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Tamm L, Hamik EM, Zoromski AK, Duncan A. Use of the Weekly Calendar Planning Activity to Assess Executive Function in Adolescents With Autism Spectrum Disorder. Am J Occup Ther 2024; 78:7801205040. [PMID: 38206796 PMCID: PMC10846385 DOI: 10.5014/ajot.2024.050295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
IMPORTANCE Youths with autism spectrum disorder (ASD) have challenges with executive function (EF). However, there are few measures to objectively assess EF, such as time management and prioritization. The Weekly Calendar Planning Activity (WCPA) is a promising performance-based EF measure that has rarely been used with youths with ASD. OBJECTIVE To characterize the performance of youths with ASD on the WCPA and the association of WCPA performance with caregiver-rated EF. DESIGN Observational and summary data obtained during a baseline evaluation for a research study. SETTING Middle school. PARTICIPANTS Thirty-nine adolescents with ASD and without an intellectual disability. METHOD Youth were administered the WCPA; caregivers completed EF ratings. Descriptive statistics characterized WCPA performance. Correlations between WCPA scores and age, IQ, and EF ratings were computed. RESULTS The majority of youth performed poorly on the WCPA and lacked insight into their poor performance. Many struggled to enter appointments. Appointment accuracy was <30%. The most common errors were location errors. Appointment accuracy and planning time were moderately associated with IQ but not with caregiver-rated EF or age. CONCLUSIONS AND RELEVANCE Overall, the WCPA was cognitively demanding for youths with ASD without an intellectual disability. These results have implications for using evidence-based strategies to teach adolescents with ASD how to manage their time and plan and prioritize homework assignments, upcoming tests or quizzes, and extracurricular activities. Plain-Language Summary: Youths with autism spectrum disorder have significant problems with executive function, particularly organization, prioritization, time management, and planning. There are few objective, performance-based measures of executive function, especially those that can be used with autistic youths. To our knowledge, this study is the first to use the Weekly Calendar Planning Activity (WCPA) with autistic adolescents who do not have an intellectual disability. The WCPA captured their deficits related to executive function and could be a useful tool for assessment and treatment planning.
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Affiliation(s)
- Leanne Tamm
- Leanne Tamm, PhD, is Professor, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH;
| | - Elizabeth M Hamik
- Elizabeth M. Hamik, BA, is Clinical Research Coordinator, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Allison K Zoromski
- Allison K. Zoromski, PhD, is Associate Professor, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Amie Duncan
- Amie Duncan, PhD, is Associate Professor, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH
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2
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Giles GM, Marks TS, Edwards DF. Loss-of-Set and Strategy Application on the Menu Task: An Exploratory Study. Can J Occup Ther 2023; 90:413-422. [PMID: 37218122 DOI: 10.1177/00084174231175018] [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] [Indexed: 05/24/2023]
Abstract
Background. The Menu Task (MT) is an occupational therapy screening measure designed to identify people in need of functional cognitive (FC) assessment. Purpose. To explore whether test-taker strategy selection on the MT is clinically informative. Methods. Using a cross-sectional design we administered assessments of FC including the MT and the After MT interview, cognitive screening measures, and self-report instrumental activities of daily living assessment to a convenience sample of 55 community-dwelling adults. After MT interviews responses were qualitatively characterized as (a) loss of set (e.g., not recognizing that food preferences are irrelevant to task performance), (b) calorie counting, or (c) planning. Findings. Loss of set was associated with poorer performance on most study measures, calorie counting was associated with superior performance on most study measures, and no differences were observed relating to planning. Implications. Determining the test-takers approach to the MT adds information to that provided by the MT itself.
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3
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Tamm L, Hamik E, Yeung TS, Zoromski AK, Mara CA, Duncan A. Achieving Independence and Mastery in School: A School-Based Executive Function Group Intervention for Autistic Middle Schoolers. J Autism Dev Disord 2023:10.1007/s10803-023-06164-7. [PMID: 37991661 DOI: 10.1007/s10803-023-06164-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/23/2023]
Abstract
Executive functioning (EF) deficits, such as challenges with planning, organization, and materials management, negatively impact academic performance, particularly for middle-school students with autism spectrum disorder (ASD) without intellectual disability (ID). The aim was to assess the initial efficacy of the school-based version of the Achieving Independence and Mastery in School (AIMS) intervention in a pilot randomized clinical trial. 47 autistic middle-schoolers without ID attending nine different schools were randomized to participate in AIMS or to wait to receive AIMS the following semester (waitlist control = WLC). Youth, caregivers, and teachers rated academic EFs and academic functioning, and youth completed an objective EF measure, at baseline and outcome (post). Effect sizes were computed comparing baseline and post measures within each group. Individuals randomized to AIMS improved from baseline to post on academic EF outcome measures with small to moderate effect sizes, compared to WLC, who made some improvements but with generally smaller effect sizes. Analyses with academic functioning measures showed a similar pattern of results. These promising results suggest that AIMS delivered in the school by school-based personnel to small groups of students with ASD without ID can improve academic EF skills.
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Affiliation(s)
- Leanne Tamm
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Department of Pediatrics, Center for ADHD, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 10006, Cincinnati, OH, 45229-3039, USA.
| | - Elizabeth Hamik
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Eastern Michigan University, Ypsilanti, MI, USA
| | - Tat Shing Yeung
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Allison K Zoromski
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Constance A Mara
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amie Duncan
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Arvidsson P, Janeslätt G, Wennberg B, Lidström-Holmqvist K, Holmefur M, Hayat Roshanay A. Evaluation of the group intervention "Let's Get Organized" for improving time management, organisational, and planning skills in people with mild intellectual disability. Scand J Occup Ther 2023; 30:1257-1266. [PMID: 37278986 DOI: 10.1080/11038128.2023.2217545] [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: 09/14/2022] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Limited time management skills cause problems in daily life for people with mild intellectual disability (ID) and "Let's Get Organized" (LGO) is a promising manual-based occupational therapy group intervention aiming to support management skills. AIMS/OBJECTIVES To evaluate the applicability of the Swedish version of LGO-S by i) exploring enhancements in time management skills, satisfaction with daily occupations, and aspects of executive functioning in people with time-management difficulties and mild ID, and ii) describing clinical experiences of using the LGO-S for people with mild ID. MATERIAL AND METHODS Twenty-one adults with mild ID were included. Data were collected pre-/post-intervention and at 3- and 12-month follow-ups with: Swedish version of Assessment of Time Management Skills (ATMS-S), Satisfaction with Daily Occupation (SDO-13), and Weekly Calendar Planning Activity (WCPA-SE). There were few follow-up participants (n = 6-9). RESULTS Significant change in time management skills that maintained at 12-months follow-ups. Significant increase in regulation of emotions at 12-month follow-up. Results at 12-months follow-up indicated sustainability in outcomes as measured by ATMS-S. A non-significant positive trend was observed in other outcomes between pre- and post-intervention. CONCLUSIONS AND SIGNIFICANCE LGO-S seems applicable for improving skills in time management, organisation and planning also for people with mild ID.
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Affiliation(s)
- Patrik Arvidsson
- Centre for Research & Development, Region Gävleborg, Gävle, Sweden
- School of Health and Welfare, Disability Research, Jönköping University, Jönköping, Sweden
| | - Gunnel Janeslätt
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research in Dalarna, Uppsala University, Sweden
| | - Birgitta Wennberg
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Marie Holmefur
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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5
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Fogel Y. Cognitive Strategies: Moderating the Relationship between Executive Functions and Daily Functioning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16845. [PMID: 36554722 PMCID: PMC9778739 DOI: 10.3390/ijerph192416845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Whereas prior studies have addressed relationships between cognitive strategies and learning and achievement, very few dealt with their connection to daily functioning. This study examines the moderation effect of the frequency of compensatory cognitive strategy use within that relationship among university students. A sample of 336 students (18-36 years; 180 women, 156 men) answered the Dysexecutive Questionnaire (DEX; executive function components), Time Organization and Participation Scale (TOPS; daily functioning), and Compensatory Cognitive Strategies Scale (CCSS; strategy use). The results showed significant correlations between the DEX and TOPS for three CCSS levels (-1.0, -1.0 to 1.0, and 1.0 SD from average); the higher the frequency of cognitive strategy use, the stronger the association between the DEX and TOPS. The findings suggest that more frequently use of cognitive strategies can strengthen efficient daily functioning.
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Affiliation(s)
- Yael Fogel
- Department of Occupational Therapy, Ariel University, Ariel 40700, Israel
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6
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Fisher O, Berger I, Grossman ES, Tal-Saban M, Maeir A. Weekly Calendar Planning Activity (WCPA): Validating a Measure of Functional Cognition for Adolescents With Attention Deficit Hyperactivity Disorder. Am J Occup Ther 2022; 76:23975. [PMID: 36485012 DOI: 10.5014/ajot.2022.049028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Adolescents with attention deficit hyperactivity disorder (ADHD) often experience difficulties with executive function and participation in life roles. Ecologically valid performance-based tests (PBTs) are needed to assess functional cognition in this population. OBJECTIVE To examine the known-groups, concurrent, and ecological validity of a functional cognition PBT, the Hebrew version of the Weekly Calendar Planning Activity (WCPA) Middle/High School Version, among adolescents with and without ADHD. DESIGN Cross-sectional between-groups design. SETTING Community. PARTICIPANTS One hundred two adolescents (ages 12-18 yr), with (n = 52) and without (n = 50) ADHD. OUTCOMES AND MEASURES The Hebrew version of the WCPA Middle/High School Version, MOXO™-Continuous Performance Test (MOXO-CPT), Behavior Rating Inventory of Executive Function (BRIEF) parent form, and Child and Adolescent Scale of Participation (CASP). RESULTS The results showed significant between-groups differences with medium to large effect sizes for scores on most WCPA measures, with the ADHD group receiving significantly lower scores. Significant correlations in the expected direction were found between scores on the MOXO-CPT Attention and Hyperactivity indices and WCPA measures. Significant correlations were also found between most WCPA measures and the BRIEF Global Executive Composite (GEC) and the CASP. Multiple linear regression on the CASP indicated that the WCPA strategy score and the BRIEF GEC were significant predictors in the model. CONCLUSIONS AND RELEVANCE Results support the known-groups validity of the WCPA Middle/High School Version between adolescents with and without ADHD. Concurrent and ecological validity were supported by significant associations with measures of cognition and participation. What This Article Adds: These results reinforce the premise that the WCPA Middle/High School Version can be implemented as a valid measure of functional cognition among adolescents with ADHD.
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Affiliation(s)
- Orit Fisher
- Orit Fisher, PhD, OT, is Occupational Therapist and Lecturer, School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel;
| | - Itai Berger
- Itai Berger, MD, is Professor, Paul Baerwald School of Social Work and Social Welfare, Hebrew University, Jerusalem, Israel, and Head, Pediatric Neurology Service, Assuta-Ashdod University Medical Center, Ashdod, Israel
| | - Ephraim S Grossman
- Ephraim S. Grossman, PhD, is Senior Lecturer, Department of Education, Ariel University, Ariel, Israel
| | - Miri Tal-Saban
- Miri Tal-Saban, PhD, OT, is Senior Lecturer and Occupational Therapist, School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Adina Maeir
- Adina Maeir, PhD, OT, is Professor and Occupational Therapist, School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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7
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Al-Heizan MO, Marks TS, Giles GM, Edwards DF. Further Validation of the Menu Task: Functional Cognition Screening for Older Adults. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2022; 42:286-294. [PMID: 35899792 DOI: 10.1177/15394492221110546] [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: 11/15/2022]
Abstract
Occupational therapists need a brief tool to identify the potential for functional cognitive deficits leading to impaired occupational performance. The objective is to establish the sensitivity and specificity, concurrent and known-group validity of the Menu Task by comparison with performance on the Weekly Calendar Planning Activity (WCPA). Using a cross-sectional design, we administered the Menu Task and the WCPA to a community-dwelling convenience sample of 287 adults aged from 55 to 93 years. The receiver operating characteristic (ROC) analysis estimated sensitivity and specificity. Concurrent and known-group construct validity was examined by comparing scores on the Menu Task with the WCPA scores. As a result, a new cutoff score of 9 was established for the Menu Task (area under the curve [AUC] = 0.80, sensitivity = 0.89, 95% confidence interval [CI] = [0.73, 0.97]; specificity = 0.58, 95% CI = [0.52, 0.64]). Both concurrent and construct validity were supported. The Menu Task demonstrates sensitivity to functional cognitive impairments in a community sample.
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Affiliation(s)
| | | | - Gordon M Giles
- Samuel Merritt University, Oakland, CA, USA.,Crestwood Behavioral Health, Inc., Sacramento, CA, USA
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8
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Doherty M, Dickerson D, Kadela K, Noetzel M, Wolf TJ, Berg C, Dodd J. Initial Validation of the Weekly Calendar Planning Activity With Adolescents With ABI. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2022; 42:305-314. [PMID: 35440259 DOI: 10.1177/15394492221087191] [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: 11/16/2022]
Abstract
The purpose of this study was to assess the validity of the Weekly Calendar Planning Activity Middle/High School (WCPA) in adolescents with acquired brain injuries (ABI). We recruited neurotypical controls (n = 27) and adolescents with ABI (n = 14) to complete a 90-min battery of cognitive tests. Adolescents with ABI were further divided into mild and severe groups by Glasgow Coma Scale Score and compared with controls. Mann-Whitney U tests revealed significant differences (p = .05) on the WCPA between groups in total time to complete and rules followed. Between the controls and severe group, a significant difference (p = .05) was found for total time spent, errors, rules followed, strategies used, and accurate appointments (p = .01). Moderate correlations were found between the WCPA and neuropsychological tests (ρ = .31-.45). The WCPA is a valid performance-based assessment of functional cognition that can be used to detect deficits in adolescents with severe ABI.
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Affiliation(s)
| | - Dawn Dickerson
- Washington University in St. Louis School of Medicine, MO, USA
| | - Kathryn Kadela
- Washington University in St. Louis School of Medicine, MO, USA
| | - Michael Noetzel
- Washington University in St. Louis School of Medicine, MO, USA
| | | | - Christine Berg
- Washington University in St. Louis School of Medicine, MO, USA
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9
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Fisher O, Berger I, Grossman ES, Maeir A. Online and Intellectual Awareness of Executive Functioning in Daily Life among Adolescents with and without ADHD. J Atten Disord 2022; 26:870-880. [PMID: 34378435 DOI: 10.1177/10870547211031982] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Executive function deficits (EFD) are a central mechanism underlying negative outcomes in ADHD. This study examined awareness of EFD manifested in "real-time" task performance (Online Awareness) and in general self-knowledge of daily activities, outside the context of a specific task (Intellectual Awareness) among adolescents with and without ADHD. METHODS 102 adolescents with (n = 52) and without (n = 50) ADHD were administered Weekly Calendar Planning Activity (WCPA) and Behavior Rating Inventory of Executive Function (BRIEF). Parents completed the BRIEF parent version. Awareness was defined using the discrepancy paradigm: performance versus estimation on WCPA for online awareness; self versus parent report on the BRIEF for intellectual awareness. RESULTS Adolescents with ADHD overestimated their performance on the WCPA and underestimated their EFD on the BRIEF compared to parent's ratings. The discrepancy scores in both types of awareness were significantly larger among ADHD than controls (p < .005). CONCLUSIONS Adolescents with ADHD demonstrate significantly lower rates of online and intellectual awareness of EFD compared to controls.
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Affiliation(s)
| | - Itai Berger
- The Hebrew University, Jerusalem, Israel.,Ben-Gurion University of the Negev, Beer-Sheva, Southern, Israel
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10
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Wingren M, Lidström-Holmqvist K, Roshanai AH, Arvidsson P, Janeslätt G, White S, Holmefur M. One-year follow-up after the time management group intervention Let's Get Organized. Scand J Occup Ther 2021; 29:305-314. [PMID: 34288758 DOI: 10.1080/11038128.2021.1954687] [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: 01/17/2023]
Abstract
BACKGROUND Time management skills are essential to maintain occupations in everyday life. People with neurodevelopmental or mental disorders often experience persistent difficulties with managing time and organizing daily life, consequently, there is a need to establish interventions with sustainable results. AIM The aim was to perform a one-year post-intervention follow-up after the intervention Let's Get Organized (LGO-S) for people with neurodevelopmental or mental disorders. METHODS The study is a one-year follow-up of a single group pre-test-post-test design. Thirty-eight persons with difficulties in time management due to neurodevelopmental or mental disorders participated. Instruments to collect data were Assessment of Time Management Skills; Weekly Calendar Planning Activity and the Satisfaction with Daily Occupations instrument. Wilcoxons's signed-rank test was used to compare data over time. RESULTS There were no significant differences in the participants' outcomes between post-intervention and one-year follow-up in time management skills and regulation of emotions, satisfaction with daily occupations, and global satisfaction. A significant improvement could be seen in the subscale organization and planning at the one-year follow-up compared to post-intervention. CONCLUSIONS Improvements in time management skills, organization, and planning, regulation of emotions, and satisfaction with daily occupations after the LGO-S can be maintained in the long term.
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Affiliation(s)
- Maria Wingren
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kajsa Lidström-Holmqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Patrik Arvidsson
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden.,Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa.,CHILD, Swedish Institute for Disability Research, Jönköping University, Jönköping, Sweden
| | - Gunnel Janeslätt
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden
| | - Suzanne White
- Downstate Medical Center, State University of New York, Brooklyn, NY, United States
| | - Marie Holmefur
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Zlotnik S, Gal E, Weiss PL. Video modelling as a tool to evaluate self-perception of strategies used by adolescents during daily tasks. Disabil Rehabil Assist Technol 2020; 17:177-183. [DOI: 10.1080/17483107.2020.1774809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sharon Zlotnik
- Department of Occupational Therapy Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Eynat Gal
- Department of Occupational Therapy Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Patrice L. Weiss
- Department of Occupational Therapy Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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12
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Harwood-Gross A, Lambez B, Feldman R, Rassovsky Y. Perception of Caregiving During Childhood is Related to Later Executive Functions and Antisocial Behavior in At-Risk Boys. Front Psychiatry 2020; 11:37. [PMID: 32116852 PMCID: PMC7016333 DOI: 10.3389/fpsyt.2020.00037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
Executive functions are considered essential for effective navigation in the social world. Parental responsiveness is a critical ingredient for normative social development and, as such, may be connected with the development of executive functions. Disruption of this development may, in turn, lead to maladaptive and antisocial behaviors. The purpose of this study was to evaluate the nature of the connections among perceived patterns of caregiving experienced in childhood, executive functions, and antisocial behaviors in at-risk adolescents. Seventy-one adolescent boys were recruited from two high-schools for adolescents who were not deemed suitable for regular schooling due to behavioral and emotional issues. Executive functions were tested using a computer-administered neuropsychological battery (CANTAB), and maternal parenting experiences and antisocial behaviors were assessed using retrospective and current questionnaires. Structural equation modeling (SEM) approach was employed to examine whether executive functions mediated the relationship between children's perceived patterns of maternal care and subsequent development of antisocial behaviors. Although maternal care had a significant direct effect on executive function (standardized coefficient = .49, p = .03) and antisocial behavior (standardized coefficient = .53, p = .05), SEM demonstrated no mediating relationships among these variables. Instead, maternal care predicted unique variance in both executive functions (standardized coefficient = .61, p = .02) and antisocial behavior (standardized coefficient = .51, p = .05). This study suggests a link between the experience of childhood caregiving and adolescent executive functions and delinquency and highlights the importance of early parenting interventions to aid executive function development. Such early interventions could potentially enhance long-term pro-social behavior.
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Affiliation(s)
| | - Bar Lambez
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Ruth Feldman
- Center for Developmental, Social, and Relationship Neuroscience, Interdisciplinary Center, Herzliya, Israel
| | - Yuri Rassovsky
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.,Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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13
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Boone AE, Wolf TJ, Engsberg JR. Combining Virtual Reality Motor Rehabilitation With Cognitive Strategy Use in Chronic Stroke. Am J Occup Ther 2019; 73:7304345020p1-7304345020p9. [DOI: 10.5014/ajot.2019.030130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Importance: Rehabilitation interventions for chronic stroke are largely impairment based, with results confined to the level of impairment instead of function. In contrast, cognitive strategy training interventions have demonstrated clinically meaningful improvements in functional outcomes. Integration of these approaches has yet to be explored.
Objective: To evaluate acceptability, recruitment, and retention rate and determine which outcome measures best capture the effect of the intervention.
Design: Single-group, pre–post design.
Setting: Research laboratory.
Participants: Adults with chronic stroke and hemiparesis (N = 10).
Intervention: A 12-wk intervention integrating cognitive strategy training with upper extremity motor training. Two weekly sessions used Kinect-based virtual reality to encourage high numbers of upper extremity movement repetitions. The third weekly session focused on the use of cognitive strategies with practice of client-centered goals.
Outcomes and Measures: Upper extremity motor performance was measured with the Fugl–Meyer Assessment. Occupational performance on trained and untrained goals was measured via the Performance Quality Rating Scale and the Canadian Occupational Performance Measure. Outcome data were gathered preintervention, postintervention, and at 3-mo follow-up.
Results: The intervention was perceived as acceptable. Recruitment rate was 15%, and retention rate was 100%. Large effects were found on outcomes of upper extremity motor performance, occupational performance, and participation at follow-up.
Conclusion and Relevance: MetacogVR is feasible for adults with chronic stroke. The effect of MetacogVR is best captured through measures of upper extremity motor performance, occupational performance, and participation.
What This Articles Adds: Traditional, impairment-based approaches to chronic stroke rehabilitation may require integration with cognitive-strategy training to affect performance on meaningful goals.
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Affiliation(s)
- Anna E. Boone
- Anna E. Boone, MSOT, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Missouri–Columbia;
| | - Timothy J. Wolf
- Timothy J. Wolf, OTD, PhD, OTR/L, FAOTA, is Department Chair and Associate Professor, Department of Occupational Therapy, University of Missouri–Columbia
| | - Jack R. Engsberg
- Jack R. Engsberg, PhD, is Retired Professor, Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO
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14
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Holmqvist KL, Holmefur M, Arvidsson P. Test–retest reliability of the Swedish version of the Weekly Calendar Planning Activity – a performance-based test of executive functioning. Disabil Rehabil 2019; 42:2647-2652. [DOI: 10.1080/09638288.2019.1568590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Kajsa Lidström Holmqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Sweden
| | - Marie Holmefur
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Sweden
| | - Patrik Arvidsson
- CHILD, Swedish Institute for Disability Research, Jönköping University, Sweden
- Centre for Research & Development, Region Gävleborg, Uppsala University, Sweden
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15
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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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Hanberg VL, MacKenzie DE, Merritt BK. Scoping review of the Multiple Errands Test: Is it relevant to youths with acquired brain injury? Br J Occup Ther 2018. [DOI: 10.1177/0308022618791714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction For youths who sustain acquired brain injuries, distinguishing typical development of executive function from the impairment(s) can be a challenging but critical assessment consideration. Occupational therapists working with individuals after brain injury can use the Multiple Errands Test as a performance-based assessment of the effect of executive dysfunction in the real world. Although numerous test versions exist for different settings and diagnostic populations, their relevance to youths is unclear. We surveyed the non-virtual reality literature for test versions to determine the measurement properties and clinical utility for assessing youths in a community setting. Method A scoping review was completed to summarize study purpose/design, Multiple Errands Test structure, assessment environment, sample characteristics, psychometric properties, clinical utility and main findings of the test versions. Results We included 10 quantitative studies and found the strongest reliability and validity evidence for male adults with moderate to severe acquired brain injury, in a hospital setting. Multiple Errands Test versions can distinguish people with brain injury from controls and identify challenges in the home and community. No studies examined the test performance of younger participants. Conclusion This review highlights the research of several Multiple Errands Test versions and identifies gaps in that research, including the need for development of a test version for youths in a community setting.
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Affiliation(s)
- Vanessa L Hanberg
- MSc post-professional candidate, Faculty of Health, School of Occupational Therapy, Dalhousie University, Canada
| | - Diane E MacKenzie
- Associate Professor, Faculty of Health, School of Occupational Therapy, Dalhousie University, Canada
| | - Brenda K Merritt
- Dean (Acting) and Associate Professor, Faculty of Health, School of Occupational Therapy, Dalhousie University, Canada
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Zlotnik S, Schiff A, Ravid S, Shahar E, Toglia J. A new approach for assessing executive functions in everyday life, among adolescents with Genetic Generalised Epilepsies. Neuropsychol Rehabil 2018; 30:333-345. [PMID: 29712502 DOI: 10.1080/09602011.2018.1468272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Studies have characterised relationships between cognitive status and a variety of clinical epilepsy factors. The aim of this study was to describe a new approach for assessing executive functions in everyday life and its unique expression in adolescents with Genetic Generalised Epilepsies (GGEs) compared with typical peers. Twenty adolescents with a diagnosis of GGEs and 20 typical healthy peers, matched by age and gender, were studied. Assessment of everyday executive function was carried out using: (1) the Weekly Calendar Planning Activity (WCPA), a direct performance based and outcome measure of strategy use and cognitive performance; and (2) Behavior Rating Inventory of Executive Function (BRIEF) parental report. Adolescents with GGEs demonstrated significantly less accuracy, less efficiency and fewer strategies used, as measured by the WCPA. Parents of adolescents with GGEs rated their child's daily performance as less efficient compared with typical peers. Better ratings of executive function (low BRIEF score) were associated with greater WCPA accuracy in the entered appointments. The WCPA provides a useful evaluation of cognitive performance for adolescents with GGEs and a functionally relevant information on task efficiency, self-monitoring and effective strategy use. Direct observation of performance supplements parental ratings and has strong potential to guide intervention and measure outcomes.
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Affiliation(s)
- Sharon Zlotnik
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Aharon Schiff
- Meyer Children's Hospital, Paediatric Neurology Unit, Haifa, Israel
| | - Sarit Ravid
- Meyer Children's Hospital, Paediatric Neurology Unit, Haifa, Israel
| | - Eli Shahar
- Meyer Children's Hospital, Paediatric Neurology Unit, Haifa, Israel
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, USA
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Rosenblum S. Inter-relationships between objective handwriting features and executive control among children with developmental dysgraphia. PLoS One 2018; 13:e0196098. [PMID: 29689111 PMCID: PMC5918172 DOI: 10.1371/journal.pone.0196098] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/08/2018] [Indexed: 12/02/2022] Open
Abstract
Objective To describe handwriting and executive control features and their inter-relationships among children with developmental dysgraphia, in comparison to controls. Method Participants included 64 children, aged 10–12 years, 32 with dysgraphia based on the Handwriting Proficiency Screening Questionnaire (HPSQ) and 32 matched controls. Children copied a paragraph onto paper affixed to a digitizer that supplied handwriting process objective measures (Computerized Penmanship Evaluation Tool (ComPET). Their written product was evaluated by the Hebrew Handwriting Evaluation (HHE). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire about their child's executive control abilities. Results Significant group differences were found for handwriting performance measures (HHE and ComPET) and executive control domains (BRIEF). Based on one discriminate function, including handwriting performance and executive control measures, 98.4% of the participants were correctly classified into groups. Significant correlations were found in each group between working memory and legibility as well as for other executive domains and handwriting measures. Furthermore, twenty percent of the variability of the mean pressure applied towards the writing surface among children with was explained by their 'emotional control' (BRIEF). Conclusion The results strongly suggest consideration of executive control domains to obtain better insight into handwriting impairment characteristics among children with dysgraphia to improve their identification, evaluation and the intervention process.
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Affiliation(s)
- Sara Rosenblum
- Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
- * E-mail:
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19
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Zlotnik S, Toglia J. Measuring Adolescent Self-Awareness and Accuracy Using a Performance-Based Assessment and Parental Report. Front Public Health 2018; 6:15. [PMID: 29456993 PMCID: PMC5801478 DOI: 10.3389/fpubh.2018.00015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/16/2018] [Indexed: 11/25/2022] Open
Abstract
Aim The aim of this study was to assess awareness of performance and performance accuracy for a task that requires executive functions (EF), among healthy adolescents and to compare their performance to their parent’s ratings. Method Participants: 109 healthy adolescents (mean age 15.2 ± 1.86 years) completed the Weekly Calendar Planning Activity (WCPA). The discrepancy between self-estimated and actual performance was used to measure the level of awareness. The participants were divided into high and low accuracy groups according to the WCPA accuracy median score. The participants were also divided into high and low awareness groups. A comparison was conducted between groups using WCPA performance and parent ratings on the Behavior Rating Inventory of Executive Function (BRIEF). Results Higher awareness was associated with better EF performance. Participants with high accuracy scores were more likely to show high awareness of performance as compared to participants with low accuracy scores. The high accuracy group had better parental ratings of EF, higher efficiency, followed more rules, and were more aware of their WCPA performance. Conclusion Our results highlight the important contribution that self-awareness of performance may have on the individual’s function. Assessing the level of awareness and providing metacognitive training techniques for those adolescents who are less aware, could support their performance.
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Affiliation(s)
- Sharon Zlotnik
- Laboratory for Innovation in Rehabilitation Technology Israel Center for Research Excellence: LINKS - Learning in a NetworKed Society, Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
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Lahav O, Ben-Simon A, Inbar-Weiss N, Katz N. Weekly Calendar Planning Activity for University Students: Comparison of Individuals With and Without ADHD by Gender. J Atten Disord 2018; 22:368-378. [PMID: 25555627 DOI: 10.1177/1087054714564621] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To introduce a revised version of the Weekly Calendar Planning Activity (WCPA) adapted for university students (Weekly Calendar Performance Activity for students [WCPA-S]) and compare the performance of this activity between students with and without ADHD and across gender groups. METHOD Participants included a total of 157 students, ages 20 to 30, enrolled in universities/colleges and divided into two groups: students with ADHD (male = 23, female = 38) and without ADHD (male = 33, female = 63). A two-way ANOVA was used for data analyses. The WCPA-S was administered to each student individually. RESULTS Significant differences were found between students with and without ADHD and across genders in performance, duration of performance, and in the number of strategies used. CONCLUSION The WCPA-S proved to be an effective performance-based diagnostic tool for the utilization of executive functions in the daily life of university students. This instrument can be used to predict success in higher education and to support learning among university students with ADHD.
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Affiliation(s)
- Orit Lahav
- 1 Ono Academic College, Kiryat Ono, Israel
| | - Anat Ben-Simon
- 2 National Institute for Testing and Evaluation, Jerusalem, Israel
| | | | - Noomi Katz
- 1 Ono Academic College, Kiryat Ono, Israel
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21
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Toglia J, Lahav O, Ben Ari E, Kizony R. Adult Age and Cultural Differences in Performance on the Weekly Calendar Planning Activity (WCPA). Am J Occup Ther 2017; 71:7105270010p1-7105270010p8. [DOI: 10.5014/ajot.2016.020073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We compared performance on a cognitively demanding task, the Weekly Calendar Planning Activity, of participants in three age groups and two countries (United States and Israel).
METHOD. A sample of 375 U.S. and 433 Israeli healthy adults participated. During the activity, participants were observed for speed, accuracy, strategy use, and efficiency.
RESULTS. Accuracy scores were similar in both countries; however, Israeli participants were slower and less efficient (p < .05). The younger and middle-aged Israeli groups were more strategic and the older Israeli group followed fewer rules than the corresponding U.S. groups (p < .05). Older participants in both countries were less accurate, efficient, and strategic than younger participants (p < .05).
CONCLUSION. Limited strategy use and poor time allocation may contribute to difficulty managing cognitively demanding activities for older adults and may also be influenced by culture. Practitioners should consider these factors when screening people for occupational performance difficulties.
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Affiliation(s)
- Joan Toglia
- Joan Toglia, PhD, OTR/L, FAOTA, is Dean, School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY;
| | - Orit Lahav
- Orit Lahav, PhD, OT, is Deputy Director, Occupational Therapy Department, Ono Academic College, Kiryat Ono, Israel
| | - Eynat Ben Ari
- Eynat Ben Ari, PhD, OTR, is Faculty, Department of Occupational Therapy, Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Kizony
- Rachel Kizony, PhD, OT, is Senior Lecturer, Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel, and Research Occupational Therapist, Department of Occupational Therapy, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
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22
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Fitts W, Massimo L, Lim N, Grossman M, Dahodwala N. Computerized assessment of goal-directed behavior in Parkinson's disease. J Clin Exp Neuropsychol 2016; 38:1015-25. [PMID: 27270271 PMCID: PMC4979569 DOI: 10.1080/13803395.2016.1184232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Apathy is a syndrome characterized by a reduction in goal-directed behavior. Neurodegenerative diseases frequently exhibit apathy. However, we lack an objective measure of apathy. The Philadelphia Apathy Computerized Task (PACT) measures impairments in goal-directed behavior that contribute to apathy, including initiation, planning, and motivation. We sought to examine these mechanisms in Parkinson's disease (PD) patients. METHOD PD patients and healthy controls with a caregiver were recruited for the study. Participants were administered the PACT, a novel computerized assessment of goal-directed behavior based on reaction times, and the Starkstein Apathy Scale (AS). Care partners completed the Neuropsychiatric Inventory (NPI). Baseline demographic characteristics of PD and control participants were compared using t tests and Wilcoxon rank sum tests. Linear regressions were used to compare PD patients to controls on each of the three PACT subtasks (initiation, planning, and motivation) while controlling for motor slowing. We then compared performance on each PACT subtask between PD subjects defined as apathetic using the NPI and Starkstein Apathy Scale and controls. RESULTS We included 30 PD and 15 control participants in the analysis. When controlling for motor slowing, both all PD and PD apathetic subjects were significantly slower than controls on the planning task and on the initiation task. There were no significant differences between PD patients and controls on the motivation tasks. CONCLUSIONS PD patients showed specific initiation and planning deficits compared to control participants. After using traditional scales to define apathy, PD apathetic patients still exhibited impaired initiation and planning behaviors. These results suggest that the PACT measures aspects of impaired goal-directed behavior that may contribute to apathy in PD.
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Affiliation(s)
- Whitney Fitts
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Lauren Massimo
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Nicholas Lim
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Nabila Dahodwala
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
- Institute on Aging, Perelman School of Medicine, University of Pennsylvania
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Brown T, Bourke-Taylor H. Children and youth instrument development and testing articles published in the American journal of occupational therapy, 2009-2013: a content, methodology, and instrument design review. Am J Occup Ther 2015; 68:e154-216. [PMID: 25184476 DOI: 10.5014/ajot.2014.012237] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We extracted 35 articles published between January 2009 and September 2013 in the American Journal of Occupational Therapy (AJOT) that focused on children and youth instrument development and testing, summarized study details and traits of the 37 measures reported in them, and then critiqued the measures. Most of the articles contained Level III evidence (one-group nonrandomized and noncontrolled). The most common types of reliability reported in the articles were internal consistency, test-retest reliability, and interrater reliability; the most frequent types of validity reported were discriminant validity and construct validity. Most pediatric assessment tools were designed for school-age children between ages 5 and 12 yr. The two most common purposes for the assessments were reported as descriptive and discriminative. The continued publication of instruments that measure children and youth participation in meaningful occupations and life roles in home, school, and community environments is recommended.
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Affiliation(s)
- Ted Brown
- Ted Brown, PhD, MSc, MPA, OT(C), OTR, is Associate Professor, Undergraduate Course Convener, and Department Postgraduate Coordinator, Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University-Peninsula Campus, Frankston, Victoria 3800, Australia;
| | - Helen Bourke-Taylor
- Helen Bourke-Taylor, PhD, MSc, is Senior Lecturer in Occupational Therapy, School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Melbourne Campus (St Patrick's), Victoria, Australia;
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Massimo L, Powers JP, Evans LK, McMillan CT, Rascovsky K, Eslinger P, Ersek M, Irwin DJ, Grossman M. Apathy in Frontotemporal Degeneration: Neuroanatomical Evidence of Impaired Goal-directed Behavior. Front Hum Neurosci 2015; 9:611. [PMID: 26617508 PMCID: PMC4639601 DOI: 10.3389/fnhum.2015.00611] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/23/2015] [Indexed: 12/12/2022] Open
Abstract
Background: Apathy, the major manifestation of impaired goal-directed behavior (GDB), is the most common neuropsychiatric syndrome associated with behavioral variant frontotemporal degeneration (bvFTD). The behavioral and biological mechanisms of apathy, however, are not well understood. We hypothesized that GDB has multiple components—including at least initiation, planning and motivation—and that GDB is supported by a network of multiple frontal brain regions. In this study, we examined this hypothesis by evaluating the selective breakdown of GDB in bvFTD, and relating these deficits to gray matter (GM) atrophy and white matter (WM) integrity. Methods: Eighteen apathetic bvFTD participants and 17 healthy controls completed the Philadelphia Apathy Computerized Test (PACT). This test quantifies each of three components of GDB hypothesized to contribute to apathy. We then used regression analyses to relate PACT scores to GM atrophy and reduced white matter (WM) fractional anisotropy (FA) in bvFTD. Results: Compared to controls, bvFTD participants demonstrated significant impairments in each of the three hypothesized components of GDB that contribute to apathy. Regression analyses related each component to disease in specific GM structures and associated WM tracts. Poor initiation thus was related to GM atrophy in anterior cingulate and reduced FA in the cingulum. Planning impairment was related to GM atrophy in dorsolateral prefrontal cortex and reduced FA in superior longitudinal fasciculus. Poor motivation was related to GM atrophy in orbitofrontal cortex (OFC) and reduced FA in uncinate fasciculus (UNC). Conclusions: bvFTD patients have difficulty with initiation, planning and motivation components of GDB. These findings are consistent with the hypotheses that GDB encompasses at least three processes, that these are supported by a large-scale neural network within specific portions of the frontal lobe, and that degradation of any one of these prefrontal regions in bvFTD may contribute to apathy.
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Affiliation(s)
- Lauren Massimo
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA ; School of Nursing, University of Pennsylvania Philadelphia, PA, USA
| | - John P Powers
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Lois K Evans
- School of Nursing, University of Pennsylvania Philadelphia, PA, USA
| | - Corey T McMillan
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Katya Rascovsky
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Paul Eslinger
- Department of Neurology, Penn State Hershey Milton S. Hershey Medical Center Hershey, PA, USA
| | - Mary Ersek
- School of Nursing, University of Pennsylvania Philadelphia, PA, USA
| | - David J Irwin
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Murray Grossman
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
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Massimo L, Evans LK. Differentiating subtypes of apathy to improve person-centered care in frontotemporal degeneration. J Gerontol Nurs 2015; 40:58-65. [PMID: 25199154 DOI: 10.3928/00989134-20140827-01] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/05/2014] [Indexed: 12/13/2022]
Abstract
Apathy, a reduction in goal-directed behavior (GDB), affects 90% of individuals with behavioral variant frontotemporal degeneration, which is a common cause of early onset neurodegenerative disease. The cognitive and neural impairments associated with apathy make it difficult to initiate, plan, and self-motivate activities toward a specific goal, such as dressing or bathing. These impairments are associated with significant decline in functional ability, caregiver burden, and increased cost of care due to early institutionalization. The current article reviews the evidence suggesting that apathy arises from the interruption of one or any combination of three GDB processes: initiation, planning, and motivation. From this perspective, three subtypes of apathy related to dysfunction at the level of GDB and the corresponding neuroanatomy are explored. Further research is required to confirm and measure these subtypes of apathy for use in clinical and research settings. A more precise classification of apathy by subtype will allow implementation of the most appropriate person-centered, individualized therapy.
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Yuen HK, Austin SL. Systematic Review of Studies on Measurement Properties of Instruments for Adults Published in the American Journal of Occupational Therapy, 2009–2013. Am J Occup Ther 2014; 68:e97-106. [DOI: 10.5014/ajot.2014.011171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We describe the methodological quality of recent studies on instrument development and testing published in the American Journal of Occupational Therapy (AJOT).
METHOD. We conducted a systematic review using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist to appraise 48 articles on measurement properties of assessments for adults published in AJOT between 2009 and 2013.
RESULTS. Most studies had adequate methodological quality in design and statistical analysis. Common methodological limitations included that methods used to examine internal consistency were not consistently linked to the theoretical constructs underpinning assessments; participants in some test–retest reliability studies were not stable during the interim period; and in several studies of reliability and convergent validity, sample sizes were inadequate.
CONCLUSION. AJOT’s dissemination of psychometric research evidence has made important contributions to moving the profession toward the American Occupational Therapy Association’s Centennial Vision. This study’s results provide a benchmark by which to evaluate future accomplishments.
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Affiliation(s)
- Hon K. Yuen
- Hon K. Yuen, PhD, OTR/L, is Professor and Director of Research, Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, 1530 Third Avenue South, Birmingham, AL 35294;
| | - Sarah L. Austin
- Sarah L. Austin, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, Chicago State University, College of Health Sciences, Chicago, IL
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Gutman SA. State of the Journal, 2013. Am J Occup Ther 2013; 67:616-23. [DOI: 10.5014/ajot.2013.009548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The American Journal of Occupational Therapy (AJOT) has developed into a solid research journal, increasingly disseminating evidence-based research able to inform practice.
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Affiliation(s)
- Sharon A. Gutman
- Sharon A. Gutman, PhD, OTR, FAOTA, is Editor-in-Chief, American Journal of Occupational Therapy, and Associate Professor, Columbia University, Programs in Occupational Therapy, New York;
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