Executive dysfunction in children with early brain disease: Outcomes postHaemophilus influenzaemeningitis

Haemophilus influenzae type b vaccination and anthropometric, cognitive, and schooling outcomes among Indian children

Haemophilus influenzae type b (Hib) affects 337,000 Indian children every year. A vaccine against Hib was introduced in 2011 as part of the pentavalent vaccine and scaled up nationwide. This study investigated the associations between Hib vaccination and child anthropometry, cognition, and schooling outcomes in India. We used longitudinal survey data and employed propensity score matching to control for observed systematic differences between children who reported receipt or nonreceipt of Hib vaccine before age 6 years (n = 1824). Z-scores of height-for-age (HAZ) and BMI-for-age (BMIZ), percentage scores of English, mathematics, reading, and Peabody Picture Vocabulary tests, and attained schooling grade of children were examined. Hib-vaccinated children had 0.25 higher HAZ, scored 4.09 percentage points (pp) higher on the English test and 4.78 pp higher on the mathematics test, and attained 0.16 more schooling grades than Hib-unvaccinated children at age 11-12 years. At age 14-15 years, they had 0.18 higher HAZ, scored 3.63 pp higher on the reading test and 3.22 pp higher on the mathematics test, and attained 0.15 more schooling grades than Hib-unvaccinated children. The findings indicate potential long-term health, cognitive, and schooling benefits of the Hib vaccine, subject to the effect of unobserved confounding factors.

Neuropsychological testing in a rural African school-age population: evaluating contributions to variability in test performance

This study investigated the psychometric properties of a number of neuropsychological tests adapted for use in sub-Saharan Africa. A total of 308 school-age children in a predominantly rural community completed the tests. These tests were developed to assess skills similar to those measured by assessments of cognitive development published for use in Western contexts. Culturally appropriate adaptations were made to enhance within-population variability. Internal consistency ranged from .70 to .84. Scores on individual tests were related to various background factors at the level of the child, household, and neighborhood. School experience was the most consistent predictor of outcome, accounting for up to 22.9% of the variance observed. Significant associations were identified to determine salient background characteristics that should be taken into account when measuring the discrete effects of disease exposure in similar sociocultural and economic settings.

Developmentally sensitive measures of executive function in preschool children

Changes in executive functioning in the preschool years are recognized as playing a critical role in cognitive and social development, yet comprehensive data and recommendations about measurement of these changes are lacking. The performance of 602 preschool children on several executive function tasks was analyzed and reported as (a) age trends in performance and (b) task difficulty scales at 2, 3, 4, and 5 to 6 years of age. This analysis informs theories of executive function development and offers researchers an evidence-based guide to task selection and design.

Longitudinal outcomes of very low birth weight: neuropsychological findings

To investigate the effects of very low birth weight (VLBW, &1500 g) on the development of neuropsychological skills, we assessed 67 children with birth weight <750 g, 64 with birth weight 750-1499 g, and 67 term-born controls. Growth modeling of raw scores from mean ages 7-14 years revealed persistent VLBW sequelae. Even when adjusting for IQ, the <750 g group scored more poorly than the term-born group on measures of language processing, verbal list learning, and perceptual-motor and organizational abilities. This group also made slower age-related progress than the control group on tests of perceptual-motor and executive functions. Environmental factors moderated group differences in change on other cognitive measures. These results revealed further evidence for slower skill development in both VLBW groups relative to controls, as well as"catch-up" growth in the 750-1499 g group on some measures. The findings suggest age-related changes in the cognitive sequelae of VLBW that depend on the skill assessed, the degree of VLBW, and environmental factors.

Assessing cognitive outcomes in a rural African population: development of a neuropsychological battery in Kilifi District, Kenya

The ability to measure neuropsychological outcomes in a comparable manner in different cultural groups is important if studies conducted in geographically diverse regions are to advance knowledge of disease effects and moderating influences. The purpose of this study was to evaluate the application of neuropsychological test procedures developed for use in North America and Europe to children in a rural region of Kenya. Our specific aim was to determine if these methods could be adapted to a non-Western culture in a manner that would preserve test reliability and validity. Procedural modifications yielded reliable tests that were sensitive to both the sequelae of cerebral malaria and to children's social and school backgrounds. Results suggest that adaptations of existing tests can be made in such a way as to preserve their utility in measuring the cross-cultural sequelae of childhood neurological diseases.

Differential development of attention and executive functions in 3- to 12-year-old Finnish children

The developmental sequence of attention and executive functions (EFs) was studied by utilizing normative data from four hundred 3- through 12-year-old Finnish children. Data from 10 subtests measuring impulse control and inhibition of irrelevant responses, auditory and visual attention, visual search, planning, and verbal and visual fluency were included. The development proceeded sequentially, from motor inhibition and impulse control to functions of selective and sustained attention, and finally to EFs of fluency. Significant relations between gender and development and between parent education and development were found in several subtests. In a factor analysis, inhibition, auditory attention, visual attention, and the EF of fluency clustered into separate factors. The developmental staging and clustering of functions suggests that, although inhibition, attention, and EFs are highly interrelated cognitive functions, their developmental sequences are separate from one another. The development of basic inhibitory functions precedes the development of more complex functions of selective attention, and EFs continue to develop into adolescence.

Adolescent neuropsychological development after early right prefrontal cortex damage

Adolescent development and pattern of recovery are described for a 15-year-old boy who sustained extensive right dorsolateral prefrontal cortex damage at age 7 from rupture and surgical treatment of a deep arteriovenous malformation. Follow-up evaluations at 4 years and most recently 8 years after illness have shown clear improvement in social-behavioral and almost all cognitive areas initially assessed. He demonstrated resolution of left hemispatial neglect and other visuospatial impairments in working memory, design fluency, and planning and organization. However, at the 8-year follow-up interval, an acquired form of attention deficit disorder remains evident. We hypothesized that this is the likely cause of comparatively lower scores in general intelligence, verbal learning and memory, discourse, and processing speed, that at the 4-year follow-up interval. New measures of emotional face and voice recognition showed only minor difficulties, principally in identifying vocal disgust and fear. Social and psychological maturation has continued to improve, with no evidence of developmental arrest or pervasive social impairment, although the individual is confused at times by complexities and nuances of social interaction. The pattern of findings 8 years after early right dorsolateral prefrontal cortex damage suggests remarkable recovery of primary visuospatial and social impairments, but lingering and somewhat worsening performance deficits which may be due to attentional difficulties and impulsive responding. Treatment of the attentional difficulties is currently being investigated.

An intervention for children with disorders of executive functions

This article describes a cognitive-behavioral approach to teaching metacognitive executive thinking strategies to children with disorders of executive function. The intervention is based on the notion that some children with disorders of executive function have disorders of higher level language, which predispose them to the executive impairments. It is proposed that teaching and reinforcing metacognitive thinking strategies may help advance verbal mediation of complex tasks and self-regulation of behavior. Despite the growing literature on developmental executive disorders, little has been written about interventions that may enable the children to acquire some of the requisite adaptive skills. The ideas expressed herein should be considered an invitation for the initiation of empirical studies of intervention and outcome effects.

Frontal MRI findings associated with impairment on the Executive Interview (EXIT25)

We examined the association between the Executive Interview (EXIT25), a bedside measure of executive control, and regional magnetic resonance imaging (MRI) pathology among 52 consecutive geriatric patients presenting to a university dementia assessment clinic. Left frontal (p < .002), left medial (p < .03), right frontal (p < .02), and right medial (p < .02) cortical lesions significantly worsened EXIT25 scores, even after adjusting for age, global cognitive impairment (on the Mini-Mental State Examination), and the severity of cortical dementia on the Qualitative Evaluation of Dementia [QED]. The EXIT25's associations with right hemisphere lesions did not persist after adjusting for left frontal lesions. Left posterior lesions did not significantly affect the EXIT25. Similarly, left frontal circuit pathology worsened EXIT25 scores (p < .05). Pathology in left anterior subcortical structures showed a trend (p = .052). EXIT25 scores were not affected by right subcortical pathology, nor by pathology in either hippocampus. We conclude that the EXIT25 is specifically affected by frontal system MRI lesions, particularly on the left. This conclusion is consistent with earlier functional neuroimaging studies associating EXIT25 performance with left mesiofrontal perfusion.

Development of the pediatric test of brain injury

OBJECTIVE

The Pediatric Test of Traumatic Brain Injury (PTBI) (currently in its research edition) is a tool for assessing the cognitive-linguistic skills of school-aged children and adolescents in acute care and rehabilitation settings after traumatic brain injury. Development of the PTBI was motivated by the fact that, to date, no standardized test has been available to assess the full range of cognitive-linguistic impairments associated with pediatric brain injury. In this article we describe how the research edition of the PTBI was developed, provide rationale for the areas of assessment, discuss a plan for standardization, and illustrate its use with three children with TBI.

DESIGN

The PTBI was constructed to sample the attention, memory, language, reading, writing, metalinguistic, and metacognitive skills that are particularly at risk in pediatric brain injury and that are relevant to the general education curriculum.

MATERIAL

The test material for the PTBI was selected on the basis of clinical and experimental evidence that children and adolescents with TBI demonstrate a wide range of cognitive and language deficits. These first appear in the early stages of recovery and often persist but change over time.

CONCLUSION

Our goal is to standardize the PTBI so it can be used to establish baseline behaviors and track cognitive-linguistic recovery.

Joint Working between Occupational Therapy and Clinical Psychology in a School Setting: A Neurorehabilitation Case Study of a Child with an Acquired Developmental Disability

This article presents a case study of the assessment and treatment of an 8-year-old boy with developmental disabilities following meningitis. It aims to explore the extent to which clinical child psychologists and paediatric occupational therapists share a common frame of reference that enables them to work jointly, in an effective and complementary way, to improve clinical standards.

Following a combined programme of intervention, the outcome assessment showed significant improvement in the specific components of visual attention and visual search. However, more generalised improvement in daily living skills was not apparent. The implications for joint working between health professionals and for collaboration with teachers are discussed.

Utility of kindergarten teacher judgments in identifying early learning problems

Most existing research on early identification of learning difficulties has examined the validity of methods for predicting future academic problems. The present study focused instead on the sensitivity of kindergarten teachers to learning problems in their students and on the continuity of teacher-identified problems over time. To identify early learning problems, kindergarten teachers in a suburban school district rated student progress toward six academic objectives as satisfactory or unsatisfactory. Twenty percent of the district's 303 kindergarten children received unsatisfactory ratings in at least one area. Thirty-eight of these children (identified group) were matched to 34 children with satisfactory ratings in all areas (nonidentified group). Results of testing conducted during kindergarten revealed poorer academic achievement in identified children than in nonidentified children. Children from the identified group also performed more poorly than children from the nonidentified group on tests of phonological processing and working memory/executive function and were rated by teachers as having more behavior and attention problems and lower social competence. Follow-up of the sample to first grade documented continued learning problems in the identified group. These findings support the use of teacher judgements in early detection of learning problems and argue against reliance on discrepancy criteria.

Acute-phase neurologic complications of Haemophilus influenzae type b meningitis: association with developmental problems at school age

The purposes of this study were to describe the incidence of acute-phase neurologic complications in a sample of 126 children with Haemophilus influenzae type b meningitis, and to determine if these complications were associated with higher rates of learning and behavior problems at school age. Risks were assessed by comparing rates of adverse psychoeducational outcomes in the 53 children in the sample with complications to corresponding outcome rates in the 67 children who were free of neurologic complications and who did not have abnormal electroencephalograms (EEGs) or computed tomographic (CT) scans. Comparisons were made by means of logistic regression analysis. Twenty-nine children (23% of the sample) had seizures, 16 (13%) were comatose or obtunded, 15 (12%) had sensorineural hearing loss, 8 (6%) had hemiparesis, and 7 (6%) had cranial nerve deficits other than hearing loss. Relative to children without complications, those with complications had higher rates of grade repetition and substandard performance on neuropsychological and achievement testing. Adverse outcomes, however, consisted primarily of more subtle cognitive and learning problems; only two of the children in the sample obtained prorated IQ scores below 70. Sequelae were associated with persistent neurologic deficits and bilateral hearing loss, as well as with transient symptoms including seizures, coma, and hemiparesis. While study findings argue against adverse consequences for the vast majority of children treated for this disease, the results clarify learning and behavior outcomes and indicate which children are at greatest risk.