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Stech K, Habibi B. Pain Related Quality of Life in Neurofibromatosis Type 1: A Narrative Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01283-x. [PMID: 38935244 DOI: 10.1007/s11916-024-01283-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW The purpose of this narrative review is to summarize pain symptomatology and mechanisms in neurofibromatosis type 1 (NF1), discuss the pain related quality of life impacts of NF1, and discuss the literature exploring interventions to improve quality of life. RECENT FINDINGS Chronic pain in NF1 is described as headache and non-headache pain. The literature describes mechanisms contributing to neuronal hyperexcitability in the setting of reduced neurofibromin as key contributors to pain in NF1. Pain in NF1 negatively impacts quality of life with pain interference, depression, anxiety, and cognitive functioning acting as important mediators. Mitogen-activated protein kinase (MEK) inhibitors are pharmacologic agents that interfere with pain mechanisms. Mind-body interventions improve coping skills to improve quality of life. Chronic pain in NF1 is heterogeneous with negative impacts on quality of life. New developments in pharmacological and non-pharmacological interventions offer promising approaches to pain management and quality of life improvement. Additional research is necessary to validate the use of MEK inhibitors and mind-body interventions in the treatment of NF1.
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Affiliation(s)
- Karina Stech
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
| | - Behnum Habibi
- Department of Physical Medicine & Rehabilitation, Temple University Hospital, Philadelphia, PA, USA
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2
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Weiss EM, Guhathakurta D, Petrušková A, Hundrup V, Zenker M, Fejtová A. Developmental effect of RASopathy mutations on neuronal network activity on a chip. Front Cell Neurosci 2024; 18:1388409. [PMID: 38910965 PMCID: PMC11190344 DOI: 10.3389/fncel.2024.1388409] [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: 02/19/2024] [Accepted: 05/14/2024] [Indexed: 06/25/2024] Open
Abstract
RASopathies are a group of genetic disorders caused by mutations in genes encoding components and regulators of the RAS/MAPK signaling pathway, resulting in overactivation of signaling. RASopathy patients exhibit distinctive facial features, cardiopathies, growth and skeletal abnormalities, and varying degrees of neurocognitive impairments including neurodevelopmental delay, intellectual disabilities, or attention deficits. At present, it is unclear how RASopathy mutations cause neurocognitive impairment and what their neuron-specific cellular and network phenotypes are. Here, we investigated the effect of RASopathy mutations on the establishment and functional maturation of neuronal networks. We isolated cortical neurons from RASopathy mouse models, cultured them on multielectrode arrays and performed longitudinal recordings of spontaneous activity in developing networks as well as recordings of evoked responses in mature neurons. To facilitate the analysis of large and complex data sets resulting from long-term multielectrode recordings, we developed MATLAB-based tools for data processing, analysis, and statistical evaluation. Longitudinal analysis of spontaneous network activity revealed a convergent developmental phenotype in neurons carrying the gain-of-function Noonan syndrome-related mutations Ptpn11 D61Y and Kras V14l. The phenotype was more pronounced at the earlier time points and faded out over time, suggesting the emergence of compensatory mechanisms during network maturation. Nevertheless, persistent differences in excitatory/inhibitory balance and network excitability were observed in mature networks. This study improves the understanding of the complex relationship between genetic mutations and clinical manifestations in RASopathies by adding insights into functional network processes as an additional piece of the puzzle.
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Affiliation(s)
- Eva-Maria Weiss
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Debarpan Guhathakurta
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Aneta Petrušková
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Third Faculty of Medicine, Charles University, Prague, Czechia
- National Institute of Mental Health, Prague, Czechia
| | - Verena Hundrup
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Martin Zenker
- Medical Faculty, Institute of Human Genetics, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
| | - Anna Fejtová
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Hocking DR, Sun X, Haebich K, Darke H, North KN, Vivanti G, Payne JM. Delineating Visual Habituation Profiles in Preschoolers with Neurofibromatosis Type 1 and Autism Spectrum Disorder: A Cross-Syndrome Study. J Autism Dev Disord 2024; 54:1998-2011. [PMID: 36877426 DOI: 10.1007/s10803-023-05913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 03/07/2023]
Abstract
Atypical habituation to repetitive information has been commonly reported in Autism Spectrum Disorder (ASD) but it is not yet clear whether similar abnormalities are present in Neurofibromatosis Type 1 (NF1). We employed a cross-syndrome design using a novel eye tracking paradigm to measure habituation in preschoolers with NF1, children with idiopathic ASD and typically developing (TD) children. Eye movements were recorded to examine fixation duration to simultaneously presented repeating and novel stimuli. Children with NF1 showed a bias for longer look durations to repeating stimuli at the expense of novel stimuli, and slower habituation in NF1 was associated with elevated ASD traits. These findings could indicate aberrant modulation of bottom-up attentional networks that interact with the emergence of ASD phenotypes.
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Affiliation(s)
- Darren R Hocking
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Xiaoyun Sun
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kristina Haebich
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Hayley Darke
- Murdoch Children's Research Institute, Parkville, Australia
| | - Kathryn N North
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Giacomo Vivanti
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, 19104-3734, Philadelphia, PA, USA
| | - Jonathan M Payne
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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Remaud J, Besnard J, Barbarot S, Roy A. Social cognition in children with neurofibromatosis type 1. J Clin Exp Neuropsychol 2024:1-8. [PMID: 38678397 DOI: 10.1080/13803395.2024.2348214] [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: 09/10/2023] [Accepted: 04/21/2024] [Indexed: 04/30/2024]
Abstract
INTRODUCTION Neurofibromatosis type 1 (NF1) is a genetic pathology that can lead to impaired social functioning that has a negative impact on patients' quality of life. To date, although the hypothesis of impaired social cognition has been proposed as a potential explanation for these difficulties, very few studies have focused on theory of mind in children with NF1. Furthermore, other complex sociocognitive abilities have never been investigated. The aim of the present study was to assess theory of mind, moral reasoning, and social information processing in children with NF1 compared with a control group. METHOD We administered the Paediatric Evaluation of Emotions, Relationships and Socialization® to 38 children with NF1 aged between 8 years and 16 years 11 months (mean = 11.4, SD = 2.3) and 43 control children with comparable sociodemographic characteristics. RESULTS Patients performed significantly worse than controls on moral reasoning and social information processing tests, but there was no significant difference on theory of mind. CONCLUSIONS These results seem to confirm the presence of social cognition difficulties in NF1 that could explain, at least in part, their social difficulties, although not all dimensions are concerned. The differences between the processes we assessed are discussed in relation to the methodologies used to measure them, and raises questions about the complementarity of traditional tools and more ecological assessments.
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Affiliation(s)
- Julie Remaud
- Pays de la Loire Psychology Laboratory (LPPL), SFR Confluences, Universities of Angers & Nantes, Angers, France
| | - Jérémy Besnard
- Pays de la Loire Psychology Laboratory (LPPL), SFR Confluences, Universities of Angers & Nantes, Angers, France
| | - Sébastien Barbarot
- Nantes Neurofibromatosis Expert Center, Nantes University Hospital, Nantes, France
| | - Arnaud Roy
- Pays de la Loire Psychology Laboratory (LPPL), SFR Confluences, Universities of Angers & Nantes, Angers, France
- Nantes Neurofibromatosis Expert Center, Nantes University Hospital, Nantes, France
- Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France
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Vernet M, Ducrot S, Chaix Y. A Systematic Review on Visual-Processing Deficits in Neurofibromatosis Type 1: What Possible Impact on Learning to Read? Dev Neuropsychol 2024; 49:111-137. [PMID: 38469855 DOI: 10.1080/87565641.2024.2326151] [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: 09/22/2023] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
This systematic review aimed to examine the possible implication of visual-perceptual, visuo-attentional and oculomotor processing in the reading deficits frequently experienced by children with Neurofibromatosis type 1 (NF1), as previously shown in dyslexia. Using PRISMA methodological guidelines, we examined 49 studies; most of these reported visual-processing deficits in this population, raising the importance of directly studying the visuo-perceptual and visuo-attentional processes and eye-movement control involved in the learning-to-read process in NF1. The discussion provides a reflection for a better understanding of how visual-processing skills interact with reading deficits in NF1, as well as new avenues for their screening and care.
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Affiliation(s)
- Marie Vernet
- Aix Marseille Univ, CNRS, LPL, Aix-en-Provence, France
- Centre de jour enfants, Centre hospitalier de Digne-les-Bains, Digne-les-Bains, France
- TONIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | | | - Yves Chaix
- TONIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
- Neuropediatric Department, Toulouse-Purpan University Hospital, Toulouse, France
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Maier A, Pride NA, Hearps SJC, Shah N, Porter M, North KN, Payne JM. Neuropsychological factors associated with performance on the rey-osterrieth complex figure test in children with neurofibromatosis type 1. Child Neuropsychol 2024; 30:348-359. [PMID: 37038321 DOI: 10.1080/09297049.2023.2199975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
Children with neurofibromatosis type 1 (NF1) are at considerable risk for cognitive difficulties, including visuospatial deficits and executive dysfunction. This study aimed to (1) assess the overall performance of children with NF1 on the Rey-Osterrieth Complex Figure Test (RCFT) compared to unaffected siblings and (2) examine neuropsychological predictors of RCFT performance in children with NF1. A retrospective clinical audit was performed on neuropsychological records from a multidisciplinary NF1 Clinic in Australia. We searched for children that had completed an assessment between 2000 and 2015 which included the RCFT and other neuropsychological outcomes in this study. These included the Wechsler Intelligence Scale for Children, Judgment of Line Orientation (JLO), Tower of London test, Conners ADHD Scales, and the Behavioral Rating Inventory of Executive Function (BRIEF). The study population consisted of 191 children with NF1 aged 6-16 years, and 55 unaffected siblings recruited from a separate study. Results revealed that 62% of children with NF1 performed at or below the first percentile on the RCFT copy, which was significantly worse than their unaffected siblings. Visuospatial skills, parent-rated executive abilities, ADHD symptoms, and intellectual skills all predicted poorer performance on the RCFT copy, however the best fitting multiple regression model only contained the JLO, BRIEF Metacognition Index, and chronological age. The JLO emerged as the strongest predictor of RCFT performance. This study provides evidence that visuospatial deficits are a key driver of reduced RCFT performance in NF1 and that executive skills as well as a younger age are also independent predictors of RCFT performance.
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Affiliation(s)
- Alice Maier
- The Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Australia
| | - Natalie A Pride
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Stephen J C Hearps
- The Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Nijashree Shah
- School of Psychology, Macquarie University, Sydney, Australia
| | - Melanie Porter
- School of Psychology, Macquarie University, Sydney, Australia
| | - Kathryn N North
- The Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Jonathan M Payne
- The Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Pardej SK, Casnar CL, Yund BD, Klein-Tasman BP. An evaluation of computerized attention and executive function measures for use with school age children with neurofibromatosis type 1. Child Neuropsychol 2024:1-16. [PMID: 38214530 DOI: 10.1080/09297049.2024.2302634] [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: 10/07/2021] [Accepted: 12/21/2023] [Indexed: 01/13/2024]
Abstract
The present study investigated the performance of children with neurofibromatosis type 1 on computerized assessments of attention and executive function. Relations to ADHD symptomatology were also examined. Participants included 37 children (20 male) with NF1 (9-13 years; Mage = 11.02). Participants completed the NIH Toolbox Dimensional Change Card Sort, List Sort Working Memory (LSWM), and Flanker tasks, as well as Cogstate Identification and One Back tests. ADHD symptomatology was assessed using the K-SADS. Average performance was significantly different from the normative mean on every measure, except LSWM. The NIH Toolbox Flanker and Cogstate Identification tasks detected the highest proportion of participants with at least mild difficulty, and the Cogstate Identification task detected the highest proportion of participants with severe difficulty. Analyses revealed significant relations with ADHD symptomatology for two NIH toolbox tasks. The various computerized measures of attention and executive function offer different information when working with school age children with NF1. The NIH Flanker may offer the most room for change and offers face validity, which may be beneficial for clinical trials research. However, the LSWM shows most support for relations with behavioral indicators of attention and executive challenges.
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Affiliation(s)
- Sara K Pardej
- Department of Psychology, University of Wisconsin - Milwaukee, Milwaukee, WI, USA
| | | | - Brianna D Yund
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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van Aken B, Rietveld R, Wierdsma A, Voskes Y, Pijnenborg G, van Weeghel J, Mulder C. Self-report versus performance based executive functioning in people with psychotic disorders. Schizophr Res Cogn 2023; 34:100293. [PMID: 37886698 PMCID: PMC10598699 DOI: 10.1016/j.scog.2023.100293] [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: 07/10/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023]
Abstract
Background Although executive functioning is often measured using performance-based measures, these measures have their limits, and self-report measures may provide added value. Especially since these two types of measures often do not correlate with one another. It thus has been proposed they might measure different aspects of the same construct. To explore the differences between a performance-based measure of executive functioning and a self-report measure, we examined their associations in patients with a psychotic disorder with the following: other neurocognitive measures; psychotic symptoms; anxiety and depression symptoms, and daily-life outcome measures. Method This cross-sectional study consisted of baseline measures collected as part of a cohort study of people with a psychotic disorder (the UP'S study; n = 301). The Behavioral Rating Inventory of Executive Functioning Adult version (BRIEF-A) was used to assess self-rated executive functioning, and the Tower of London (TOL) to assess performance-based executive functioning. Generalized linear models (GLM) were used with the appropriate distribution and link function to study the associations between TOL and BRIEF-A, and the other variables, including the Brief Assessment of Cognition in Schizophrenia (BACS), the Positive and Negative Symptoms Scale-Remission (PANSS-R), the General Anxiety Disorder - 7 (GAD-7), the Patient Health Questionnaire - 9 (PHQ-9) and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Model selection was based on the Wald test. Results The TOL was associated with other neurocognitive measures, such as verbal list learning (β = 0.24), digit sequencing (β = 0.35); token motor task (β = 0.20); verbal fluency (β = 0.24); symbol coding (β = 0.43); and a screener for intelligence (β = 2.02). It was not associated with PANNS-R or WHO-DAS scores. In contrast, the BRIEF-A was associated not with other neurocognitive measures, but with the PANSS-R (β = 0.32); PHQ-9 (β = 0.52); and GAD-7 (β = 0.55); and with all the WHODAS domains: cognition domain (β = 0.54), mobility domain (β = 0.30) and selfcare domain (β = 0.22). Conclusion Performance-based and self-report measures of executive functioning measure different aspects of executive functioning. Both have different associations with neurocognition, symptomatology and daily functioning measures. The difference between the two instruments is probably due to differences in the underlying construct assessed.
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Affiliation(s)
- B.C. van Aken
- Department of Psychiatry, Erasmus MC, Epidemiological and Social Psychiatric Research Institute, Rotterdam, the Netherlands
- Fivoor Forensic Psychiatric Institute, Rotterdam, the Netherlands
| | - R. Rietveld
- Department of Psychiatry, Erasmus MC, Epidemiological and Social Psychiatric Research Institute, Rotterdam, the Netherlands
| | - A.I. Wierdsma
- Department of Psychiatry, Erasmus MC, Epidemiological and Social Psychiatric Research Institute, Rotterdam, the Netherlands
| | - Y. Voskes
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, the Netherlands
- GGz Breburg, Tilburg, the Netherlands
| | - G.H.M. Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Assen, the Netherlands
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - J. van Weeghel
- Phrenos Centre of Expertise, Utrecht, the Netherlands
- Tranzo Department, Tilburg School of Behavioural and Social Sciences, Tilburg University, Tilburg, the Netherlands
| | - C.L. Mulder
- Department of Psychiatry, Erasmus MC, Epidemiological and Social Psychiatric Research Institute, Rotterdam, the Netherlands
- Parnassia Psychiatric Institute, Rotterdam, the Netherlands
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Harriott EM, Nguyen TQ, Landman BA, Barquero LA, Cutting LE. Using a semi-automated approach to quantify Unidentified Bright Objects in Neurofibromatosis type 1 and linkages to cognitive and academic outcomes. Magn Reson Imaging 2023; 98:17-25. [PMID: 36608909 PMCID: PMC9908856 DOI: 10.1016/j.mri.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous syndrome that affects multiple organ systems resulting in widespread symptoms, including cognitive deficits. In addition to the criteria required for an NF1 diagnosis, approximately 70% of children with NF1 present with Unidentified Bright Objects (UBOs) or Focal Areas of Signal Intensity, which are hyperintense bright spots seen on T2-weighted magnetic resonance images and seen more prominently on FLAIR magnetic resonance images (Sabol et al., 2011). Current findings relating the presence/absence, quantities, sizes, and locations of these bright spots to cognitive abilities are mixed. To contribute to and hopefully disentangle some of these mixed findings, we explored potential relationships between metrics related to UBOs and cognitive abilities in a sample of 28 children and adolescents with NF1 (M=12.52 years; SD=3.18 years; 16 male). We used the Lesion Segmentation Tool (LST) to automatically detect and segment the UBOs. The LST was able to qualitatively and quantitatively reliably detect UBOs in images of children with NF1. Using these automatically detected and segmented lesions, we found that while controlling for age, biological sex, perceptual IQ, study, and scanner, "total UBO volume", defined as the sum of all the voxels representing all of the UBOs for each participant, helped explain differences in word reading, phonological awareness, and visuospatial skills. These findings contribute to the emerging NF1 literature and help parse the specific deficits that children with NF1 have, to then help improve the efficacy of reading interventions for children with NF1.
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Affiliation(s)
- Emily M Harriott
- Vanderbilt Brain Institute, 465 21(st) Avenue South, Nashville, TN 37212, USA.
| | - Tin Q Nguyen
- Vanderbilt Brain Institute, 465 21(st) Avenue South, Nashville, TN 37212, USA.
| | - Bennett A Landman
- Department of Electrical Engineering and Computer Science, Vanderbilt University, 2301Vanderbilt Place, Nashville, TN 37235, USA; Vanderbilt Kennedy Center, 110 Magnolia Circle, Nashville, TN 37203, USA.
| | - Laura A Barquero
- Department of Special Education, Peabody College of Education and Human Development, Vanderbilt University, 110 Magnolia Circle, Nashville, TN 37203, USA.
| | - Laurie E Cutting
- Vanderbilt Brain Institute, 465 21(st) Avenue South, Nashville, TN 37212, USA; Department of Special Education, Peabody College of Education and Human Development, Vanderbilt University, 110 Magnolia Circle, Nashville, TN 37203, USA; Vanderbilt Kennedy Center, 110 Magnolia Circle, Nashville, TN 37203, USA.
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Speth US, König D, Burg S, Gosau M, Friedrich RE. Evaluation of the sense of taste and smell in patients with Neurofibromatosis Type 1. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101271. [PMID: 36038126 DOI: 10.1016/j.jormas.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to determine if patients with Neurofibromatosis Type 1 (NF1) have an impaired sense of smell or taste. Neurofibromin, the NF1gene protein product is ubiquitous in the body and is especially associated with the development of neurogenetic structures. Lately enlarged olfactory bulbs have been described in patients with NF1. Until now, there is no study to evaluate the sense of smell and taste in patients with NF1. METHOD This study has been approved by the Hamburg Ethics committee. An evaluation of the sense of smell and taste was undertaken in 26 patients with NF1 using the Burghart Sniffin' Sticks. Three patients were excluded due to a prior infection with the Corona virus. As a control group the same examination was performed in healthy individuals (same sex/ same age as the NF1 patients) by the same examiner. RESULTS The results show a normal sense of smell in patients with NF1. The morphologic finding of enlarged olfactory bulbs seem to have no functional equivalent. However, 8 out of 23 patients with NF1 had difficulties identifying at least one taste flavor. In total 9.8% of possible taste qualities were misidentified. In the healthy control group, all taste qualities were identified correctly. Considering each taste quality as separate case, a significant difference in the taste function was identified based on Fisher's exact test (p=0.003). CONCLUSION The current study does not show a correlation between NF1 and an impaired sense of smell. Yet significant reduction in the sense of taste was found in the patients with NF1. Further research will have to be conducted to find the underlying causal pathways. CLINICAL RELEVANCE NF1 is recently being acknowledged not only for its' macroscopic aesthetic and functional impairments, but also as a neurodevelopmental disorder. Evaluating the neural structures in regard to their function is a first step in understanding more about the disease.
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Affiliation(s)
- Ulrike Simone Speth
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
| | - Daniela König
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Simon Burg
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Reinhard Edgar Friedrich
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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Del Castillo A, Dekarchuk M, Inker T, Hussey M, Walsh KS. Understanding the Neurofibromatosis Type 1 (NF1) experience and the priorities of individuals with NF1 and their caregivers for cognitive and social-emotional research. J Psychiatr Res 2022; 154:268-277. [PMID: 35964345 DOI: 10.1016/j.jpsychires.2022.07.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 06/28/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patient engagement is increasingly recognized as a valuable, essential aspect of Neurofibromatosis research given the unique experiences and morbidities associated with the diagnosis. Engaging patients and families can enhance the relevance, methodology, and feasibility of clinical trials. METHODS A REDCap survey ascertaining information on NF-related morbidities, priorities, and interests in cognitive and social-emotional research, and willingness to participate in research was dispensed to 4,565 individuals consented to the Children's Tumor Foundation (CTF) Registry with NF1. This included children and adults with NF1 and parents/caregivers of children with NF1. RESULTS 525 individuals fully completed the survey: 295 parents/caregivers (Mage child = 10.12, range = 3-24), 194 adults with NF1 (Mage = 45.73, range = 19-81), and 36 children with NF1 (Mage = 12.61, range = 10-17). Less than 10% of respondents have participated in cognitive research, while 42.4-49.5% indicated having sought opportunities for cognitive research. Most (79.4-82.4%) respondents reported that cognitive research is very/extremely important, with learning/academics and emotional functioning were priorities. Willingness to participate in research aligned with areas of importance. CONCLUSION Analysis highlights that most survey respondents believe cognitive and social-emotional research is very important, but a relatively small number have participated. This finding may highlight poor dissemination of information of research opportunities to the broader NF community and limitations to access based on geography or other factors. Respondents indicate that learning/academic problems and emotional challenges to be research priorities. Continuing to engage patients and families with NF is expected to enhance the value and engagement in cognitive research.
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Affiliation(s)
- Allison Del Castillo
- Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
| | - Marina Dekarchuk
- Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
| | - Tess Inker
- Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
| | - Maureen Hussey
- Children's Tumor Foundation, 132 E. 43rd St, Suite 418, New York, NY, 10017, USA.
| | - Karin S Walsh
- Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, 20010, USA; The George Washington University School of Medicine, 2300 I St NW, Washington, DC, 20052, USA.
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Choi EJ, Westmacott R, Kirkham FJ, Robertson A, Muthusami P, Shroff M, Moharir M, Williams T, Dirks P, MacGregor D, Slim M, Pulcine E, Bhathal I, Kaseka ML, Kassner A, Logan W, deVeber G, Dlamini N. Fronto-Parietal and White Matter Haemodynamics Predict Cognitive Outcome in Children with Moyamoya Independent of Stroke. Transl Stroke Res 2022; 13:757-773. [PMID: 35338434 DOI: 10.1007/s12975-022-01003-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
Moyamoya disease is a major arteriopathy characterised by progressive steno-occlusion of the arteries of the circle of Willis. Studies in adults with moyamoya suggest an association between abnormal fronto-parietal and white matter regional haemodynamics and cognitive impairments, even in the absence of focal infarction. However, these associations have not been investigated in children with moyamoya. We examined the relationship between regional haemodynamics and ratings of intellectual ability and executive function, using hypercapnic challenge blood oxygen level-dependent magnetic resonance imaging of cerebrovascular reactivity in a consecutive cohort of children with confirmed moyamoya. Thirty children were included in the final analysis (mean age: 12.55 ± 3.03 years, 17 females, 15 idiopathic moyamoya and 15 syndromic moyamoya). Frontal haemodynamics were abnormal in all regardless of stroke history and comorbidity, but occipital lobe haemodynamics were also abnormal in children with syndromic moyamoya. Executive function deficits were noted in both idiopathic and syndromic moyamoya, whereas intellectual ability was impaired in syndromic moyamoya, even in the absence of stroke. Analysis of the relative effect of regional abnormal haemodynamics on cognitive outcomes demonstrated that executive dysfunction was predominantly explained by right parietal and white matter haemodynamics independent of stroke and comorbidity, while posterior circulation haemodynamics predicted intellectual ability. These results suggest that parietal and posterior haemodynamics play a compensatory role in overcoming frontal vulnerability and cognitive impairment.
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Affiliation(s)
- Eun Jung Choi
- Neurosciences and Mental Health Program, Stroke Imaging Laboratory for Children, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Westmacott
- Department of Neuropsychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Fenella J Kirkham
- Developmental Neurosciences and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Amanda Robertson
- Neurosciences and Mental Health Program, Stroke Imaging Laboratory for Children, The Hospital for Sick Children, Toronto, ON, Canada
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Prakash Muthusami
- Diagnostic Imaging, The Hospital for Sick Children, ON, Toronto, Canada
- Medical Imaging, University of Toronto, ON, Toronto, Canada
| | - Manohar Shroff
- Diagnostic Imaging, The Hospital for Sick Children, ON, Toronto, Canada
- Medical Imaging, University of Toronto, ON, Toronto, Canada
| | - Mahendranath Moharir
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tricia Williams
- Department of Neuropsychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Dirks
- Department of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daune MacGregor
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mahmoud Slim
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Pulcine
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ishvinder Bhathal
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Matsanga Leyila Kaseka
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea Kassner
- Medical Imaging, University of Toronto, ON, Toronto, Canada
- Department of Translational Medicine, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, ON, Toronto, Canada
| | - William Logan
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gabrielle deVeber
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nomazulu Dlamini
- Neurosciences and Mental Health Program, Stroke Imaging Laboratory for Children, The Hospital for Sick Children, Toronto, ON, Canada.
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada.
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13
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Pardej SK, Lee KM, Glad DM, Klein-Tasman BP. Psychometric Properties of Attention Measures in Young Children with Neurofibromatosis Type 1: Preliminary Findings. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2022; 8:123-136. [PMID: 36032331 PMCID: PMC9397181 DOI: 10.1007/s40817-022-00129-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
Children with neurofibromatosis type 1 (NF1) often demonstrate difficulties with attention and executive functioning that can be evident starting at a young age. There has been little research about which measures of attention are most suitable for use with young children with NF1. This pilot study explored several computerized measures of attention, a digits forward task, and parent report measures of attention to compare their reliability, validity, and the degree to which they capture attention difficulty in this population. Participants with NF1 ages 4 to 6 years were seen for one (n=2) or two (n=18) time points. Statistical analyses for evaluating evidence for test-retest reliability, convergent and discriminant validity, practice effects, and identification of difficulties were conducted. Each measure demonstrated relative strengths and weaknesses, and there may not be a “one size fits all” measure for use with young children with NF1. However, the Behavior Rating Inventory of Executive Function Preschool/Second Edition, Conners Early Childhood Inattention/Hyperactivity Scale, and the Conners Kiddie Continuous Performance Test Second Edition generally had the highest reliability and most evidence of validity. More specific recommendations are provided for the appropriate measure to use in clinical and research batteries.
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Affiliation(s)
- Sara K. Pardej
- Department of Psychology, University of Wisconsin – Milwaukee, 2441 E Hartford Ave, Milwaukee, WI 53211 USA
| | - Kristin M. Lee
- Department of Psychology, University of Wisconsin – Milwaukee, 2441 E Hartford Ave, Milwaukee, WI 53211 USA
| | - Danielle M. Glad
- Department of Psychology, University of Wisconsin – Milwaukee, 2441 E Hartford Ave, Milwaukee, WI 53211 USA
| | - Bonita P. Klein-Tasman
- Department of Psychology, University of Wisconsin – Milwaukee, 2441 E Hartford Ave, Milwaukee, WI 53211 USA
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14
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Cortical inhibition in neurofibromatosis type 1 is modulated by lovastatin, as demonstrated by a randomized, triple-blind, placebo-controlled clinical trial. Sci Rep 2022; 12:13814. [PMID: 35970940 PMCID: PMC9378617 DOI: 10.1038/s41598-022-17873-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/02/2022] [Indexed: 11/24/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is associated with GABAergic dysfunction which has been suggested as the underlying cause of cognitive impairments. Previous intervention trials investigated the statins’ effects using cognitive outcome measures. However, available outcome measures have led to inconclusive results and there is a need to identify other options. Here, we aimed at investigating alternative outcome measures in a feasibility trial targeting cortical inhibition mechanisms known to be altered in NF1. We explored the neurochemical and physiological changes elicited by lovastatin, with magnetic resonance spectroscopy and transcranial magnetic stimulation (TMS). Fifteen NF1 adults participated in this randomized, triple-blind, placebo-controlled crossover trial (Clinicaltrials.gov NCT03826940) composed of one baseline and two reassessment visits after lovastatin/placebo intake (60 mg/day, 3-days). Motor cortex GABA+ and Glx concentrations were measured using HERMES and PRESS sequences, respectively. Cortical inhibition was investigated by paired-pulse, input–output curve, and cortical silent period (CSP) TMS protocols. CSP ratios were significantly increased by lovastatin (relative: p = 0.027; absolute: p = 0.034) but not by placebo. CSP durations showed a negative correlation with the LICI 50 ms amplitude ratio. Lovastatin was able to modulate cortical inhibition in NF1, as assessed by TMS CSP ratios. The link between this modulation of cortical inhibition and clinical improvements should be addressed by future large-scale studies.
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15
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Badaly D, Beers SR, Ceschin R, Lee VK, Sulaiman S, Zahner A, Wallace J, Berdaa-Sahel A, Burns C, Lo CW, Panigrahy A. Cerebellar and Prefrontal Structures Associated With Executive Functioning in Pediatric Patients With Congenital Heart Defects. Front Neurol 2022; 13:827780. [PMID: 35356449 PMCID: PMC8959311 DOI: 10.3389/fneur.2022.827780] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Children, adolescents, and young adults with congenital heart defects (CHD) often display executive dysfunction. We consider the prefrontal and cerebellar brain structures as mechanisms for executive dysfunction among those with CHD. Methods 55 participants with CHD (M age = 13.93) and 95 healthy controls (M age = 13.13) completed magnetic resonance imaging (MRI) of the brain, from which we extracted volumetric data on prefrontal and cerebellar regions. Participants also completed neuropsychological tests of executive functioning; their parents completed ratings of their executive functions. Results Compared to healthy controls, those with CHD had smaller cerebellums and lateral, medial, and orbital prefrontal regions, they performed more poorly on tests of working memory, inhibitory control, and mental flexibility, and their parents rated them as having poorer executive functions across several indices. Across both groups, there were significant correlations for cerebellar and/or prefrontal volumes with cognitive assessments of working memory, mental flexibility, and inhibitory control and with parent-completed ratings of task initiation, working memory, and planning/organization. Greater prefrontal volumes were associated with better working memory, among those with larger cerebellums (with group differences based on the measure and the prefrontal region). Greater prefrontal volumes were related to better emotional regulation only among participants with CHD with smaller cerebellar volumes, and with poorer inhibition and emotional regulation only among healthy controls with larger cerebellar volumes. Conclusion The cerebellum not only contributes to executive functioning among young individuals with CHD but may also modulate the relationships between prefrontal regions and executive functioning differently for pediatric patients with CHD vs. health controls.
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Affiliation(s)
- Daryaneh Badaly
- Learning and Development Center, Child Mind Institute, New York, NY, United States
- *Correspondence: Daryaneh Badaly
| | - Sue R. Beers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Rafael Ceschin
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Vincent K. Lee
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
- Department of Bioengineering, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Shahida Sulaiman
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Alexandria Zahner
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Julia Wallace
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Aurélia Berdaa-Sahel
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Cheryl Burns
- Traumatic Brain Injury Program, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Cecilia W. Lo
- Department of Developmental Biology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ashok Panigrahy
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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16
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Chisholm AK, Haebich KM, Pride NA, Walsh KS, Lami F, Ure A, Maloof T, Brignell A, Rouel M, Granader Y, Maier A, Barton B, Darke H, Dabscheck G, Anderson VA, Williams K, North KN, Payne JM. Delineating the autistic phenotype in children with neurofibromatosis type 1. Mol Autism 2022; 13:3. [PMID: 34983638 PMCID: PMC8729013 DOI: 10.1186/s13229-021-00481-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background Existing research has demonstrated elevated autistic behaviours in children with neurofibromatosis type 1 (NF1), but the autistic phenotype and its relationship to other neurodevelopmental manifestations of NF1 remains unclear. To address this gap, we performed detailed characterisation of autistic behaviours in children with NF1 and investigated their association with other common NF1 child characteristics. Methods Participants were drawn from a larger cross-sectional study examining autism in children with NF1. The population analysed in this study scored above threshold on the Social Responsiveness Scale-Second Edition (T-score ≥ 60; 51% larger cohort) and completed the Autism Diagnostic Interview-Revised (ADI-R) and/or the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2). All participants underwent evaluation of their intellectual function, and behavioural data were collected via parent questionnaires. Results The study cohort comprised 68 children (3–15 years). Sixty-three per cent met the ADOS-2 ‘autism spectrum’ cut-off, and 34% exceeded the more stringent threshold for ‘autistic disorder’ on the ADI-R. Social communication symptoms were common and wide-ranging, while restricted and repetitive behaviours (RRBs) were most commonly characterised by ‘insistence on sameness’ (IS) behaviours such as circumscribed interests and difficulties with minor changes. Autistic behaviours were weakly correlated with hyperactive/impulsive attention deficit hyperactivity disorder (ADHD) symptoms but not with inattentive ADHD or other behavioural characteristics. Language and verbal IQ were weakly related to social communication behaviours but not to RRBs. Limitations Lack of genetic validation of NF1, no clinical diagnosis of autism, and a retrospective assessment of autistic behaviours in early childhood. Conclusions Findings provide strong support for elevated autistic behaviours in children with NF1. While these behaviours were relatively independent of other NF1 comorbidities, the importance of taking broader child characteristics into consideration when interpreting data from autism-specific measures in this population is highlighted. Social communication deficits appear similar to those observed in idiopathic autism and are coupled with a unique RRB profile comprising prominent IS behaviours. This autistic phenotype and its relationship to common NF1 comorbidities such as anxiety and executive dysfunction will be important to examine in future research. Current findings have important implications for the early identification of autism in NF1 and clinical management. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00481-3.
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Affiliation(s)
- Anita K Chisholm
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.,The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Kristina M Haebich
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Natalie A Pride
- Kids Neuroscience Centre, The Children's Hospital at Westmead, 178A Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Karin S Walsh
- Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Michigan Avenue NW, Washington, DC, 20310, USA
| | - Francesca Lami
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Alex Ure
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Developmental Paediatrics, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Tiba Maloof
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.,The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Amanda Brignell
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Melissa Rouel
- Kids Neuroscience Centre, The Children's Hospital at Westmead, 178A Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Yael Granader
- Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Michigan Avenue NW, Washington, DC, 20310, USA
| | - Alice Maier
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Belinda Barton
- Kids Neuroscience Centre, The Children's Hospital at Westmead, 178A Hawkesbury Road, Westmead, NSW, 2145, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, 2050, Australia.,Children's Hospital Education Research Institute, The Children's Hospital at Westmead, 178A Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Hayley Darke
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Gabriel Dabscheck
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.,The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Vicki A Anderson
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.,The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Katrina Williams
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Paediatrics, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Developmental Paediatrics, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Kathryn N North
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jonathan M Payne
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia. .,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia. .,The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.
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17
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Tang H, Wu Q, Li S, Fang Y, Yang Z, Wang B, Wang X, Liu P. Visuospatial but Not Verbal Working Memory Deficits in Adult Patients With Neurofibromatosis Type 1. Front Psychol 2021; 12:751384. [PMID: 34858280 PMCID: PMC8631787 DOI: 10.3389/fpsyg.2021.751384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cognitive dysfunction is one of the main symptoms of neurofibromatosis type 1 (NF1). As an important cognitive function, working memory (WM) has rarely been systematically analyzed in NF1 by isolating the particular domain of WM, and existing data involving WM in adult patients with NF1 are insufficient. This study aimed to investigate the characteristics of different types of WM in NF1 from the perspective of the adult population. Method: We comprehensively analyzed WM in both verbal and visuospatial WM domains by using the N-back task (including the verbal N-back task and the visuospatial N-back task) in 31 adults with NF1 and 34 healthy controls matched for age, gender, education levels, and general cognitive status. The accuracy and reaction times (RTs) in the N-back task were entered into mixed-design ANOVA. Results: Compared with healthy controls, adults with NF1 presented significantly lower mean accuracy and longer RTs in the visuospatial N-back task. However, no significant difference was found between the NF1 group and healthy controls in the verbal N-back task. Conclusions: The present study suggested that adults with NF1 might have deficits in visuospatial WM. We did not find evidence for verbal WM deficits in adult patients with NF1. Our findings supplement and refine the existing data on WM in the context of NF1.
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Affiliation(s)
- Hanlu Tang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiong Wu
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Shiwei Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yehong Fang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhijun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingchao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Pinan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
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18
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Hardy KK, Berger C, Griffin D, Walsh KS, Sharkey CM, Weisman H, Gioia A, Packer RJ, Acosta MT. Computerized Working Memory Training for Children With Neurofibromatosis Type 1 (NF1): A Pilot Study. J Child Neurol 2021; 36:1078-1085. [PMID: 34472416 DOI: 10.1177/08830738211038083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The present study aimed to evaluate the feasibility and efficacy of CogmedRM, a computerized, home-based working memory (WM) training program, in children with NF1. METHOD A pre-post design was used to evaluate changes in performance-based measures of attention and WM, and parent-completed ratings of executive functioning. Children meeting eligibility criteria completed CogmedRM over 9 weeks. Primary outcomes included compliance statistics and change in attention and WM scores. RESULTS Thirty-one children (52% male; M age = 10.97 ± 2.51), aged 8-15, were screened for participation; 27 children (87%) evidenced WM difficulties and participated in CogmedRM training. On average, participants completed 19.7 out of 25 prescribed sessions, with an adherence rate of 69%. Participants demonstrated improvements in short-term memory, attention, and executive functioning (all Ps < .05). CONCLUSION Results suggest that computerized, home-based WM training programs may be both feasible and efficacious for children with NF1 and cognitive deficits.
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Affiliation(s)
- Kristina K Hardy
- Children's National Hospital, Washington, DC, USA.,Department of Pediatrics and Neurology, The George Washington University School of Medicine, Washington, DC, USA
| | - Carly Berger
- Children's National Hospital, Washington, DC, USA
| | | | - Karin S Walsh
- Children's National Hospital, Washington, DC, USA.,Department of Pediatrics and Neurology, The George Washington University School of Medicine, Washington, DC, USA
| | - Christina M Sharkey
- Children's National Hospital, Washington, DC, USA.,Department of Pediatrics and Neurology, The George Washington University School of Medicine, Washington, DC, USA
| | | | | | - Roger J Packer
- Children's National Hospital, Washington, DC, USA.,Department of Pediatrics and Neurology, The George Washington University School of Medicine, Washington, DC, USA
| | - Maria T Acosta
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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19
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Haebich KM, Dao DP, Pride NA, Barton B, Walsh KS, Maier A, Chisholm AK, Darke H, Catroppa C, Malarbi S, Wilkinson JC, Anderson VA, North KN, Payne JM. The mediating role of ADHD symptoms between executive function and social skills in children with neurofibromatosis type 1. Child Neuropsychol 2021; 28:318-336. [PMID: 34587865 DOI: 10.1080/09297049.2021.1976129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Children with neurofibromatosis type 1 (NF1) often experience executive dysfunction, attention deficit/hyperactivity disorder (ADHD) symptoms and poor social skills, however, the nature of the relationships between these domains in children with NF1 is unclear. This study investigated these relationships using primary caregiver ratings of executive functions, ADHD symptoms and social skills in children with NF1. Participants were 136 children with NF1 and 93 typically developing (TD) controls aged 3-15 years recruited from 3 multidisciplinary neurofibromatosis clinics in Melbourne and Sydney, Australia, and Washington DC, USA. Mediation analysis was performed on primary outcome variables: parent ratings of executive functions (Behavior Rating Inventory of Executive Function, Metacognition Index), ADHD symptoms (Conners-3/Conners ADHD Diagnostic and Statistical Manual for Mental Disorders Scales) and social skills (Social Skills Improvement System-Rating Scale), adjusting for potential confounders (full scale IQ, sex, and social risk). Results revealed significantly poorer executive functions, elevated ADHD symptoms and reduced social skills in children with NF1 compared to controls. Poorer executive functions significantly predicted elevated ADHD symptoms and poorer social skills. Elevated ADHD symptoms significantly mediated the relationship between executive functions and social skills problems although did not fully account for social dysfunction. This study provides evidence for the importance of targeting ADHD symptoms as part of future interventions aimed at promoting prosocial behaviors in children with NF1.
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Affiliation(s)
- Kristina M Haebich
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences,University of Melbourne, Melbourne, Australia
| | - Duy P Dao
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - Natalie A Pride
- Kids Ne Uroscience Centre, the Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics & Child Health, University of Sydney, Sydney, Australia
| | - Belinda Barton
- Kids Ne Uroscience Centre, the Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics & Child Health, University of Sydney, Sydney, Australia.,Children's Hospital Education Research Institute, the Children's Hospital at Westmead, Sydney, Australia
| | - Karin S Walsh
- Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, DC, USA.,Departments of Pediatrics and Psychiatry, The George Washington University School of Medicine, Washington, DC, USA
| | - Alice Maier
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - Anita K Chisholm
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences,University of Melbourne, Melbourne, Australia
| | - Hayley Darke
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences,University of Melbourne, Melbourne, Australia
| | - Stephanie Malarbi
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences,University of Melbourne, Melbourne, Australia
| | - Jake C Wilkinson
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,School of Psychology, Cardiff University, Cardiff, UK
| | - Vicki A Anderson
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences,University of Melbourne, Melbourne, Australia
| | - Kathryn N North
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences,University of Melbourne, Melbourne, Australia
| | - Jonathan M Payne
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences,University of Melbourne, Melbourne, Australia
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20
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Blockade of Serotonin 5-HT 6 Receptor Constitutive Activity Alleviates Cognitive Deficits in a Preclinical Model of Neurofibromatosis Type 1. Int J Mol Sci 2021; 22:ijms221810178. [PMID: 34576341 PMCID: PMC8467191 DOI: 10.3390/ijms221810178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 02/04/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is a common inherited disorder caused by mutations of the NF1 gene that encodes the Ras-GTPase activating protein neurofibromin, leading to overactivation of Ras-dependent signaling pathways such as the mTOR pathway. It is often characterized by a broad range of cognitive symptoms that are currently untreated. The serotonin 5-HT6 receptor is a potentially relevant target in view of its ability to associate with neurofibromin and to engage the mTOR pathway to compromise cognition in several cognitive impairment paradigms. Here, we show that constitutively active 5-HT6 receptors contribute to increased mTOR activity in the brain of Nf1+/− mice, a preclinical model recapitulating some behavioral alterations of NF1. Correspondingly, peripheral administration of SB258585, a 5-HT6 receptor inverse agonist, or rapamycin, abolished deficits in long-term social and associative memories in Nf1+/− mice, whereas administration of CPPQ, a neutral antagonist, did not produce cognitive improvement. These results show a key influence of mTOR activation by constitutively active 5-HT6 receptors in NF1 cognitive symptoms. They provide a proof of concept that 5-HT6 receptor inverse agonists already in clinical development as symptomatic treatments to reduce cognitive decline in dementia and psychoses, might be repurposed as therapies alleviating cognitive deficits in NF1 patients.
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21
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Walsh KS, Wolters PL, Widemann BC, Del Castillo A, Sady MD, Inker T, Roderick MC, Martin S, Toledo-Tamula MA, Struemph K, Paltin I, Collier V, Mullin K, Fisher MJ, Packer RJ. Impact of MEK Inhibitor Therapy on Neurocognitive Functioning in NF1. NEUROLOGY-GENETICS 2021; 7:e616. [PMID: 34377779 PMCID: PMC8351286 DOI: 10.1212/nxg.0000000000000616] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/06/2021] [Indexed: 11/21/2022]
Abstract
Background and Objectives Neurofibromatosis type 1 (NF1)-associated cognitive impairments carry significant lifelong morbidity. The lack of targeted biologic treatments remains a significant unmet need. We examine changes in cognition in patients with NF1 in the first 48 weeks of mitogen-activated protein kinase inhibitor (MEKi) treatment. Methods Fifty-nine patients with NF1 aged 5–27 years on an MEKi clinical trial treating plexiform neurofibroma underwent pretreatment and follow-up cognitive assessments over 48 weeks of treatment. Performance tasks (Cogstate) and observer-reported functioning (BRIEF) were the primary outcomes. Group-level (paired t tests) and individual-level analyses (Reliable Change Index, RCI) were used. Results Analysis showed statistically significant improvements on BRIEF compared with baseline (24-week Behavioral Regulation Index: t(58) = 3.03, p = 0.004, d = 0.24; 48-week Metacognition Index: t(39) = 2.70, p = 0.01, d = 0.27). RCI indicated that more patients had clinically significant improvement at 48 weeks than expected by chance (χ2 = 11.95, p = 0.001, odds ratio [OR] = 6.3). Group-level analyses indicated stable performance on Cogstate (p > 0.05). RCI statistics showed high proportions of improved working memory (24-week χ2 = 8.36, p = 0.004, OR = 4.6, and 48-week χ2 = 9.34, p = 0.004, OR = 5.3) but not visual learning/memory. Patients with baseline impairments on BRIEF were more likely to show significant improvement than nonimpaired patients (24 weeks 46% vs 8%; χ2 = 9.54, p = 0.008, OR = 9.22; 48 weeks 63% vs 16%; χ2 = 7.50, p = 0.02, OR = 9.0). Discussion Our data show no evidence of neurotoxicity in 48 weeks of treatment with an MEKi and a potential clinical signal supporting future research of MEKi as a cognitive intervention.
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Affiliation(s)
- Karin S Walsh
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Pamela L Wolters
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Brigitte C Widemann
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Allison Del Castillo
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Maegan D Sady
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Tess Inker
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Marie Claire Roderick
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Staci Martin
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Mary Anne Toledo-Tamula
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Kari Struemph
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Iris Paltin
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Victoria Collier
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Kathy Mullin
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Michael J Fisher
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
| | - Roger J Packer
- Children's National Medical Center (K.S.W., A.C., M.D.S., T.I., R.J.P.), Washington, DC; National Cancer Institute (P.L.W., B.C.W., M.C.R., S.M., K.S.), Bethesda, MD; Clinical Research Directorate (M.A.T.-T.), Frederick National Library for Cancer Research, MD; and Children's Hospital of Philadelphia (I.P., V.C., K.M., M.J.F.), Philadelphia
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22
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Kenborg L, Andersen EW, Duun-Henriksen AK, Jepsen JRM, Doser K, Dalton SO, Bidstrup PE, Krøyer A, Frederiksen LE, Johansen C, Østergaard JR, Hove H, Sørensen SA, Riccardi VM, Mulvihill JJ, Winther JF. Psychiatric disorders in individuals with neurofibromatosis 1 in Denmark: A nationwide register-based cohort study. Am J Med Genet A 2021; 185:3706-3716. [PMID: 34327813 DOI: 10.1002/ajmg.a.62436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/01/2021] [Accepted: 07/10/2021] [Indexed: 12/19/2022]
Abstract
The aim of this study was to assess the risks of psychiatric disorders in a large cohort of 905 individuals with NF1 and 7614 population comparisons matched on sex and year of birth. The cohort was linked to the Danish Psychiatric Central Research Register to ascertain information on hospital contacts for psychiatric disorders based on the International Classification of Diseases version 8 and 10. The hazard ratio (HR) for a first psychiatric hospital contact was higher in girls (4.19, 95% confidence interval [CI] 1.81-9.69) and boys with NF1 (5.02, 95% CI 3.27-7.69) <7 years of age than in the population comparisons. Both sexes had increased HRs for developmental disorders, including attention deficit/hyperactivity disorders, autism spectrum disorders, and intellectual disabilities in childhood. Females with NF1 had also increased HRs for unipolar depression, other emotional and behavioral disorders, and severe stress reaction and adjustment disorders in early adulthood. The HRs for psychoses, schizophrenia, bipolar disorders, and substance abuse were similar in individuals with NF1 and the population comparisons. Finally, the cumulative incidence of a first hospital contact due to any psychiatric disorder by age 30 years was 35% (95% CI 29-41) in females and 28% (95% CI 19-37) in males with NF1. Thus, screening for psychiatric disorders may be important for early diagnosis and facilitation of appropriate and effective treatment in individuals with NF1.
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Affiliation(s)
- Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Elisabeth W Andersen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Jens R M Jepsen
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research and Center for Neuropsychiatric Schizophrenia Research, Mental Health Service Capital Region, University of Copenhagen, Copenhagen, Denmark.,Child and Adolescent Mental Health Centre, Mental Health Services Capital Region, University of Copenhagen, Copenhagen, Denmark
| | - Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne O Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Line E Frederiksen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John R Østergaard
- Department of Pediatrics, Centre for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Hove
- Department of Pediatrics, Centre for Rare Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,The RareDis Database, Section of Rare Diseases, Department of Clinical Genetics and Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sven Asger Sørensen
- Department of Neurogenetics, Institute of Cellular and Molecular Medicine, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
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23
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Payne JM, Haebich KM, MacKenzie R, Walsh KS, Hearps SJC, Coghill D, Barton B, Pride NA, Ullrich NJ, Tonsgard JH, Viskochil D, Schorry EK, Klesse L, Fisher MJ, Gutmann DH, Rosser T, Packer RJ, Korf B, Acosta MT, Bellgrove MA, North KN. Cognition, ADHD Symptoms, and Functional Impairment in Children and Adolescents With Neurofibromatosis Type 1. J Atten Disord 2021; 25:1177-1186. [PMID: 31838937 DOI: 10.1177/1087054719894384] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: We examined the contribution of attention and executive cognitive processes to ADHD symptomatology in NF1, as well as the relationships between cognition and ADHD symptoms with functional outcomes. Methods: The study sample consisted of 141 children and adolescents with NF1. Children were administered neuropsychological tests that assessed attention and executive function, from which latent cognitive variables were derived. ADHD symptomatology, adaptive skills, and quality of life (QoL) were assessed using parent-rated questionnaires. Path analyses were conducted to test relationships among cognitive functioning, ADHD symptomatology, and functional outcomes. Results: Significant deficits were observed on all outcome variables. Cognitive variables did not predict ADHD symptomatology. Neither did they predict functional outcomes. However, elevated ADHD symptomatology significantly predicted functional outcomes. Conclusion: Irrespective of cognitive deficits, elevated ADHD symptoms in children with NF1 negatively impact daily functioning and emphasize the importance of interventions aimed at minimizing ADHD symptoms in NF1.
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Affiliation(s)
- Jonathan M Payne
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Kristina M Haebich
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | | | - Karin S Walsh
- Children's National Health System, Washington, DC, USA
| | - Stephen J C Hearps
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Coghill
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Belinda Barton
- The Children's Hospital at Westmead, New South Wales, Australia.,The University of Sydney, New South Wales, Australia
| | - Natalie A Pride
- The Children's Hospital at Westmead, New South Wales, Australia.,The University of Sydney, New South Wales, Australia
| | | | - James H Tonsgard
- The University of Chicago Medicine Comer Children's Hospital, IL, USA
| | | | | | - Laura Klesse
- University of Texas Southwestern Medical Center, Dallas, USA
| | | | | | | | | | - Bruce Korf
- The University of Alabama at Birmingham, USA
| | | | | | - Kathryn N North
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia
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24
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Beaussart-Corbat ML, Barbarot S, Farges D, Martin L, Roy A. Executive functions in preschool-aged children with neurofibromatosis type 1: Value for early assessment. J Clin Exp Neuropsychol 2021; 43:163-175. [PMID: 33685350 DOI: 10.1080/13803395.2021.1893277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Executive functions (EFs) impairment is common in children with neurofibromatosis type 1 (NF1), and could be a significant vulnerability associated with this medical disorder. However, we still know little about EFs in preschool NF1. Our study assessed EFs in NF1 children using performance-based tests and daily life questionnaires, which combined the views of parents and teachers.Method: Seven classic experimental tasks were used to evaluate EFs in 33 NF1 children aged 3 to 5 years old, and BRIEF-P questionnaires were completed by their parents and teachers. These children's performance was compared with a control group of 52 healthy children matched in age, gender and socio-cultural status.Results: NF1 children have significantly lower scores for 5 out of 7 executive tasks than control children and significantly higher levels of EF concerns in the parent and teacher BRIEF-P ratings. The correlations between performance-based tests and questionnaires are weak.Conclusions: Our results support an early executive dysfunction in NF1 children and call for early and systematic assessment of EFs. Both performance-based tests and questionnaires are complementary tools to investigate early EFs dysfunction in children with NF1.
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Affiliation(s)
| | - Sébastien Barbarot
- Department of Dermatology, Nantes University, CHU Nantes, Nantes, France.,Neurofibromatosis Clinic, Nantes University Hospital, Nantes, France
| | - Denis Farges
- Pediatrics Department, Angers University Hospital, France
| | - Ludovic Martin
- Department of Dermatology, Angers University Hospital, France.,Reference Center for Inherited Skin Disorders (MAGEC Nord), Angers University Hospital, France
| | - Arnaud Roy
- Laboratory of Psychology, LPPL EA4638, University of Angers, Angers, France.,Neurofibromatosis Clinic, Nantes University Hospital, Nantes, France.,Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France
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25
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Lion-François L, Herbillon V, Peyric E, Mercier C, Gérard D, Ginhoux T, Coutinho V, Kemlin I, Kassai B, Desportes V, Michael GA. Attention and Executive Disorders in Neurofibromatosis 1: Comparison Between NF1 With ADHD Symptomatology (NF1 + ADHD) and ADHD Per Se. J Atten Disord 2020; 24:1807-1823. [PMID: 28587546 DOI: 10.1177/1087054717707579] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: To compare children with Neurofibromatosis type 1 and associated ADHD symptomatology (NF1 + ADHD) with children having received a diagnosis of ADHD without NF1. The idea was that performance differences in tasks of attention between these two groups would be attributable not to the ADHD symptomatology, but to NF1 alone. Method: One group of children with NF1 + ADHD (N = 32), one group of children with ADHD (N = 31), and one group of healthy controls (N = 40) participated in a set of computerized tasks assessing intensive, selective, and executive aspects of attention. Results: Differences were found between the two groups of patients in respect of several aspects of attention. Children with NF1 + ADHD did not always perform worse than children with ADHD. Several double dissociations can be established between the two groups of patients. Conclusion: ADHD symptomatology in NF1 does not contribute to all attention deficits, and ADHD cannot account for all attention impairments in NF1.
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Affiliation(s)
- Laurence Lion-François
- Hospices Civils de Lyon, Service de Neurologie pédiatrique, Hôpital Femme Mère Enfant, Lyon, France
| | - Vania Herbillon
- Hospices Civils de Lyon, Epilepsie, sommeil et explorations fonctionnelles neuropédiatriques, Hôpital Femme Mère Enfant, Lyon, France
| | - Emeline Peyric
- Hospices Civils de Lyon, Service de Neurologie pédiatrique, Hôpital Femme Mère Enfant, Lyon, France
| | - Catherine Mercier
- Laboratoire Biostatistique-Santé, UMR CNRS 5558, Université de Lyon, France
| | - Daniel Gérard
- Service de Psychiatrie infantile, Hôpital Pierre Wertheimer, Lyon, France
| | | | - Virginie Coutinho
- Service de Neuropédiatrie, Hôpital Trousseau La Roche-Guyon, Hôpitaux Universitaires Est Parisien, Paris, France
| | - Isabelle Kemlin
- Service de Neuropédiatrie, Hôpital Trousseau La Roche-Guyon, Hôpitaux Universitaires Est Parisien, Paris, France
| | - Behrouz Kassai
- Service de Pharmacologie Clinique, Inserm EPICIME-CIC 1407, CHU Lyon, Bron, France.,Laboratoire de Biométrie et Biologie Evolutive, CNRS, UMR 5558, Université Lyon 1, Villeurbanne, France
| | - Vincent Desportes
- Hospices Civils de Lyon, Service de Neurologie pédiatrique, Hôpital Femme Mère Enfant, Lyon, France
| | - George A Michael
- Laboratoire d'Étude des Mécanismes Cognitifs, EA 3082, Université de Lyon, Université Lumière-Lyon 2, Lyon, France
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26
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An executive functioning perspective in neurofibromatosis type 1: from ADHD and autism spectrum disorder to research domains. Childs Nerv Syst 2020; 36:2321-2332. [PMID: 32617712 DOI: 10.1007/s00381-020-04745-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/11/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Neurofibromatosis type 1 (NF1) is a rare monogenic disorder associated with executive function (EF) deficits and heightened risk for attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). The goal of this paper is to understand how EFs provide a common foundation to understand vulnerabilities for ADHD and ASD within NF1. METHODS A literature review and synthesis was conducted. RESULTS EF difficulties in working memory, inhibitory control, cognitive flexibility, and planning are evident in NF1, ADHD, and ASD. However, relatively little is known about the heterogeneity of EFs and ADHD and ASD outcomes in NF1. Assessment of ADHD and ASD in NF1 is based on behavioral symptoms without understanding neurobiological contributions. Recent efforts are promoting the use of dimensional and multidisciplinary methods to better understand normal and abnormal behavior, including integrating information from genetics to self-report measures. CONCLUSION NF1 is a monogenic disease with well-developed molecular and phenotypic research as well as complementary animal models. NF1 presents an excellent opportunity to advance our understanding of the neurobiological impact of known pathogenic variation in normal and abnormal neural pathways implicated in human psychopathology. EFs are core features of NF1, ADHD, and ASD, and these neurodevelopmental outcomes are highly prevalent in NF1. We propose a multilevel approach for understanding EFs in patients with NF1.This is essential to advance targeted interventions for NF1 patients and to advance the exciting field of research in this condition.
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27
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Adaptive Behavior and Executive Functioning in Children with Neurofibromatosis Type 1 Using a Mixed Design. J Dev Behav Pediatr 2020; 41:637-643. [PMID: 33064400 DOI: 10.1097/dbp.0000000000000833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Children with neurofibromatosis type 1 (NF1) demonstrate poorer adaptive functioning compared with same-aged peers; however, there is limited research about the longitudinal pattern of adaptive behavior. The aim of this investigation was to examine parent-reported adaptive behavior of children with NF1 longitudinally beginning in early childhood and to examine relations with executive functioning. METHOD Children with NF1 were assessed during early childhood (n = 59; aged 3-7; mean = 4.8, SD = 1.42) or school age (n = 39; aged 9-13; mean = 10.85, SD = 1.58), and a subset was seen at both time points (n = 26). The Scales of Independent Behavior-Revised was used to assess adaptive functioning, and the Behavior Rating Inventory of Executive Function-Preschool Version/Behavior Rating Inventory of Executive Function was used to evaluate everyday executive functioning. RESULTS Adaptive behavior in early childhood was significantly correlated with adaptive behavior at school age (with the exception of social interaction and communication skills) and was significantly poorer at school age. The frequency of difficulties increased over time for overall adaptive behavior and motor skills. Executive functioning was related to adaptive behavior cross-sectionally within early childhood and at school age and showed longitudinal predictive value over time. CONCLUSION This research contributes to the limited NF1 adaptive behavior literature by characterizing the longitudinal pattern of adaptive behavior and relations with executive abilities.
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28
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Varni JW, Nutakki K, Swigonski NL. Cognitive functioning and pain interference mediate pain predictive effects on health-related quality of life in pediatric patients with Neurofibromatosis Type 1. Eur J Paediatr Neurol 2020; 28:64-69. [PMID: 32847704 DOI: 10.1016/j.ejpn.2020.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/28/2020] [Accepted: 07/25/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The objective was to investigate the serial mediating effects of perceived cognitive functioning and pain interference in daily living in the relationship between perceived pain and overall generic health-related quality of life (HRQOL) in children, adolescents, and young adults with Neurofibromatosis Type 1 (NF1). METHODS The Pain, Cognitive Functioning, and Pain Impact Scales from the PedsQL Neurofibromatosis Type 1 Module and the PedsQL 4.0 Generic Core Scales were completed in a multi-site national study by 323 patients ages 5-25 and 335 parents. A serial multiple mediator model analysis was conducted to test the hypothesized sequential mediating effects of cognitive functioning and pain interference as intervening variables in the association between pain as a predictor variable and overall generic HRQOL. RESULTS Pain predictive effects on overall generic HRQOL were serially mediated by cognitive functioning and pain interference. In predictive analytics models utilizing hierarchical multiple regression analyses with age and gender demographic covariates, pain, cognitive functioning and pain interference accounted for 66% of the variance in patient-reported generic HRQOL and 57% of the variance in parent proxy-reported generic HRQOL (P < 0.001), reflecting large effect sizes. CONCLUSIONS Cognitive functioning and pain interference explain in part the mechanism of pain predictive effects on overall generic HRQOL in pediatric patients with NF1. Identifying NF1-specific pain, cognitive functioning, and pain interference as salient predictors of overall generic HRQOL from the patient and parent perspective facilitates a family-centered orientation to the comprehensive care of children, adolescents, and young adults with NF1.
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Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX, USA.
| | - Kavitha Nutakki
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nancy L Swigonski
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
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Hou Y, Allen T, Wolters PL, Toledo-Tamula MA, Martin S, Baldwin A, Reda S, Gillespie A, Goodwin A, Widemann BC. Predictors of cognitive development in children with neurofibromatosis type 1 and plexiform neurofibromas. Dev Med Child Neurol 2020; 62:977-984. [PMID: 32052421 PMCID: PMC7332409 DOI: 10.1111/dmcn.14489] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 11/29/2022]
Abstract
AIM To describe the cognitive development of children with neurofibromatosis type 1 (NF1) and plexiform neurofibromas, and identify predictors of cognitive development. METHOD Participants included 88 children with NF1 and plexiform neurofibromas (50 males, 38 females, aged 6-18y, mean=12y, SD=3y 7mo) on a natural history study at the National Cancer Institute. Neuropsychological assessments (e.g. IQ, academic achievement, attention, and executive functioning) were administered three times over 6 years. RESULTS Relative to normative peers, the total sample of children with NF1 and plexiform neurofibromas demonstrated significantly lower scores in most cognitive domains and decreasing z-scores over time in math, writing, inhibitory control, and working memory. Children who had parents with (vs without) NF1 were more likely to experience decreased z-scores in performance IQ, reading, writing, attention, and working memory. Higher (vs lower) parental education was related to higher levels of IQ, math, reading, and cognitive flexibility and a slower decrease in math z-scores. Children's sex and the number of NF1 disease-related complications were not related to most cognitive outcomes. INTERPRETATION Children with NF1 and plexiform neurofibromas are at high risk for cognitive difficulties and declining z-scores in various domains of cognitive functioning over time. The findings highlight the need for a better understanding of the within-group differences in these children and their need for individualized educational plans. WHAT THIS PAPER ADDS Math, writing, inhibitory control, and working memory scores decreased over time. The proportion of children with clinically significant cognitive deficits increased over time. Parental neurofibromatosis type 1 and low education were related to greater cognitive difficulties in children.
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Affiliation(s)
- Yang Hou
- Department of Family Sciences, University of Kentucky, Lexington, KY, USA
- NIH Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Taryn Allen
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA
| | - Pamela L Wolters
- NIH Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Mary Anne Toledo-Tamula
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA
| | - Staci Martin
- NIH Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Andrea Baldwin
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA
| | - Stephanie Reda
- NIH Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Andy Gillespie
- NIH Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Anne Goodwin
- NIH Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
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30
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Janusz J, Harrison C, Boada C, Cordeiro L, Howell S, Tartaglia N, Boada R. Executive function in XXY: Comparison of performance-based measures and rating scales. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:469-481. [PMID: 32519473 DOI: 10.1002/ajmg.c.31804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 11/07/2022]
Abstract
Few studies have systematically assessed executive functioning (EF) skills in boys with XXY, and these are limited by small samples and restricted EF assessment. This study used a broader battery of performance-based measures as well as parent-rating scales of EF in 77 boys and adolescents with XXY (mean age = 12.5 years), recruited from a clinical trial and an outpatient clinic. Exploratory factor analyses were used to create EF domains from performance-based measures, and similar domains were measured using the Behavior Rating Inventory of Executive Function and Conners Parent-Rating Scales. The boys with XXY showed a distinct EF profile, with the greatest deficit in attention and more moderate deficits in working memory, switching, and planning/problem solving. Parent ratings showed similar challenges, as well as impaired inhibition. Independent sample t-tests showed no difference on performance measures between boys diagnosed or not diagnosed with attention-deficit/hyperactivity disorder (ADHD), although parents of boys diagnosed with ADHD reported more difficulties. There were no differences on performance-based tests between those diagnosed pre- and postnatally, although parents of postnatally diagnosed boys reported more metacognitive problems. Language deficits, cognition, and socio-economic status did not account for EF deficits.
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Affiliation(s)
- Jennifer Janusz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Neurology, Children's Hospital Colorado, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Caroline Harrison
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cristina Boada
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lisa Cordeiro
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Susan Howell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Richard Boada
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Neurology, Children's Hospital Colorado, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
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31
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Biotteau M, Déjean S, Lelong S, Iannuzzi S, Faure-Marie N, Castelnau P, Rivier F, Lauwers-Cancès V, Baudou E, Chaix Y. Sporadic and Familial Variants in NF1: An Explanation of the Wide Variability in Neurocognitive Phenotype? Front Neurol 2020; 11:368. [PMID: 32431664 PMCID: PMC7214842 DOI: 10.3389/fneur.2020.00368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Cognitive impairment is the most common neurological manifestation in NF1 and occurs in 30–70% of NF1 cases. The onset and severity of each specific cognitive deficit varies greatly from child to child, with no apparent external causes. The wide variability of phenotype is the most complex aspect in terms of management and care. Despite multiple research, the mechanism underlying the high heterogeneity in NF1 has not yet been elucidated. While many studies have focused on the effects of specific and precise genetic mutations on the NF1 phenotype, little has been done on the impact of NF1 transmission (sporadic vs. familial cases). We used a complete neuropsychological evaluation designed to assess five large cognitive areas: general cognitive functions (WISC-IV and EVIP); reading skills (“L'Alouette,” ODEDYS-2 and Lobrot French reading tests); phonological process (ODEDYS-2 test); visual perceptual skills (JLO, Thurstone and Corsi block tests) and attention (CPT-II), as well as psychosocial adjustments (CBCL) to explore the impact of NF1 transmission on cognitive disease manifestation in 96 children affected by NF1 [55 sporadic cases (29♀, 26♂); 41 familial cases (24♀, 17♂)]. Results: Familial and Sporadic form of NF1 only differ in IQ expression. The families' socioeconomic status (SES) impacts IQ performance but not differently between sporadic and familial variants. However, SES is lower in familial variants than in the sporadic variant of NF1. No other cognitive differences emerge between sporadic and familial NF1. Conclusions: Inheritance in NF1 failed to explain the phenotype variability in its entirety. IQ differences between groups seems in part linked to the environment where the child grows up. Children with NF1, and especially those that have early diagnoses (most often in inherited cases), must obtain careful monitoring from their early childhood, at home to strengthen investment in education and in school to early detect emerging academic problems and to quickly place them into care. Trial Registration: IDRCB, IDRCB2008-A01444-51. Registered 19 January 2009.
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Affiliation(s)
- Maëlle Biotteau
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France.,Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | - Sébastien Déjean
- Institut de Mathématiques de Toulouse, UMR5219 Université de Toulouse, CNRS UPS, Toulouse, France
| | - Sandrine Lelong
- Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | - Stéphanie Iannuzzi
- Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | | | - Pierre Castelnau
- UMR 1253, iBrain, University of Tours, INSERM, Tours, France.,Department of Medicine, University of Tours Francois Rabelais, Tours, France.,Pediatric Neurology, Clocheville Children's Hospital, Tours University Hospital, Tours, France
| | - François Rivier
- Department of Pediatric Neurology and Reference Center for Language Disabilities, CHU Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | | | - Eloïse Baudou
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France.,Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | - Yves Chaix
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France.,Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
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Clinical Management of Children and Adolescents with Neurofibromatosis Type 1 Like Phenotypes and Complex Behavioural Manifestations: A Multidisciplinary and Dimensional Approach. Case Rep Psychiatry 2020; 2019:4764031. [PMID: 32089936 PMCID: PMC7011498 DOI: 10.1155/2019/4764031] [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: 05/23/2019] [Accepted: 11/27/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction. Cognitive and behavioural problems associated with Neurofibromatosis type 1 (NF1) are common sources of distress and the reasons behind seeking help. Here we describe patients with NF1 or NF1-like phenotypes referred to a Tier 3 Child and Adolescent Psychiatry Department and highlight the benefits of a multidisciplinary assessment.
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Neurofibromatosis Type 1 Implicates Ras Pathways in the Genetic Architecture of Neurodevelopmental Disorders. Behav Genet 2020; 50:191-202. [DOI: 10.1007/s10519-020-09991-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 01/04/2020] [Indexed: 01/12/2023]
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34
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Baudou E, Nemmi F, Biotteau M, Maziero S, Peran P, Chaix Y. Can the Cognitive Phenotype in Neurofibromatosis Type 1 (NF1) Be Explained by Neuroimaging? A Review. Front Neurol 2020; 10:1373. [PMID: 31993017 PMCID: PMC6971173 DOI: 10.3389/fneur.2019.01373] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/11/2019] [Indexed: 12/29/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is one of the most frequent monogenetic disorders. It can be associated with cognitive dysfunctions in several domains such as executive functioning, language, visual perception, motor skills, social skills, memory and/or attention. Neuroimaging is becoming more and more important for a clearer understanding of the neural basis of these deficits. In recent years, several studies have used different imaging techniques to examine structural, morphological and functional alterations in NF1 disease. They have shown that NF1 patients have specific brain characteristics such as Unidentified Bright Objects (UBOs), macrocephaly, a higher volume of subcortical structures, microstructure integrity alterations, or connectivity alterations. In this review, which focuses on the studies published after the last 2 reviews of this topic (in 2010 and 2011), we report on recent structural, morphological and functional neuroimaging studies in NF1 subjects, with special focus on those that examine the neural basis of the NF1 cognitive phenotype. Although UBOs are one of the most obvious and visible elements in brain imaging, correlation studies have failed to establish a robust and reproducible link between major cognitive deficits in NF1 and their presence, number or localization. In the same vein, the results among structural studies are not consistent. Functional magnetic resonance imaging (fMRI) studies appear to be more sensitive, especially for understanding the executive function deficit that seems to be associated with a dysfunction in the right inferior frontal areas and the middle frontal areas. Similarly, fMRI studies have found that visuospatial deficits could be associated with a dysfunction in the visual cortex and especially in the magnocellular pathway involved in the processing of low spatial frequency and high temporal frequency. Connectivity studies have shown a reduction in anterior-posterior “long-range” connectivity and a deficit in deactivation in default mode network (DMN) during cognitive tasks. In conclusion, despite the contribution of new imaging techniques and despite relative advancement, the cognitive phenotype of NF1 patients is not totally understood.
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Affiliation(s)
- Eloïse Baudou
- Children's Hospital, Purpan University Hospital, Toulouse, France.,ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Federico Nemmi
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Maëlle Biotteau
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Stéphanie Maziero
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France.,Octogone-Lordat, University of Toulouse, Toulouse, France
| | - Patrice Peran
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Yves Chaix
- Children's Hospital, Purpan University Hospital, Toulouse, France.,ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
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35
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Attention Deficit Predicts Intellectual Functioning in Children with Neurofibromatosis Type 1. Int J Pediatr 2019; 2019:9493837. [PMID: 31915440 PMCID: PMC6930769 DOI: 10.1155/2019/9493837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/10/2019] [Accepted: 08/23/2019] [Indexed: 11/18/2022] Open
Abstract
Aims Attention deficit hyperactivity disorder (ADHD) is one of the most frequent neurocognitive impairments in neurofibromatosis type 1 (NF1) and a well-known risk factor for intellectual dysfunction in general. Since NF1 is per se associated with intellectual difficulties, this comorbidity may be crucial for the cognitive development of affected patients. In our study, we investigated if attention deficits are associated with intellectual functioning in NF1 and if children with NF1 plus ADHD differ in their intellectual and attention profiles from children affected by NF1-only or ADHD only. Methods 111 children aged between 6 and 12 years (53 NF1 plus ADHD, 28 NF1-only, 30 ADHD-only) performed the German version of the intelligence test WISC-IV and a continuous performance test (T.O.V.A.) to assess attention functions. Parents completed questionnaires about everyday attention and executive functions (Conners 3®, BRIEF). Results Children with NF1 plus ADHD showed significantly lower intelligence test scores (full-scale IQ: 89.39 [1.40]) than patients with NF1-only (full-scale IQ: 101.14 [1.98]; p < .001), and intellectual functioning correlated significantly with attention performance in NF1 (p < .001). As compared to NF1-only, attention, and executive functioning were impaired on several dimensions (T.O.V.A., Conners 3® and BRIEF) in NF1 plus ADHD. ADHD-only was associated with significantly higher problem scores regarding hyperactivity/impulsivity and inattention (Conners 3®). NF1-only was associated with inattentiveness when compared to the normative sample of the T.O.V.A. Conclusion NF1 is associated with variable attention problems. Severe attention deficits appear to be a risk factor for intellectual dysfunction in NF1, more than NF1 without attention deficit. NF1 plus ADHD presents a specific cognitive profile, which differs from that of NF1 and from neurotypical ADHD.
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36
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Payne JM, Hearps SJC, Walsh KS, Paltin I, Barton B, Ullrich NJ, Haebich KM, Coghill D, Gioia GA, Cantor A, Cutter G, Tonsgard JH, Viskochil D, Rey-Casserly C, Schorry EK, Ackerson JD, Klesse L, Fisher MJ, Gutmann DH, Rosser T, Packer RJ, Korf B, Acosta MT, North KN. Reproducibility of cognitive endpoints in clinical trials: lessons from neurofibromatosis type 1. Ann Clin Transl Neurol 2019; 6:2555-2565. [PMID: 31797581 PMCID: PMC6917317 DOI: 10.1002/acn3.50952] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 11/10/2022] Open
Abstract
Objective Rapid developments in understanding the molecular mechanisms underlying cognitive deficits in neurodevelopmental disorders have increased expectations for targeted, mechanism‐based treatments. However, translation from preclinical models to human clinical trials has proven challenging. Poor reproducibility of cognitive endpoints may provide one explanation for this finding. We examined the suitability of cognitive outcomes for clinical trials in children with neurofibromatosis type 1 (NF1) by examining test‐retest reliability of the measures and the application of data reduction techniques to improve reproducibility. Methods Data were analyzed from the STARS clinical trial (n = 146), a multi‐center double‐blind placebo‐controlled phase II trial of lovastatin, conducted by the NF Clinical Trials Consortium. Intra‐class correlation coefficients were generated between pre‐ and post‐performances (16‐week interval) on neuropsychological endpoints in the placebo group to determine test‐retest reliabilities. Confirmatory factor analysis was used to reduce data into cognitive domains and account for measurement error. Results Test‐retest reliabilities were highly variable, with most endpoints demonstrating unacceptably low reproducibility. Data reduction confirmed four distinct neuropsychological domains: executive functioning/attention, visuospatial ability, memory, and behavior. Test‐retest reliabilities of latent factors improved to acceptable levels for clinical trials. Applicability and utility of our model was demonstrated by homogeneous effect sizes in the reanalyzed efficacy data. Interpretation These data demonstrate that single observed endpoints are not appropriate to determine efficacy, partly accounting for the poor test‐retest reliability of cognitive outcomes in clinical trials in neurodevelopmental disorders. Recommendations to improve reproducibility are outlined to guide future trial design.
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Affiliation(s)
- Jonathan M Payne
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen J C Hearps
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Karin S Walsh
- Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC
| | - Iris Paltin
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Belinda Barton
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The University of Sydney Children's Hospital Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Kristina M Haebich
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Coghill
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Gerard A Gioia
- Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC
| | - Alan Cantor
- Department of Preventative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gary Cutter
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - James H Tonsgard
- Division of Neurology, The University of Chicago Medicine Comer Children's Hospital, Chicago, Illinois
| | - David Viskochil
- Department of Genetics, University of Utah, Salt Lake City, Utah
| | | | - Elizabeth K Schorry
- Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joseph D Ackerson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Laura Klesse
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael J Fisher
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Tena Rosser
- Department of Neurology, Children's Hospital of Los Angeles, Los Angeles, California
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC
| | - Bruce Korf
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Maria T Acosta
- Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC.,National Institutes of Health, National Human Genome Research Institute, Bethesda, Maryland
| | - Kathryn N North
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Haebich KM, Pride NA, Walsh KS, Chisholm A, Rouel M, Maier A, Anderson V, Barton B, Silk T, Korgaonkar M, Seal M, Lami F, Lorenzo J, Williams K, Dabscheck G, Rae CD, Kean M, North KN, Payne JM. Understanding autism spectrum disorder and social functioning in children with neurofibromatosis type 1: protocol for a cross-sectional multimodal study. BMJ Open 2019; 9:e030601. [PMID: 31558455 PMCID: PMC6773330 DOI: 10.1136/bmjopen-2019-030601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Children with the single-gene disorder neurofibromatosis type 1 (NF1) appear to be at an increased risk for autism spectrum disorder (ASD) and exhibit a unique social-cognitive phenotype compared with children with idiopathic ASD. A complete framework is required to better understand autism in NF1, from neurobiological levels through to behavioural and functional outcomes. The primary aims of this study are to establish the frequency of ASD in children with NF1, examine the social cognitive phenotype, investigate the neuropsychological processes contributing to ASD symptoms and poor social functioning in children with NF1, and to investigate novel structural and functional neurobiological markers of ASD and social dysfunction in NF1. The secondary aim of this study is to compare the neuropsychological and neurobiological features of ASD in children with NF1 to a matched group of patients with idiopathic ASD. METHODS AND ANALYSIS This is an international, multisite, prospective, cross-sectional cohort study of children with NF1, idiopathic ASD and typically developing (TD) controls. Participants will be 200 children with NF1 (3-15 years of age), 70 TD participants (3-15 years) and 35 children with idiopathic ASD (7-15 years). Idiopathic ASD and NF1 cases will be matched on age, sex and intelligence. All participants will complete cognitive testing and parents will rate their child's behaviour on standardised questionnaires. Neuroimaging will be completed by a subset of participants aged 7 years and older. Children with NF1 that screen at risk for ASD on the parent-rated Social Responsiveness Scale 2nd Edition will be invited back to complete the Autism Diagnostic Observation Scale 2nd Edition and Autism Diagnostic Interview-Revised to determine whether they fulfil ASD diagnostic criteria. ETHICS AND DISSEMINATION This study has hospital ethics approval and the results will be disseminated through peer-reviewed publications and international conferences.
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Affiliation(s)
- Kristina M Haebich
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
| | - Natalie A Pride
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Westmead, NSW, Australia
| | - Karin S Walsh
- Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, United States
- Departments of Pediatrics and Psychiatry, The George Washington University School of Medicine, Washington, DC, United States
| | - Anita Chisholm
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
| | - Melissa Rouel
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Alice Maier
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Vicki Anderson
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
| | - Belinda Barton
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Westmead, NSW, Australia
- Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Tim Silk
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Mayuresh Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
| | - Marc Seal
- Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Francesca Lami
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jennifer Lorenzo
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Gabriel Dabscheck
- Department of Neurology, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Caroline D Rae
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
| | - Michael Kean
- Imaging Department, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Kathryn N North
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jonathan M Payne
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
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38
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Pendergrass C, Peraza J. A comparison of neuropsychological function between monozygotic twins with neurofibromatosis, type 1: A case report. Clin Neuropsychol 2019; 34:1049-1064. [PMID: 31154935 DOI: 10.1080/13854046.2019.1621381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Neurofibromatosis type 1 (NF-1) is an autosomal dominant genetic disorder that commonly presents with cognitive impairment and greater rates of learning disorders and academic difficulty compared to the general population. Investigations of neurological and physiological expression of NF-1 in monozygotic twins identified intrapair similarities and differences. Monozygotic twins with NF-1 have been found to have similar IQ scores as well as concordant diagnoses of attention-deficit/hyperactivity disorder and learning disabilities. There have been no previous reports on similarities and differences in neuropsychological profiles between monozygotic twins with NF-1. The purpose of this article is to examine the results of comprehensive neuropsychological evaluations for a pair of monozygotic twins with NF-1.Method: A pair of 19-year-old female, African-American monozygotic twins with NF-1 underwent neuropsychological evaluations in an outpatient clinic. Findings are reported following the CAse REport (CARE) guidelines.Results: The twins demonstrated similar impairment in processing speed, working memory, and attention span; however, differences also were found.Conclusions: Intrapair similarities and differences on neuropsychological assessment were found between monozygotic twins with NF-1. Primary deficits were suggestive of a frontal-subcortical pattern and could be consistent with remote neuroimaging. When differences did occur, performance was typically better for Twin A, who had also showed greater improvement on neuroimaging. Implications and directions for future research are discussed. Specifically, this case demonstrates the need for inclusion of neuropsychological assessment in studies of larger cohorts of monozygotic twins with NF-1 and correlation of neuropsychological findings with neuroimaging and postzygotic mutations.
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Affiliation(s)
- Cody Pendergrass
- Graduate School of Professional Psychology, University of Denver, Denver, CO, USA.,Outpatient Behavioral Health Services, Denver Health Medical Center, Denver, CO, USA
| | - Jennifer Peraza
- Outpatient Behavioral Health Services, Denver Health Medical Center, Denver, CO, USA.,Department of Psychiatry, University of Colorado, Aurora, CO, USA
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Loe IM, Heller NA, Chatav M. Behavior problems and executive function impairments in preterm compared to full term preschoolers. Early Hum Dev 2019; 130:87-95. [PMID: 30708271 PMCID: PMC6856007 DOI: 10.1016/j.earlhumdev.2019.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children born preterm (PT) are at high risk for behavior problems and deficits in executive function (EF), a set of cognitive processes that guide goal-directed behaviors. Behavior differences have been found as early as 2 years in PT children; EF differences have been found in infancy. Whether behavior problems and EF deficits co-occur at young ages has not been fully investigated. AIMS To determine whether (1) PT children have more behavior problems and EF impairment than full term (FT) children and (2) larger proportions of PT children show behavior problems or EF impairments. DESIGN/METHODS PT (≤34 wks, n = 82) and FT (n = 79) preschoolers (mean age 4.4 years) completed an EF battery. Parents completed rating scales of behavior problems and EF skills. Mean scores and proportions with impairment were compared between groups. Logistic regression predicting to impairment defined odds ratios for PT/FT groups. RESULTS PT compared to FT had more problems on most behavior and EF scales and poorer EF scores on all tasks and greater proportion with impairments on most behavior scales, all EF ratings, and all EF tasks, p < .05. PT had elevated odds for impaired performance-based EF, parent-rated EF and CBCL scores compared to FT, p < .05. Within the PT group, EF impairments were twice as common as behavior impairment. CONCLUSIONS We recommend early identification of EF impairments in PT children. Future research should evaluate whether EF impairments serve as better early markers for later functional difficulties compared to behavior problems, as well as targets for intervention.
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Affiliation(s)
- Irene M. Loe
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road, MSOB X109, MC 5415, Stanford, CA, 94305, USA
| | - Nicole A. Heller
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road, MSOB X109, MC 5415, Stanford, CA, 94305, USA
| | - Maya Chatav
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road, MSOB X109, MC 5415, Stanford, CA, 94305, USA
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Lewis AK, Porter MA, Williams TA, Bzishvili S, North KN, Payne JM. Attention to faces in social context in children with neurofibromatosis type 1. Dev Med Child Neurol 2019; 61:174-180. [PMID: 29873078 DOI: 10.1111/dmcn.13928] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 02/06/2023]
Abstract
AIM To examine visual attention to faces within social scenes in children with neurofibromatosis type 1 (NF1) and typically developing peers. METHOD Using eye-tracking technology we investigated the time taken to fixate on a face and the percentage of time spent attending to faces relative to the rest of the screen within social scenes in 24 children with NF1 (17 females, seven males; mean age 10y 4mo [SD 1y 9mo]). Results were compared with those of 24 age-matched typically developing controls (11 females, 13 males; mean age 10y 3mo [SD 2y]). RESULTS There was no significant between-group differences in time taken to initially fixate on a face (p=0.617); however, children with NF1 spent less time attending to faces within scenes than controls (p=0.048). Decreased attention to faces was associated with elevated autism traits in children with NF1. INTERPRETATION Children with NF1 spend less time attending to faces than typically developing children when presented in social scenes. Our findings contribute to a growing body of literature suggesting that abnormal face processing is a key aspect of the social-cognitive phenotype of NF1 and appears to be related to autism spectrum disorder traits. Clinicians should consider the impact of reduced attention to faces when designing and implementing treatment programmes for social dysfunction in this population. WHAT THIS PAPER ADDS Children with neurofibromatosis type 1 (NF1) demonstrated atypical gaze behaviour when attending to faces. NF1 gaze behaviour was characterized by normal initial fixation on faces but shorter face dwell time. Decreased attention to faces was associated with elevated autism traits in the sample with NF1.
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Affiliation(s)
- Amelia K Lewis
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Melanie A Porter
- Department of Psychology, Macquarie University, Sydney, NSW, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, Australia
| | - Tracey A Williams
- Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | | | - Kathryn N North
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Vic., Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia
| | - Jonathan M Payne
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Vic., Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia
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Pain, skin sensations symptoms, and cognitive functioning predictors of health-related quality of life in pediatric patients with Neurofibromatosis Type 1. Qual Life Res 2018; 28:1047-1052. [DOI: 10.1007/s11136-018-2055-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
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42
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Measurement considerations in pediatric research on autism spectrum disorders. PROGRESS IN BRAIN RESEARCH 2018. [PMID: 30447755 DOI: 10.1016/bs.pbr.2018.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Studying Autism Spectrum Disorders (ASD) in genetic syndromes has gained interest in the scientific community as a way to elucidate mechanisms and symptom profiles to understand ASD more broadly. Appropriate and adequate measurement of constructs, symptomatology, and outcomes in clinical research is of vital importance in establishing the prevalence of such symptoms and measuring change in symptoms in the context of clinical trials. As such, we provide an overview of the prevalence of ASD, present current diagnostic guidelines, discuss important comorbidities to consider, describe current assessment strategies in assessing ASD, and discuss these within the context of a specific genetic condition to highlight how ASD can be best evaluated.
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O’Meagher S, Norris K, Kemp N, Anderson P. Examining the relationship between performance-based and questionnaire assessments of executive function in young preterm children: Implications for clinical practice. Child Neuropsychol 2018; 25:899-913. [DOI: 10.1080/09297049.2018.1531981] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Sari O’Meagher
- School of Medicine (Psychology), University of Tasmania, Hobart, Australia
| | - Kimberley Norris
- School of Medicine (Psychology), University of Tasmania, Hobart, Australia
| | - Nenagh Kemp
- School of Medicine (Psychology), University of Tasmania, Hobart, Australia
| | - Peter Anderson
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia
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Systematic Review and Meta-analysis of Executive Functions in Preschool and School-Age Children With Neurofibromatosis Type 1. J Int Neuropsychol Soc 2018; 24:977-994. [PMID: 30375317 DOI: 10.1017/s1355617718000383] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Neurofibromatosis type 1 (NF1) is a genetic disorder in which the most frequent complication in children is learning disabilities. Over the past decade, growing arguments support the idea that executive dysfunction is a core deficit in children with NF1. However, some data remain inconsistent. The aim of this study was to determine the magnitude of impairment for each executive function (EF) and clarify the impact of methodological choices and participant's characteristics on EFs. METHODS In this meta-analysis, 19 studies met the selection criteria and were included with data from a total of 805 children with NF1 and 667 controls. Based on the Diamond's model (2013), EF measures were coded separately according to the following EF components: working memory, inhibitory control, cognitive flexibility, planning/problem solving. The review protocol was registered with PROSPERO (International prospective register of systematic reviews; CRD42017068808). RESULTS A significant executive dysfunction in children with NF1 is demonstrated. Subgroup analysis showed that the impairment varied as a function of the specific component of executive functioning. The effect size for working memory and planning/problem solving was moderate whereas it was small for inhibitory control and cognitive flexibility. Executive dysfunction seems to be greater with increasing age whereas assessment tool type, intellectual performance, attention deficit hyperactivity disorder and control group composition did not seem to affect EF results. CONCLUSIONS EF deficits are a core feature in children with NF1 and an early identification of executive dysfunctions is essential to limit their impact on the quality of life. (JINS, 2018, 24, 977-994).
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Josman N, Meyer S. Conceptualisation and use of executive functions in paediatrics: A scoping review of occupational therapy literature. Aust Occup Ther J 2018; 66:77-90. [DOI: 10.1111/1440-1630.12525] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Naomi Josman
- Department of Occupational Therapy; Faculty of Social Welfare & Health Sciences; University of Haifa; Haifa Israel
| | - Sonya Meyer
- Laboratory of Complex Human Activity and Participation (CHAP); Department Occupational Therapy; Faculty of Social Welfare & Health Sciences; University of Haifa; Haifa Israel
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Pride NA, Barton B, Hutchins P, Coghill DR, Korgaonkar MS, Hearps SJC, Rouel M, Malarbi S, North KN, Payne JM. Effects of methylphenidate on cognition and behaviour in children with neurofibromatosis type 1: a study protocol for a randomised placebo-controlled crossover trial. BMJ Open 2018; 8:e021800. [PMID: 30166301 PMCID: PMC6119452 DOI: 10.1136/bmjopen-2018-021800] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Dopamine dysregulation has been identified as a key modulator of behavioural impairment in neurofibromatosis type 1 (NF1) and a potential therapeutic target. Preclinical research demonstrates reduced dopamine in the brains of genetically engineered NF1 mouse strains is associated with reduced spatial-learning and attentional dysfunction. Methylphenidate, a stimulant medication that increases dopaminergic and noradrenergic neurotransmission, rescued the behavioural and dopamine abnormalities. Although preliminary clinical trials have demonstrated that methylphenidate is effective in treating attention deficit hyperactivity disorder (ADHD) symptoms in children with NF1, its therapeutic effect on cognitive performance is unclear. The primary aim of this clinical trial is to assess the efficacy of methylphenidate for reducing attention deficits, spatial working memory impairments and ADHD symptoms in children with NF1. METHODS AND ANALYSIS A randomised, double-blind, placebo-controlled trial of methylphenidate with a two period crossover design. Thirty-six participants with NF1 aged 7-16 years will be randomised to one of two treatment sequences: 6 weeks of methylphenidate followed by 6 weeks of placebo or; 6 weeks of placebo followed by 6 weeks of methylphenidate. Neurocognitive and behavioural outcomes as well as neuroimaging measures will be completed at baseline and repeated at the end of each treatment condition (week 6, week 12). Primary outcome measures are omission errors on the Conners Continuous Performance Test-II (attention), between-search errors on the Spatial Working Memory task from the Cambridge Neuropsychological Test Automated Battery (spatial working memory) and the Inattentive and Hyperactivity/Impulsivity Symptom Scales on the Conners 3-Parent. Secondary outcomes will examine the effect of methylphenidate on executive functions, attention, visuospatial skills, behaviour, fine-motor skills, language, social skills and quality of life. ETHICS AND DISSEMINATION This trial has hospital ethics approval and the results will be disseminated through peer-reviewed publications and international conferences. TRIAL REGISTRATION NUMBER ACTRN12611000765921.
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Affiliation(s)
- Natalie A Pride
- Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Universtiy of Sydney, Sydney, New South Wales, Australia
| | - Belinda Barton
- Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Universtiy of Sydney, Sydney, New South Wales, Australia
- Children's Hosptial Education Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Paul Hutchins
- Children's Hosptial Education Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - David R Coghill
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Stephen J C Hearps
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Melissa Rouel
- Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Stephanie Malarbi
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Kathryn N North
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan M Payne
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
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Hall ML, Eigsti IM, Bortfeld H, Lillo-Martin D. Executive Function in Deaf Children: Auditory Access and Language Access. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:1970-1988. [PMID: 30073268 PMCID: PMC6198917 DOI: 10.1044/2018_jslhr-l-17-0281] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/28/2017] [Accepted: 04/17/2018] [Indexed: 05/04/2023]
Abstract
Purpose Deaf children are frequently reported to be at risk for difficulties in executive function (EF); however, the literature is divided over whether these difficulties are the result of deafness itself or of delays/deficits in language that often co-occur with deafness. The purpose of this study is to discriminate these hypotheses by assessing EF in populations where the 2 accounts make contrasting predictions. Method We use a between-groups design involving 116 children, ages 5-12 years, across 3 groups: (a) participants with normal hearing (n = 45), (b) deaf native signers who had access to American Sign Language from birth (n = 45), and (c) oral cochlear implant users who did not have full access to language prior to cochlear implantation (n = 26). Measures include both parent report and performance-based assessments of EF. Results Parent report results suggest that early access to language has a stronger impact on EF than early access to sound. Performance-based results trended in a similar direction, but no between-group differences were significant. Conclusions These results indicate that healthy EF skills do not require audition and therefore that difficulties in this domain do not result primarily from a lack of auditory experience. Instead, results are consistent with the hypothesis that language proficiency, whether in sign or speech, is crucial for the development of healthy EF. Further research is needed to test whether sign language proficiency also confers benefits to deaf children from hearing families.
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Affiliation(s)
- Matthew L. Hall
- Department of Psychology, University of Massachusetts Dartmouth
- Department of Linguistics, University of Connecticut, Storrs
| | | | - Heather Bortfeld
- Department of Psychological Sciences, University of California, Merced
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Domon-Archambault V, Gagnon L, Benoît A, Perreault S. Psychosocial Features of Neurofibromatosis Type 1 in Children and Adolescents. J Child Neurol 2018; 33:225-232. [PMID: 29318935 DOI: 10.1177/0883073817749367] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Neurofibromatosis type 1 (NF1) is a common neurologic condition associated with a wide variety of developmental deficits that have an important impact on children and adolescents. OBJECTIVE This article aims to document the psychosocial features of NF1 and to report the interventions described to address the needs of pediatric patients with NF1. METHODS A literature review was conducted concerning the social life, mental health, and quality of life (QOL) of children and adolescents with NF1 as well as the psychosocial interventions addressed to this population. RESULTS Compared to unaffected children and adolescents of the general population, pediatric patients with NF1 have an increased risk of having social difficulties, mental health disorders, behavioral and emotional problems, as well as diminished QOL. Only 3 articles describe interventions within the NF1 population to address these difficulties. CONCLUSION There is a need to develop and assess psychosocial interventions for patients with NF1.
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Affiliation(s)
| | - Louise Gagnon
- 2 Department of Pediatric, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Amélie Benoît
- 2 Department of Pediatric, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Sébastien Perreault
- 2 Department of Pediatric, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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49
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Cohen R, Halevy A, Aharon S, Shuper A. Attention Deficit Hyperactivity Disorder in Neurofibromatosis Type 1: Evaluation with a Continuous Performance Test. J Clin Neurol 2018; 14:153-157. [PMID: 29629523 PMCID: PMC5897196 DOI: 10.3988/jcn.2018.14.2.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/26/2017] [Accepted: 04/26/2017] [Indexed: 12/22/2022] Open
Abstract
Background and Purpose The objective of this study was to determine if the MOXO visual- and vocal-distractors-based continuous performance test distinguishes patients with attention deficit hyperactivity disorder (ADHD) and neurofibromatosis type 1 (NF1) from those without NF1. Methods Thirty-five patients (16 males; mean age 9.91 years) attending a multidisciplinary NF1 clinic completed the MOXO test. The findings were compared to 532 healthy age-matched standardized control subjects (285 males) without ADHD. Results The overall performance in the MOXO text was significantly worse in the NF1 group than in controls (p<0.01), but no group-specific pattern was identified. Impulsivity and hyperactivity were significantly more prominent in males than females (p<0.01). Compared to controls, the NF1 group exhibited significantly more failures to respond to target stimuli in the presence of visual distractors. Conclusions MOXO scores are abnormal in patients with NF1, but the test cannot differentiate between NF1 with ADHD characteristics and ADHD. The test highlights sex differences in ADHD characteristics in NF1. Overreactivity to visual distractors may form part of the attention deficit in NF1.
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Affiliation(s)
- Rony Cohen
- Neurofibromatosis Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ayelet Halevy
- Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Aharon
- Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avinoam Shuper
- Neurofibromatosis Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Burgio F, Benavides-Varela S, Arcara G, Trevisson E, Frizziero D, Clementi M, Semenza C. Numerical activities of daily living in adults with neurofibromatosis type 1. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:1069-1077. [PMID: 28853219 DOI: 10.1111/jir.12408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 07/20/2017] [Accepted: 07/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND This study aimed to identify the mathematical domains affected in adults with neurofibromatosis 1 (NF1) and the impact of the numerical difficulties on the patients' activities of daily living. METHODS We assessed 28 adult patients with NF1 and 28 healthy control participants. All participants completed the standardised battery of numerical activities of daily living along with clinical batteries of cognitive (Mini-Mental State Examination) and daily functioning (instrumental activities of daily living). The group comparisons of the performance on numerical activities of daily living were carried out using t-test correcting for multiple comparisons. RESULTS The results showed that the NF1 group performed worse than controls in written subtractions, written multiplication, multiplication principles and digit comprehension (dot counting) tasks. Importantly, no significant differences in numerical ecological tasks were found between patients and controls, suggesting a possible use of compensatory strategies in daily living abilities in spite of calculation deficits. CONCLUSION The findings indicate that NF1 affects calculation but not the basic comprehension or representation of numbers in adult patients. These data have important implications for designing cognitive interventions tailored to the cognitive profile of individuals with NF1.
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Affiliation(s)
- F Burgio
- San Camillo Hospital IRCCS, Venice, Italy
| | | | - G Arcara
- San Camillo Hospital IRCCS, Venice, Italy
| | - E Trevisson
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padova, Italy
| | - D Frizziero
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padova, Italy
| | - M Clementi
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padova, Italy
| | - C Semenza
- San Camillo Hospital IRCCS, Venice, Italy
- Department of Neuroscience (Padova Neuroscience Centre), University of Padova, Italy
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