household chores of children/adolescents with DS in Brazil. Caregivers of twenty-eight children/adolescents with DS were interviewed using the CHORES and a standardized questionnaire about personal (child's age and sex) and environmental (socioeconomic level and maternal schooling) factors. Multiple linear regression analysis identified if/how these factors are associated with level of independence. For CHORES self-care and CHORES total, sex was a significant variable explaining 21.8% and 15.8%, respectively, of the variation in the outcomes. For the outcome CHORES family care none of the variables was significant. Female sex was associated with a lower need for assistance. We conclude that only the personal factor assessed related to female sex in children with DS was associated with the independence level in household chores. This finding highlights the importance of health care providers and families to encourage the independence in chores regardless of sex and promote opportunities for both boys and girls.
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Affiliation(s)
- Beatriz Helena Brugnaro
- Universidade Federal de São Carlos/UFSCar, Departamento de Fisioterapia, Laboratório de Análise do Desenvolvimento Infantil (LADI), Rodovia Washington Luís, s/n, Monjolinho, 13565-905 São Carlos, SP, Brazil
| | - Camila R G Lima
- Universidade Federal de São Carlos/UFSCar, Departamento de Fisioterapia, Laboratório de Análise do Desenvolvimento Infantil (LADI), Rodovia Washington Luís, s/n, Monjolinho, 13565-905 São Carlos, SP, Brazil
| | - Isabelle G R DA Costa
- Universidade Federal de São Carlos/UFSCar, Departamento de Fisioterapia, Laboratório de Análise do Desenvolvimento Infantil (LADI), Rodovia Washington Luís, s/n, Monjolinho, 13565-905 São Carlos, SP, Brazil
| | - Gesica Fernandes
- Universidade Federal de São Carlos/UFSCar, Departamento de Fisioterapia, Laboratório de Análise do Desenvolvimento Infantil (LADI), Rodovia Washington Luís, s/n, Monjolinho, 13565-905 São Carlos, SP, Brazil
| | - Ana Carolina DE Campos
- Universidade Federal de São Carlos/UFSCar, Departamento de Fisioterapia, Laboratório de Análise do Desenvolvimento Infantil (LADI), Rodovia Washington Luís, s/n, Monjolinho, 13565-905 São Carlos, SP, Brazil
| | - Peter Rosenbaum
- McMaster University, CanChild, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Silvia Letícia Pavão
- Universidade Federal do Paraná, Departamento de Prevenção e Reabilitação em Fisioterapia, Rua XV de Novembro, 1299, Centro, 80060-000 Curitiba, PR, Brazil
| | - Nelci Adriana C F Rocha
- Universidade Federal de São Carlos/UFSCar, Departamento de Fisioterapia, Laboratório de Análise do Desenvolvimento Infantil (LADI), Rodovia Washington Luís, s/n, Monjolinho, 13565-905 São Carlos, SP, Brazil
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Jain A, Boyd NK, Paulsen KC, Vogel BN, Nguyen L, Santoro JD. Ophthalmologic and neuro-ophthalmologic findings in children with Down syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2023; 193:e32068. [PMID: 37794641 DOI: 10.1002/ajmg.c.32068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
Down syndrome, also known as Trisomy 21, is a genetic disorder associated with mild-to-moderate intellectual disability, delays in growth, and characteristic facial features. A wide range of ocular complications are seen in children with Down syndrome, including strabismus, nystagmus, refractive errors, congenital cataracts, the presence of keratoconus, and decreased visual acuity. Early ophthalmic examination is needed for early diagnosis and treatment in patients. This narrative review examines ocular manifestations in children with Down syndrome and the importance of prompt ophthalmic interventions for treatment.
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Affiliation(s)
| | - Natalie K Boyd
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Kelli C Paulsen
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Benjamin N Vogel
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Lina Nguyen
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Jonathan D Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA
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Schworer EK, Soltani A, Altaye M, Fidler DJ, Esbensen AJ. Cognitive flexibility assessment in youth with Down syndrome: Reliability, practice effects, and validity. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 133:104416. [PMID: 36603310 PMCID: PMC9852016 DOI: 10.1016/j.ridd.2022.104416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/14/2022] [Accepted: 12/30/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Cognitive flexibility refers to the ability to switch between different mental sets, tasks, or strategies and is challenging for some individuals with Down syndrome (DS). The lack of reliable and valid cognitive flexibility measures for individuals with DS is a major barrier to clinical trials and intervention studies designed to address cognitive challenges specific to DS. To avoid measurement limitations that could confound interpretations of performance in clinical trials in children with DS, it is critical to use phenotype-sensitive and psychometrically sound measures of cognitive flexibility. AIM This study aimed to evaluate the psychometric properties of three measures of cognitive flexibility including Rule-Shift, Weigl Sorting, and KiTAP Flexibility in a sample of 97 youth with DS aged 6-17 years old. METHOD Data were collected at two time points with a two-week interval. Parents also completed adaptive behavior and cognitive flexibility questionnaires. Child cognitive and language abilities were also assessed. RESULTS The Weigl Sorting met the most psychometric criteria, with adequate feasibility (≥ 80 %) and significant correlations with most of the broader developmental domains; however, the levels of test-retest reliability, practice effects, and convergent validity did not meet a priori criteria. Rule-Shift and KiTAP Flexibility measures did not have acceptable feasibility; although sensitivity and specificity analyses revealed that Rule-Shift may be appropriate for a subgroup of the participants. CONCLUSION No evaluated measures met all psychometric study criteria and, therefore, additional evaluation of cognitive flexibility measures is needed for use among individuals with DS.
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Affiliation(s)
- Emily K Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; University of Wisconsin-Madison, Waisman Center, Madison, WI, USA.
| | - Amanallah Soltani
- Department of Educational Psychology, Kerman Branch, Islamic Azad University, Kerman, Iran
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Deborah J Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, 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
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Soltani A, Schworer EK, Jacobson LA, Channell MM, Lee NR, Faught GG, Grzadzinski R, Fidler D, Esbensen AJ. Confirmatory factor analysis of the BRIEF2 in a sample of youth with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:148-158. [PMID: 36573033 PMCID: PMC9839560 DOI: 10.1111/jir.13000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/02/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The factor structure of the Behavior Rating Inventory of Executive Function, second edition (BRIEF2) has been widely examined in both typically developing children and specific clinical samples. Despite the frequent use of the BRIEF2 for measuring executive functioning in individuals with Down syndrome, no study has investigated the factorial validity or dimensionality of the BRIEF2 in this population. This study aimed to address this notable gap in the literature. METHODS Parents of 407 children and youth with Down syndrome aged 6-18 years completed the BRIEF2 as part of different studies led by six sites. Three competing models proposed by previous studies were analysed using Confirmatory Factor Analysis: the theoretical structure of the BRIEF2 where the scales were constrained to load on three factors labelled as Cognitive, Behavioral, and Emotional Regulation, a two-factor correlated model with the merged Behavioral and Emotional regulation, and a single-factor model. RESULTS The three-factor model provided a better fit than the one- and two-factor models, yet a large correlation was observed between Behavioural and Emotional regulation factors. The results provide meaningful explanatory value for the theoretical structure of the BRIEF2. However, the Behavioral and Emotional regulation factors might be less differentiated and the two-factor structure of the BRIEF2 may also make theoretical and empirical sense. CONCLUSIONS Although more studies are needed to further examine the factor structure of the BRIEF2 in youth with Down syndrome, this investigation provides preliminary support for the interpretation of the three executive function index scores provided by the BRIEF2: Cognitive, Behavioral, and Emotional Regulation.
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Affiliation(s)
- A. Soltani
- Department of Educational Psychology, Kerman BranchIslamic Azad UniversityKermanIran
| | - E. K. Schworer
- Division of Developmental and Behavioral PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOHUSA
- Waisman CenterUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - L. A. Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute; Department of Psychiatry and Behavioral SciencesJohn Hopkins UniversityBaltimoreMDUSA
| | - M. M. Channell
- Department of Speech and Hearing ScienceUniversity of Illinois at Urbana‐ChampaignChampaign, ILUSA
| | - N. R. Lee
- Department of Psychological and Brain SciencesDrexel UniversityPhiladelphiaPAUSA
| | - G. G. Faught
- Department of PsychologyThe University of AlabamaTuscaloosaALUSA
| | - R. Grzadzinski
- Carolina Institute for Developmental DisabilitiesUniversity of North CarolinaCarrboroNCUSA
| | - D. Fidler
- Department of Human Development and Family StudiesColorado State UniversityFort CollinsCOUSA
| | - A. J. Esbensen
- Division of Developmental and Behavioral PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOHUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA
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Soltani A, Schworer EK, Esbensen AJ. The Mediatory Role of Executive Functioning on the Association Between Sleep and Both Everyday Memory and ADHD Symptoms in Children and Youth With Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 128:82-95. [PMID: 36548372 PMCID: PMC9793936 DOI: 10.1352/1944-7558-128.1.82] [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: 11/05/2021] [Accepted: 04/12/2022] [Indexed: 06/17/2023]
Abstract
People with Down syndrome (DS) commonly experience challenges with sleep, executive functioning, everyday memory, and symptoms of attention deficit hyperactivity disorder (ADHD). A path analysis was conducted to determine if executive function mediated the relationship between sleep problems and both everyday memory and ADHD symptoms. Parents of 96 children and youth with DS completed questionnaires related to sleep, executive functioning, everyday memory, and ADHD symptoms. Results showed that executive functioning fully mediated the relation between sleep and both everyday memory and ADHD symptoms. Implications for education and intervention for children and youth with DS are discussed.
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Affiliation(s)
- Amanallah Soltani
- Department of Educational Psychology, Kerman Branch, Islamic Azad University, Kerman, Iran
| | - 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
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Soltani A, Schworer EK, Esbensen AJ. Executive functioning and verbal fluency performance in youth with Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 131:104358. [PMID: 36209524 PMCID: PMC9701181 DOI: 10.1016/j.ridd.2022.104358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/02/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Executive functioning (EF) is an area of challenge for individuals with Down syndrome (DS) associated with a variety of downstream difficulties. Verbal fluency performance is one potential downstream effect that is commonly assessed in individuals with DS due to the measure's utility as a predictor of dementia. Verbal fluency requires individuals to inhibit irrelevant responses, shift between groupings of related words, and monitor to prevent repetition, all skills related to EF. AIMS This study aimed to determine the association between semantic verbal fluency performance and three EF subdomains (inhibition, shifting, and working memory) in youth with DS after taking into account vocabulary and cognitive ability. METHODS AND PROCEDURES Neuropsychological assessments (verbal and visuospatial), and parent reports of EF, were completed at one time point by 69 youth with DS 6-17 years old and their caregivers. Expressive and receptive vocabulary skills and cognitive ability were also assessed. OUTCOMES AND RESULTS The results revealed that verbal fluency performance was significantly associated with neuropsychological assessments of EF and parent report of inhibition even after controlling for the effects of vocabulary and cognitive ability. CONCLUSIONS AND IMPLICATIONS The findings highlight the underlying importance of EF in verbal fluency tasks in youth with DS.
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Affiliation(s)
- Amanallah Soltani
- Department of Educational Psychology, Kerman Branch, Islamic Azad University, Kerman, Iran
| | - Emily K Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Waisman Center, University of Wisconsin-Madison, Madison, WI, 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.
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Boonstra FN, Bosch DGM, Geldof CJA, Stellingwerf C, Porro G. The Multidisciplinary Guidelines for Diagnosis and Referral in Cerebral Visual Impairment. Front Hum Neurosci 2022; 16:727565. [PMID: 35845239 PMCID: PMC9280621 DOI: 10.3389/fnhum.2022.727565] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Cerebral visual impairment (CVI) is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according to the grade method. Patients and Methods We developed the guidelines according to the GRADE method 5 searches on CVI (children, developmental age ≤ 18 years) were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic. Results Based on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23 (out of 1,007). 2. Ophthalmological and orthoptic assessment 37 (out of 816). 3. Neuropsychological assessment 5 (out of 716). 4. Neuroradiological evaluation and magnetic resonance imaging (MRI) 9 (out of 723). 5. Genetic assessment 5 (out of 458). Conclusion In medical history taking, prematurity low birth weight and APGAR (Appearance, Pulse, Grimace, Activity, Respiration) Scores (<5) are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups (extremely preterm). In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments (neurological or genetic) can be necessary to complete the diagnosis of CVI and/or to reveal the etiology.
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Affiliation(s)
- Frouke N. Boonstra
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
- *Correspondence: Frouke N. Boonstra,
| | | | - Christiaan J. A. Geldof
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
| | - Catharina Stellingwerf
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
| | - Giorgio Porro
- Department of Ophthalmology, UMC Utrecht and Amphia Hospital Breda, Breda, Netherlands
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Windsperger K, Hoehl S. Development of Down Syndrome Research Over the Last Decades-What Healthcare and Education Professionals Need to Know. Front Psychiatry 2021; 12:749046. [PMID: 34970162 PMCID: PMC8712441 DOI: 10.3389/fpsyt.2021.749046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Down syndrome (DS) is the most prevalent neurodevelopmental disorder, with a known genetic cause. Besides facial dysmorphologies and congenital and/or acquired medical conditions, the syndrome is characterized by intellectual disability, accelerated aging, and an increased likelihood of an early onset Alzheimer's disease in adulthood. These common patterns of DS are derived from the long-held standard in the field of DS research, that describes individuals with DS as a homogeneous group and compares phenotypic outcomes with either neurotypical controls or other neurodevelopmental disorders. This traditional view has changed, as modern research pinpoints a broad variability in both the occurrence and severity of symptoms across DS, arguing for DS heterogeneity and against a single "DS profile." Nevertheless, prenatal counseling does not often prioritize the awareness of potential within-group variations of DS, portraying only a vague picture of the developmental outcomes of children with DS to expectant parents. This mini-review provides a concise update on existent information about the heterogeneity of DS from a full-spectrum developmental perspective, within an interdisciplinary context. Knowledge on DS heterogeneity will not only enable professionals to enhance the quality of prenatal counseling, but also help parents to set targeted early interventions, to further optimize daily functions and the quality of life of their children.
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Affiliation(s)
- Karin Windsperger
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Stefanie Hoehl
- Research Unit Developmental Psychology, Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
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One-year effects of bifocal and unifocal glasses on executive functions in children with Down syndrome in a randomized controlled trial. Sci Rep 2021; 11:16893. [PMID: 34413362 PMCID: PMC8377071 DOI: 10.1038/s41598-021-96308-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/04/2021] [Indexed: 11/08/2022] Open
Abstract
Appropriate glasses can improve visual functioning of children with Down syndrome (DS), but it is unknown if such interventions influence their cognitive impairments. In a randomized controlled trial with 1-year follow-up. Children with DS (2-16 years) were provided either bifocal glasses (add +2.5 Dioptres; n = 50) or unifocal glasses (n = 52). Executive functions were assessed pre- and post-intervention with the task-based Minnesota Executive Function Scale (MEFS) and with questionnaires, BRIEF-P and BRIEF, parents' and teachers' version. Intervention effects and associations between executive functions, (near) vision and ocular alignment were analysed. Intervention improved MEFS-Total-scores in the bifocal group (p = 0.002; Cohen's d = 0.60) but not in the unifocal group (p = 0.191; Cohen's d = 0.24). Post-intervention, there was no intergroup difference (p = 0.120; Cohen's d = 0.34). Post-intervention, higher MEFS-scores were associated with better visual acuities (crowded near p = 0.025; uncrowded near p = 0.019; distant p = 0.045). Pre-post changes in MEFS-scores correlated significantly with improved ocular alignment (p = 0.040). Exploratory analysis of the questionnaires showed improved teacher-rated BRIEF-scores in both groups (bifocals: p = 0.014, Cohen's d = 1.91; unifocals: p = 0.022, Cohen's d = 1.46), with no intergroup difference (p = 0.594; Cohen's d = 0.23). These results demonstrate positive effects of wearing better-correcting glasses on executive functioning in children with DS, suggesting a link between their visual and executive functioning. However, the relative contributions of distant and near vision need further study.
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