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Fogel Y. Inside the Functional Individualized Therapy for Teenagers with Executive Deficits (FITTED): Insights from the Adolescents and Their Parents. Occup Ther Health Care 2024; 38:698-712. [PMID: 36571276 DOI: 10.1080/07380577.2022.2159100] [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: 06/15/2022] [Accepted: 12/12/2022] [Indexed: 12/27/2022]
Abstract
This study explores Functional Individualized Therapy for Teenagers with Executive Deficits (FITTED) factors facilitating adolescents' improvement. At each of eight therapy sessions, 41 adolescents with executive function deficits and their parents wrote the primary concept they "took away." Experts categorized their answers by the FITTED model's main factors-goals, strengths, and strategies-adding child's difficulties for the parents' answers. Results describe answer frequencies by factor in each session. Across time, strengths and strategies dominated among adolescents, and strategies and difficulties among parents. Cognitive strategies are integral to the FITTED process for improving the daily functioning of adolescents with executive function deficits.
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Affiliation(s)
- Yael Fogel
- Department of Occupational Therapy, School of Health Sciences, Ariel University, Ariel, Israel
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2
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Porter BM, Roe MA, Mitchell ME, Church JA. A longitudinal examination of executive function abilities, attention-deficit/hyperactivity disorder, and puberty in adolescence. Child Dev 2024; 95:1076-1091. [PMID: 38085108 DOI: 10.1111/cdev.14057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/16/2023] [Accepted: 11/25/2023] [Indexed: 07/05/2024]
Abstract
Executive function (EF) abilities have been linked to numerous important life outcomes. We longitudinally characterized EF and attention-deficit/hyperactivity disorder (ADHD) trajectories across adolescence (initial ages 8-19). Utilizing 3 years of annual data in 99 youth collected between years 2016 and 2020 (70.7% White, 40 females), we examined how age, puberty, and ADHD symptom burden related to EF across time. Age and puberty levels interacted to predict EF such that older youth with higher puberty had lower EF. While EF and ADHD significantly predicted each other, cross-lagged panel models revealed that earlier EF predicted later ADHD burden while controlling for baseline ADHD burden, but not vice versa. These findings inform our understanding of the dynamics between EF and mental health in adolescence.
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Affiliation(s)
- Blaire M Porter
- Department of Psychology, The University of Texas at Austin, Austin, Texas, USA
| | - Mary Abbe Roe
- Department of Psychology, The University of Texas at Austin, Austin, Texas, USA
| | - Mackenzie E Mitchell
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica A Church
- Department of Psychology, The University of Texas at Austin, Austin, Texas, USA
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3
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Maleyeff L, Park HJ, Khazal ZSH, Wypij D, Rollins CK, Yun HJ, Bellinger DC, Watson CG, Roberts AE, Newburger JW, Grant PE, Im K, Morton SU. Meta-regression of sulcal patterns, clinical and environmental factors on neurodevelopmental outcomes in participants with multiple CHD types. Cereb Cortex 2024; 34:bhae224. [PMID: 38836834 DOI: 10.1093/cercor/bhae224] [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: 03/20/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 06/06/2024] Open
Abstract
Congenital heart disease affects 1% of infants and is associated with impaired neurodevelopment. Right- or left-sided sulcal features correlate with executive function among people with Tetralogy of Fallot or single ventricle congenital heart disease. Studies of multiple congenital heart disease types are needed to understand regional differences. Further, sulcal pattern has not been studied in people with d-transposition of the great arteries. Therefore, we assessed the relationship between sulcal pattern and executive function, general memory, and processing speed in a meta-regression of 247 participants with three congenital heart disease types (114 single ventricle, 92 d-transposition of the great arteries, and 41 Tetralogy of Fallot) and 94 participants without congenital heart disease. Higher right hemisphere sulcal pattern similarity was associated with improved executive function (Pearson r = 0.19, false discovery rate-adjusted P = 0.005), general memory (r = 0.15, false discovery rate P = 0.02), and processing speed (r = 0.17, false discovery rate P = 0.01) scores. These positive associations remained significant in for the d-transposition of the great arteries and Tetralogy of Fallot cohorts only in multivariable linear regression (estimated change β = 0.7, false discovery rate P = 0.004; β = 4.1, false discovery rate P = 0.03; and β = 5.4, false discovery rate P = 0.003, respectively). Duration of deep hypothermic circulatory arrest was also associated with outcomes in the multivariate model and regression tree analysis. This suggests that sulcal pattern may provide an early biomarker for prediction of later neurocognitive challenges among people with congenital heart disease.
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Affiliation(s)
- Lara Maleyeff
- Department of Biostatistics, Epidemiology, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Hannah J Park
- Division of Newborn Medicine, Boston Children's Hospital, Boston 02115, MA, United States
| | - Zahra S H Khazal
- Division of Newborn Medicine, Boston Children's Hospital, Boston 02115, MA, United States
| | - David Wypij
- Department of Pediatrics, Harvard Medical School, Boston MA, United States
- Department of Cardiology, Boston Children's Hospital, Boston 02115, MA, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston MA, United States
| | - Caitlin K Rollins
- Department of Neurology, Boston Children's Hospital 02115 Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston MA, United States
| | - Hyuk Jin Yun
- Division of Newborn Medicine, Boston Children's Hospital, Boston 02115, MA, United States
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston 02115, MA, United States
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital 02115 Boston, MA, United States
- Department of Psychiatry, Boston Children's Hospital, Boston 02115, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston MA, United States
| | - Christopher G Watson
- Department of Neurology, Boston Children's Hospital 02115 Boston, MA, United States
| | - Amy E Roberts
- Department of Pediatrics, Harvard Medical School, Boston MA, United States
- Department of Cardiology, Boston Children's Hospital, Boston 02115, MA, United States
| | - Jane W Newburger
- Department of Pediatrics, Harvard Medical School, Boston MA, United States
- Department of Cardiology, Boston Children's Hospital, Boston 02115, MA, United States
| | - P Ellen Grant
- Department of Biostatistics, Epidemiology, and Occupational Health, McGill University, Montreal, QC, Canada
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston 02115, MA, United States
- Department of Radiology, Boston Children's Hospital, Boston 02115, MA, United States
| | - Kiho Im
- Division of Newborn Medicine, Boston Children's Hospital, Boston 02115, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston MA, United States
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston 02115, MA, United States
| | - Sarah U Morton
- Division of Newborn Medicine, Boston Children's Hospital, Boston 02115, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston MA, United States
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston 02115, MA, United States
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Leung WSW, Pei J, Rasmussen C. A working memory intervention for children with prenatal alcohol exposure: Pilot study. APPLIED NEUROPSYCHOLOGY. CHILD 2024:1-9. [PMID: 38593749 DOI: 10.1080/21622965.2024.2328672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Cogmed© is a computerized working memory training program designed to improve attention and working memory. We examined the short- and long-term impacts of a 25-session Cogmed© intervention on working memory and other cognitive and learning domains in children with prenatal alcohol exposure (PAE) and typically developing children. Participants included 38 children (4 - 13 years old) from Alberta, Canada in two groups: PAE (n = 20) and typically developing (n = 18). Significant improvements in areas of working memory and attentional control for both the PAE and the typically developing group were reported immediately after intervention completion (short-term impact). The gains on some measures were retained at five-week follow up (long-term impact). Preliminary findings indicate that computerized interventions may positively impact WM and attention control and that these changes may be maintained after a delay period.
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Affiliation(s)
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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5
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Michel E, Bimmüller A. The factorial structure of executive functions in kindergarten children: an explorative study. Child Neuropsychol 2022:1-24. [DOI: 10.1080/09297049.2022.2138303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Eva Michel
- Department of Psychology IV, University of Wuerzburg, Würzburg, Germany
| | - Antonia Bimmüller
- Department of Psychology IV, University of Wuerzburg, Würzburg, Germany
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Majeed A, Rofeberg V, Bellinger DC, Wypij D, Newburger JW. Machine Learning to Predict Executive Function in Adolescents with Repaired d-Transposition of the Great Arteries, Tetralogy of Fallot, and Fontan Palliation. J Pediatr 2022; 246:145-153. [PMID: 35314155 DOI: 10.1016/j.jpeds.2022.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To identify predictors of impaired executive function in adolescents after surgical repair of critical congenital heart disease (CHD). STUDY DESIGN We analyzed patient factors, medical and surgical history, and family social class from 3 single-center studies of adolescents with d-transposition of the great arteries (d-TGA), tetralogy of Fallot (TOF), and Fontan repair. Machine learning models were developed using recursive partitioning to predict an executive function composite score based on five subtests (population mean 10, SD 3) of the Delis-Kaplan Executive Function System. RESULTS The sample included 386 patients (139 d-TGA, 91 TOF, 156 Fontan) of age 15.1 ± 2.1 (mean ± SD) years and an executive function composite score of 8.6 ± 2.4. Family social class emerged as the most important predictive factor. The lowest (worst) mean executive function score (5.3) occurred in patients with low to medium social class (Hollingshead index <56) with one or more neurologic events and a diagnosis of TOF. The highest (best) mean score (9.7) occurred in subjects with high social class (Hollingshead index ≥56) and shorter duration of deep hypothermic circulatory arrest. Other factors predicting lower executive function scores included low birth weight and a greater number of catheterizations. CONCLUSIONS In regression tree modeling, family social class was the strongest predictor of executive function in adolescents with critical CHD, even in the presence of medical risk factors. Additional predictors included CHD diagnosis, birth weight, neurologic events, and number of procedures. These data highlight the importance of social class in mitigating risks of executive dysfunction in CHD.
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Affiliation(s)
- Amara Majeed
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Valerie Rofeberg
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital, Boston, MA; Department of Neurology, Harvard Medical School, Boston, MA
| | - David Wypij
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
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7
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Differential effects of educational and cognitive interventions on executive functions in adolescents. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Cavalli G, Galeoto G, Sogos C, Berardi A, Tofani M. The efficacy of executive function interventions in children with autism spectrum disorder: a systematic review and meta-analysis. Expert Rev Neurother 2021; 22:77-84. [PMID: 34821185 DOI: 10.1080/14737175.2022.2011215] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Children with Autism Spectrum Disorder (ASD) experience difficulties in Executive Functions (EFs) performance. However, the efficacy of EF intervention needs to be further investigated. OBJECTIVE To evaluate the efficacy of different EF interventions in children and adolescents with ASD. METHODS A systematic review and meta-analysis were carried out according to PRISMA guidelines. Relevant databases including PubMed, PsycINFO, Scopus, and Web of Science were searched up to November 2019. Papers included in the study have the following characteristics: randomized controlled trial or quasi-experimental design and published in English or Spanish. RESULTS After the elimination of duplicates, 949 were screened. Among these, six were included in the systematic review. The main approaches for EF in ASD were computer-based interventions, cognitive-behavioral therapy, and assisted-animal therapy. Statistically significant results (p = 0.003) were found in using exergames. CONCLUSION Different approaches can be used for improving EF intervention, with positive effects on working memory, behavior, and flexibility.
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Affiliation(s)
- Gioia Cavalli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,Neuromed IRCCS, Pozzilli (Isernia), Italy
| | - Carla Sogos
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marco Tofani
- Department of Neurorehabilitation and Robotics, Bambino Gesù Childrens Hospital, Rome, Italy
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Testing the Stability and Validity of an Executive Dysfunction Classification Using Task-Based Assessment in Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2021; 60:1501-1512. [PMID: 33346031 DOI: 10.1016/j.jaac.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/11/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE It is unclear if pediatric executive dysfunction assessed only with cognitive tasks predicts clinically relevant outcomes independently of psychiatric diagnoses. This study tested the stability and validity of a task-based classification of executive function. METHOD A total of 2,207 individuals (6-17 years old) from the Brazilian High-Risk Cohort Study participated in this study (1,930 at baseline, 1,532 at follow-up). Executive function was measured using tests of working memory and inhibitory control. Dichotomized age- and sex-standardized performances were used as input in latent class analysis and receiver operating curves to create an executive dysfunction classification (EDC). The study tested EDC's stability over time, association with symptoms, functional impairment, a polymorphism in the CADM2 gene, polygenic risk scores (PRS), and brain structure. Analyses covaried for age, sex, social class, IQ, and psychiatric diagnoses. RESULTS EDC at baseline predicted itself at follow-up (odds ratio [OR] = 5.11; 95% CI 3.41-7.64). Participants in the EDC reported symptoms spanning several domains of psychopathology and exhibited impairment in multiple settings, including more adverse school events (OR = 2.530; 95% CI 1.838-3.483). Children in the EDC presented higher attention-deficit/hyperactivity disorder and lower educational attainment PRS at baseline; higher schizophrenia PRS at follow-up; and lower chances of presenting a polymorphism in a gene previously linked to high performance in executive function (CADM2 gene). They also exhibited smaller intracranial volumes and smaller bilateral cortical surface areas in several brain regions. CONCLUSION Task-based executive dysfunction is associated with several validators, independently of psychiatric diagnoses and intelligence. Further refinement of task-based assessments might generate clinically useful tools.
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10
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Motamed Yeganeh N, King R, Boyd LA, Rose GM, Weber RC. Symbol relations training improves cognitive functioning in students with neurodevelopmental disorders. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:789-796. [PMID: 34464168 DOI: 10.1080/21622965.2021.1967154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Students with neurodevelopmental disorders [Specific Learning Disorders (SLD), Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD)] often experience learning challenges due to underlying weaknesses in cognitive processes. As these are some of the most common conditions to impact functioning, the development of effective treatments is a priority for neuropsychologists. However, the task of designing effective cognitive interventions has proven one of the most difficult challenges for our field. The Arrowsmith Program uses a novel approach compared to other cognitive intervention programs. We hypothesized that intensive practice of one aspect of this program would lead to improved cognitive functions in students with neurodevelopmental disorders. Twenty-seven students with neurodevelopmental disorders (ages 9.4-18.4 years) were recruited from Arrowsmith schools. Cognitive baseline and post-intervention data were gathered using components of the Woodcock-Johnson IV Tests of Cognitive Abilities. The intervention consisted of 6 weeks of intensive practice of the Symbol Relations Task. W-scores were used in a paired sample t-test analysis to determine if cognitive skill improvement occurred. Significant improvements were found in several measures of neuropsychological assessment, in particular in the Cattell-Horn-Carroll broad abilities These results provide a foundation for further work examining the utility of this novel approach to cognitive intervention.
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Affiliation(s)
- Negin Motamed Yeganeh
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, Canada
| | - Rachel King
- Department of Educational & Counselling Psychology & Special Education, The University of British Columbia, Vancouver, Canada
| | - Lara A Boyd
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Gregory M Rose
- Departments of Anatomy and Physiology, Southern Illinois University School of Medicine, Springfield, Missouri, United States
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Holingue C, Volk H, Crocetti D, Gottlieb B, Spira AP, Mostofsky SH. Links between parent-reported measures of poor sleep and executive function in childhood autism and attention deficit hyperactivity disorder. Sleep Health 2021; 7:375-383. [PMID: 33461914 PMCID: PMC8205962 DOI: 10.1016/j.sleh.2020.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to assess whether poor sleep is associated with aspects of executive function (EF) among children with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), or typical development (TD), after adjusting for demographic variables, stimulant medications, intelligence, anxiety, inattention, and hyperactivity. DESIGN Cross-sectional. SETTING Children recruited through ongoing studies at the Kennedy Krieger Institute. PARTICIPANTS We studied 735 children (323 TD; 177 ASD; 235 ADHD) aged 8 to 12 years. MEASUREMENTS We investigated associations of parent-reported sleep measures from the Children's Sleep Habits Questionnaire (CSHQ) with parent-report measures of EF and performance-based processing speed with each clinical population. EF was measured using 8 clinical T scores that fall under 2 domains (behavioral regulation and metacognition) from the Behavior Rating Inventory of EF (BRIEF) and the processing speed index from the Wechsler Intelligence Scale for Children-IV or -V. RESULTS Higher CSHQ scores were associated with poorer EF on all BRIEF scales, across all child groups, after adjustment for demographic factors, stimulant medications, and IQ. Among children with ADHD, these associations largely remained after adjusting for anxiety. Among those ASD, anxiety partially accounted for these associations, especially for behavioral regulation EF outcomes. Co-occurring symptoms of inattention and hyperactivity/impulsivity further accounted for the associations between sleep and EF. Poor sleep was not significantly associated with processing speed. CONCLUSIONS Strong links exist between parent-reported poor sleep and executive dysfunction in children with typical development. Targeting anxiety may alleviate executive dysfunction, especially among children with ASD.
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Affiliation(s)
- Calliope Holingue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA; Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.
| | - Heather Volk
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deana Crocetti
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Bridget Gottlieb
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stewart H Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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12
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Turner KM, Wilcox G, Nordstokke DW, Dick B, Schroeder M, Noel M. Executive Functioning in Youth With and Without Chronic Pain: A Comparative Analysis. Clin J Pain 2021; 37:102-117. [PMID: 33165021 DOI: 10.1097/ajp.0000000000000895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/26/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Preliminary research in youth with chronic pain suggests differences in attention and working memory, which has been similarly demonstrated in adults with chronic pain. There has been little research on other aspects of executive functioning (EF) in this population despite its critical role in problem solving, school functioning, and coping. This study aimed to examine differences in several aspects of EF between youth with chronic pain and a nonchronic pain comparison group using performance-based neuropsychological tests and a behavior rating scale. MATERIALS AND METHODS Participants completed ratings of pain; physical, emotional, social, and school functioning; sleep quality; medication; and a general intelligence screener. Standardized neuropsychological tests were used to examine EF with a focus on working memory, divided and alternating attention, inhibition, flexibility, incidental memory, and planning. A parent-report and self-report behavior rating of EF was also administered. RESULTS Recruitment from 2 tertiary-care pain clinics resulted in a sample of 26 youth with chronic pain (80.8% girls) and their parents. A comparison group of 30 youth without chronic pain and their parents were recruited from the community. Participants with chronic pain had significantly lower scores on several performance-based tests of working memory/divided attention, inhibition, and flexibility/alternating attention than the comparison group. Statistically significant group differences were also found on behavior ratings of emotion control, shifting, task initiation and completion, working memory, planning and organization, overall emotion and cognitive regulation as well as global EF. Covariate analysis was conducted in all analyses where there were significant group differences and several observed group differences remained. DISCUSSION This study is one of few multidimensional examinations of EF in youth with chronic pain, using a comprehensive neuropsychological test battery combined with behavior ratings. Our findings suggest EF differences in youth with chronic pain, across a variety of domains and may suggest risk for specific cognitive processing weaknesses in this population. Medical and educational teams should work toward identification, treatment, and compensatory support for EF within individualized pain management for youth.
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Affiliation(s)
- Kailyn M Turner
- Werklund School of Education, Educational Psychology
- Alberta Children's Hospital Research Institute, Alberta Children's Hospital
| | - Gabrielle Wilcox
- Werklund School of Education, Educational Psychology
- Hotchkiss Brain Institute
- Alberta Children's Hospital Research Institute, Alberta Children's Hospital
- Mathison Centre for Mental Health Research & Education, Calgary, AB
| | | | - Bruce Dick
- Departments of Anesthesiology & Pain Medicine
- Psychiatry
- Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Melanie Noel
- Hotchkiss Brain Institute
- Department of Psychology, University of Calgary, Calgary
- Alberta Children's Hospital Research Institute, Alberta Children's Hospital
- Mathison Centre for Mental Health Research & Education, Calgary, AB
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13
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Hahn-Markowitz J, Berger I, Manor I, Maeir A. Efficacy of Cognitive-Functional (Cog-Fun) Occupational Therapy Intervention Among Children With ADHD: An RCT. J Atten Disord 2020; 24:655-666. [PMID: 27637735 DOI: 10.1177/1087054716666955] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To examine the efficacy of a Cognitive-Functional (Cog-Fun) intervention for children with ADHD. Method: Random allocation of 107 children to study or control groups preceded 10 parent-child weekly Cog-Fun sessions emphasizing executive strategy training in games and daily activities. Controls received treatment after crossover. Study participants were followed up 3 months post-treatment. Outcomes included parent/teacher ratings of executive functions, ADHD symptoms, and parent ratings of quality of life. Results: Eight children withdrew prior to treatment. All children in both groups who began treatment completed it. Mixed effects ANOVA revealed significant Time × Group interaction effects on all parent-reported outcomes. Treatment effects were moderate to large, replicated after crossover in the control group and not moderated by medication. Parent-reported treatment gains in the study group were maintained at follow-up. No significant Time × Group interaction effects were found on teacher outcomes. Conclusion: Cog-Fun occupational therapy (OT) intervention shows positive context-specific effects on parent, but not teacher, ratings.
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Affiliation(s)
| | - Itai Berger
- Hadassah and the Hebrew University, Jerusalem, Israel.,Neuro-Cognitive Center, Jerusalem, Israel
| | - Iris Manor
- Geha Medical Center, Petah Tikva, Israel.,Tel Aviv University, Israel
| | - Adina Maeir
- Hadassah and the Hebrew University, Jerusalem, Israel
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Rantanen K, Vierikko E, Eriksson K, Nieminen P. Neuropsychological group rehabilitation on neurobehavioral comorbidities in children with epilepsy. Epilepsy Behav 2020; 103:106386. [PMID: 31645316 DOI: 10.1016/j.yebeh.2019.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 10/25/2022]
Abstract
Neurobehavioral comorbidities, particularly attention-deficits, are common in children with epilepsy (CWE). Neurobehavioral problems are manifested in school performance, peer relations, and social competence. Although the high prevalence of these comorbid behavioral problems is fully recognized, there remains to be a lack of studies on the interventions targeted for CWE. A manualized neuropsychological group intervention, Rehabilitation of EXecutive Function and ATtention (EXAT) has been developed for school-aged children (aged 6-12 years) with executive function (EF) and attention-deficits. This study aimed to explore the effects of EXAT on parent- and teacher-rated attention and behavior problems in CWE compared with children with the diagnosis of attention-deficit hyperactivity disorder (ADHD) and children with no formal diagnosis but prominent deficits in EF and attention. Forty-two children attending in neuropsychological group rehabilitation EXAT between the years 2006 and 2017 participated in this retrospective registry study. The CWE group consisted of 11 children, the ADHD group with 16 children, and EF/attention group consisted of 15 children with EF attention and/or problems without diagnosis of ADHD. The CWE group did not differ from the other two study groups (ADHD and no formal diagnosis) before the EXAT intervention. This indicates that attention problems in CWE are similar to those with diagnosed ADHD. The results were promising for applying structured multilevel intervention for CWE and neurobehavioral comorbidities. Lack of group differences between the groups participating EXAT suggests similar intervention effects between CWE, ADHD, and those with less severe EF and attention problems. In parent ratings, intervention effects were higher in hyperactivity and oppositional behavior for children with attention problems and without epilepsy. Parents in the CWE group reported no effects except for one subscale related to hyperactivity. However, teachers reported consistently positive intervention effects for both inattention and hyperactivity-impulsivity along with anxiety and emotional lability. The results suggest that neurobehavioral comorbidities in CWE could be targeted in neuropsychological group intervention. In conclusion, CWE seem to benefit from interventions and behavior modification techniques first developed for children with ADHD.
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Affiliation(s)
- Kati Rantanen
- Tampere University Hospital, Department of Pediatrics, Finland; Tampere University, Faculty of Social Sciences, Finland.
| | | | - Kai Eriksson
- Tampere Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Pediatric Neurology, Tampere University Hospital, Finland
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Puhr A, Ruud E, Anderson V, Due-Tønnessen BJ, Skarbø AB, Finset A, Andersson S. Social attainment in physically well-functioning long-term survivors of pediatric brain tumour; the role of executive dysfunction, fatigue, and psychological and emotional symptoms. Neuropsychol Rehabil 2019; 31:129-153. [PMID: 31603026 DOI: 10.1080/09602011.2019.1677480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this cross-sectional study was to investigate long-term social attainment in physically well-functioning adult survivors of pediatric brain tumour (PBT) and identify demographic, medical, and psychological factors related to poor social outcomes, with a special focus on the significance of executive dysfunction. One hundred and fourteen PBT survivors and a healthy control group provided personal data on social outcomes, i.e., education, work, and government benefits, and completed questionnaires on executive function (EF), psychological and emotional difficulties, and fatigue. A significantly higher number of survivors compared to healthy controls reported having received educational adjustments and substantial government benefits, and significantly more survivors than controls were currently not engaged in regular employment/training. PBT survivors and healthy controls did not differ on educational level or living situation. The factors most strongly associated with poor social outcomes were self-reported executive dysfunction, difficulties with adaptive functioning, and fatigue. The findings show that physically well-functioning PBT survivors are at risk of poorer social outcomes and financial dependence in adulthood compared to their healthy peers, and underline the importance of investigating EF in short- and long-term follow-ups. Future rehabilitation efforts should focus more on compensatory strategies for executive dysfunction and improving EF skills.
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Affiliation(s)
- Anita Puhr
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Ellen Ruud
- Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vicki Anderson
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | | | - Anne-Britt Skarbø
- Department of Pediatric Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Stein Andersson
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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Givon Shaham N, Sternberg S, Rand D. Executive Functioning of Older Adults Correlates with Performance of Touchscreen App-Based Puzzles. Games Health J 2018; 7:271-276. [PMID: 30106643 DOI: 10.1089/g4h.2017.0118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of touchscreen tablets has become common in healthcare. This technology has the potential to be used as a motivational tool for cognitive training. Age-related decline in executive functioning (EF) and dexterity may lead to poor performance using tablet applications (apps), but the impact on performance of app-based puzzles has not been studied. OBJECTIVES (1) To characterize and compare the experience performance of playing tablet apps of older and younger adults, (2) To determine if EF and dexterity contribute to performance of app-based puzzles. MATERIALS AND METHODS We performed a cross-sectional study of community-dwelling healthy older (n = 35) and younger adults (n = 34). EF was measured by the Trail Making Test (part B) (TMT-B) and the Weekly Calendar Planning Activity. Dexterity was assessed using the Nine-Hole Peg Test. Participants played three unfamiliar app-based puzzles requiring EF and filled out the short feedback questionnaire. RESULTS All participants succeeded in playing the apps and reported enjoyment, however, older adults perceived less success and control. Significant differences in EF, dexterity, and performance were found between groups. EF of older adults (TMT-B) accounted for 17.7%-36.8% (P < 0.05) of the total variance of performance. CONCLUSION These findings have implications for the use of tablet apps for older adults. Longer instruction and training periods may be required for training EF among older adults.
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Affiliation(s)
- Noa Givon Shaham
- 1 Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Shelley Sternberg
- 2 Department of Geriatric Services, Ministry of Health , Jerusalem, Israel
| | - Debbie Rand
- 1 Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
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Rantanen K, Vierikko E, Nieminen P. Effects of the EXAT neuropsychological multilevel intervention on behavior problems in children with executive function deficits. Scand J Psychol 2018; 59:483-495. [PMID: 30001471 DOI: 10.1111/sjop.12468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
This is a clinical intervention study of children with executive function (EF) deficits. A neuropsychological multimodal group intervention called EXAT (rehabilitation of EXecutive function and ATtention) was developed at the Psychology Clinic of the University of Tampere. Based on the principles of neuropsychological rehabilitation and behavioral modification, EXAT combines child group training, parent training, and teacher consultations. The aims of this study were to investigate behavior problems before and after the intervention in children attending EXAT and in controls, and to compare intervention effects in hyperactive, inattentive, and EF subgroups based on the primary deficit described in the referral. The participants were 86 children (6-12 years) with a mean IQ of 91.4 attending EXAT and 45 controls. The participants' parents and teachers completed the Conners' Rating Scales-Revised. In addition, the Strengths and Difficulties Questionnaire was completed by the parents attending EXAT. The parents reported statistically significant decreases with medium effect sizes for the CPRS-R subscales for impulsivity, hyperactivity, and oppositional behavior. In the controls within the same time interval, there was increase in restless and impulsive behavior, and a decrease in total problems. The teachers reported positive changes after the intervention in ADHD symptoms and anxiousness/shyness, but the effects sizes were small. The intervention effects were larger in the hyperactive subgroup. Positive intervention effects were related to a younger age, lower IQ, and simultaneous learning support. In conclusion, EXAT - a structured multilevel group intervention - has positive effects on children's behavior regulation skills by decreasing impulsivity and restless behavior.
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Affiliation(s)
- Kati Rantanen
- University of Tampere, Faculty of Social Sciences, Psychology Clinic, Finland.,Tampere University Hospital, Department of Paediatrics, Finland
| | - Elina Vierikko
- University of Tampere, Faculty of Social Sciences, Psychology Clinic, Finland
| | - Pirkko Nieminen
- University of Tampere, Faculty of Social Sciences, Psychology Clinic, Finland
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Benzing V, Schmidt M, Jäger K, Egger F, Conzelmann A, Roebers CM. A classroom intervention to improve executive functions in late primary school children: Too 'old' for improvements? BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2018; 89:225-238. [PMID: 29947142 DOI: 10.1111/bjep.12232] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 04/26/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Given the strong relationship between executive functions and academic achievement, there has been great interest in improving executive functions. School-based group interventions targeting executive functions revealed encouraging results in preschoolers and young school children; however, there is a paucity of studies in older primary school children (age 10-12). This is surprising considering that deficits in executive function performance can often be observed in this age group. AIMS Therefore, the aim of this study was to examine whether an innovative customized school-based group intervention could improve core executive functions (updating, inhibition, and shifting) in the age group concerned. SAMPLE In total, 118 ten- to twelve-year-old school children were recruited from eight participating classes. METHODS They were randomly assigned to one of two-six-week conditions of either a cognitive games group comprising of card and board games training executive functions (experimental group) or a wait-list control group (regular school lessons). In the cognitive games group, the class teachers held a 30-min training session twice a week. ANCOVAs (using pre-test values as covariate) were used to compare executive function performance between groups. RESULTS Results revealed that the cognitive games group improved specific executive functions (updating and shifting) compared to the control group. These findings indicate that a school-based group intervention can improve executive functions, even in 'older' primary school children. CONCLUSION This study provides empirical evidence for the effectiveness of a classroom-based cognitive training in older primary school children and is of practical relevance for educators.
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Affiliation(s)
| | - Mirko Schmidt
- Institute of Sport Science, University of Bern, Switzerland
| | - Katja Jäger
- Department of Psychology, University of Bern, Switzerland
| | - Fabienne Egger
- Institute of Sport Science, University of Bern, Switzerland
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Cambron C, Kosterman R, Catalano RF, Guttmannova K, Herrenkohl TI, Hill KG, Hawkins JD. The Role of Self-Regulation in Academic and Behavioral Paths to a High School Diploma. JOURNAL OF DEVELOPMENTAL AND LIFE-COURSE CRIMINOLOGY 2017; 3:304-325. [PMID: 30221127 PMCID: PMC6136652 DOI: 10.1007/s40865-017-0066-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 08/11/2017] [Accepted: 08/16/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Christopher Cambron
- Social Development Research Group, School of Social Work, University of Washington
| | - Rick Kosterman
- Social Development Research Group, School of Social Work, University of Washington
| | - Richard F. Catalano
- Social Development Research Group, School of Social Work, University of Washington
| | | | - Todd I. Herrenkohl
- Social Development Research Group, School of Social Work, University of Washington
| | - Karl G. Hill
- Social Development Research Group, School of Social Work, University of Washington
| | - J. David Hawkins
- Social Development Research Group, School of Social Work, University of Washington
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Executive Function, Social Emotional Learning, and Social Competence in School-Aged Boys With Autism Spectrum Disorder. CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2017. [DOI: 10.1177/0829573517707907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Autism Spectrum Disorder (ASD) is an aetiologically complex neurodevelopmental disorder characterized by deficits in social functioning. Children with ASD display a wide range of social competence and more variability in social domains as compared with either communication or repetitive behaviour domains. There is limited understanding of factors that contribute to the heterogeneity of social abilities in ASD. A modified version of McKown and colleagues’ social competence model was used to examine social competence in 49 8- to 13-year-old boys with ASD without cognitive disability. The relations between executive function (EF), social emotional learning (SEL), and parent reports of child social competence were examined. Results showed that EF but not SEL predicted parent-reported child social competence. Although many interventions target SEL skills, these findings support specifically targeting EF in both assessment and interventions of school-aged children with ASD.
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Stern A, Malik E, Pollak Y, Bonne O, Maeir A. The Efficacy of Computerized Cognitive Training in Adults With ADHD: A Randomized Controlled Trial. J Atten Disord 2016; 20:991-1003. [PMID: 24756172 DOI: 10.1177/1087054714529815] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This is a randomized control trial examining the efficiency of computerized cognitive training (CCT) for adults with ADHD, comparing two training conditions with graded levels of executive cognitive demands. METHOD Adults with ADHD (n = 60) were randomized into study (n = 34) and control (n = 26) groups. Training was conducted with the computerized AttenFocus program. Control group received a simple, non-hierarchical version with less executive demands. RESULTS Significant positive changes in symptoms ratings, ecological measures of executive functions, and occupational performance were found in both groups. No significant changes were found in variables of neurocognitive performance battery and quality of life. No significant time by group interaction effects were found. CONCLUSION No benefits of the intervention were found relative to the control. Lack of interaction effects may be due to insufficient power, non-specific cognitive training or placebo effects. Results demonstrate some positive findings for general CCT, yet do not support the inclusion of specific higher level executive training.
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Affiliation(s)
- Adi Stern
- School of Occupational Therapy, Hadassah and Hebrew University of Jerusalem, Israel .,Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
| | - Elad Malik
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
| | - Yehuda Pollak
- Shaare Zedek Medical Center, Jerusalem, Israel.,Hebrew University of Jerusalem, Israel
| | - Omer Bonne
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
| | - Adina Maeir
- School of Occupational Therapy, Hadassah and Hebrew University of Jerusalem, Israel
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Diamond A, Ling DS. Conclusions about interventions, programs, and approaches for improving executive functions that appear justified and those that, despite much hype, do not. Dev Cogn Neurosci 2016; 18:34-48. [PMID: 26749076 PMCID: PMC5108631 DOI: 10.1016/j.dcn.2015.11.005] [Citation(s) in RCA: 438] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/26/2015] [Accepted: 11/23/2015] [Indexed: 12/26/2022] Open
Abstract
The 'Executive Functions' (EFs) of inhibitory control, working memory, and cognitive flexibility enable us to think before we act, resist temptations or impulsive reactions, stay focused, reason, problem-solve, flexibly adjust to changed demands or priorities, and see things from new and different perspectives. These skills are critical for success in all life's aspects and are sometimes more predictive than even IQ or socioeconomic status. Understandably, there is great interest in improving EFs. It's now clear they can be improved at any age through training and practice, much as physical exercise hones physical fitness. However, despite claims to the contrary, wide transfer does not seem to occur and 'mindless' aerobic exercise does little to improve EFs. Important questions remain: How much can EFs be improved (are benefits only superficial) and how long can benefits be sustained? What are the best methods for improving EFs? What about an approach accounts for its success? Do the answers to these differ by individual characteristics such as age or gender? Since stress, sadness, loneliness, or poor health impair EFs, and the reverse enhances EFs, we predict that besides directly train EFs, the most successful approaches for improving EFs will also address emotional, social, and physical needs.
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Affiliation(s)
- Adele Diamond
- Program in Developmental Cognitive Neuroscience, Department of Psychiatry, UBC, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1.
| | - Daphne S Ling
- Program in Developmental Cognitive Neuroscience, Department of Psychiatry, UBC, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
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Structure of executive functions in typically developing kindergarteners. J Exp Child Psychol 2015; 140:120-39. [DOI: 10.1016/j.jecp.2015.07.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 11/22/2022]
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Otero TM, Barker LA, Naglieri JA. Executive Function Treatment and Intervention in Schools. APPLIED NEUROPSYCHOLOGY-CHILD 2014; 3:205-14. [DOI: 10.1080/21622965.2014.897903] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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