Generalizability of the Swedish WISC-V to the Finland-Swedish minority - the FinSwed study.

International guidelines highlight the importance of using appropriate and culturally fair test materials when conducting clinical psychological assessments. In the present study, the generalizability of the Swedish WISC-V with Scandinavian normative data was explored in 6-16-year-old Swedish-speaking children in Finland (N = 134), as no local test versions or norms are available for this minority. First, metric measurement invariance was established, i.e., the constructs measured were equivalent between the standardization data and the present sample. Second, the performance of this minority group on the Swedish WISC-V was compared to the Scandinavian normative mean. The findings showed that the Finland-Swedish children performed overall higher than the normative mean on the Swedish WISC-V, with an FSIQ of 103. The performance was significantly higher also in the indexes VSI, FRI, and WMI as well as in several subtests. However, in the subtest Vocabulary, the Finland-Swedish children achieved significantly lower scores than the Scandinavian mean. Further analyses showed significant associations between cognitive performance and age as well as parental education. For the VCI and the FSIQ, performance increased significantly with age, despite the use of age-standardized scaled scores. The general high performance was suggested to relate to the overall high educational level of the Finland-Swedes as well as to other cultural and test-related factors. The results have implications for clinicians conducting assessments with this minority, but also highlight the importance of establishing test fairness by validating tests when used in different cultural groups.

Reproductive late effects and testosterone replacement therapy in male childhood cancer survivors: A population-based study (the Fex-Can study).

Childhood cancer survivors are at risk of various endocrine late effects affecting their quality of life. The aim of this study was to assess the prevalence and predictors of endocrine and reproductive outcomes in young adult survivors. A secondary aim was to assess possible associations between testosterone replacement therapy (TRT) and other endocrine, cardiovascular and psychosocial late effects. This nationwide study comprised 1212 male childhood cancer survivors aged 19-40 years, identified through the National Quality Registry for Childhood Cancer in Sweden. Median age at diagnosis during 1981-2017 was 7 (range 0-17) and at study 29 (19-40) years. The study combined self-report survey data with cancer treatment data from the national registry. Hormone-induced puberty was self-reported by 3.8% of the survivors and ongoing TRT by 6.0%. In separate logistic regression analyses, these treatments were associated with hematopoietic stem cell transplantation and cranial radiotherapy. Hormone-induced puberty was additionally associated with younger age at diagnosis. Men with TRT had a higher prevalence of other endocrine deficiencies, cholesterol medication, depressive symptoms and fatigue as well as a lower probability of living with a partner, having a biological child or current occupation. In the total male cohort, 28.2% reported having a biological child. Reassuring reproductive outcomes after less intensive therapies and low frequency of TRT were observed in young adult male childhood cancer survivors treated in the most recent treatment era. However, men with TRT suffered from several other endocrine, cardiovascular and psychosocial late effects, indicating a need for long-term monitoring of this high-risk group.

A comparison of WPPSI-IV performance between Finland-Swedish minority children and the Scandinavian test norms: Findings from The FinSwed Study.

OBJECTIVE: The Swedish Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV) is commonly used for assessing young children belonging to the Swedish-speaking minority in Finland (Finland-Swedes), but there is no information about the generalizability of this test and its norms to this minority. Cross-cultural comparisons of WPPSI-IV are also scarce. We compared the performance of Finland-Swedish children to the Scandinavian norms of the Swedish WPPSI-IV and explored the relationship between sociodemographic factors (age, sex, parental education level, bilingualism) and the performance. METHOD: The Swedish WPPSI-IV was administered to 79 typically developing 5-6-year-old Finland-Swedish children assessed for The FinSwed Study. Their performance was compared to the Scandinavian norms using MANOVA, t-test, and confidence interval comparisons. Associations with sociodemographic variables were explored using regression analyses. RESULTS: Finland-Swedish children performed, on average, 1/3 SD higher than the Scandinavian norms, a difference which was statistically significant with medium-sized effects. However, individual subtests and indexes did not differ significantly from the norms. Significant associations with sociodemographic factors were found for some but not all index scores. CONCLUSIONS: This study provides clinically important information for using the Swedish WPPSI-IV with the Finland-Swedish minority and demonstrates aspects that clinicians working with this minority should take into account. The results are presumably partly explained by characteristics of the present sample, and partly by cultural and linguistic differences between the Finland-Swedish population and the Scandinavian countries. The findings also illustrate that cross-cultural differences in cognitive performance may be present even between similar cultures with the same language.

No impact of parental singing during the neonatal period on cognition in preterm-born children at 2-3 years.

AIM: Studies examining the long-term effects of neonatal music interventions on the cognition of children born preterm are scarce. We investigated whether a parental singing intervention before term age improves cognitive and language skills in preterm-born children. METHODS: In this longitudinal, two-country Singing Kangaroo, randomised controlled trial, 74 preterm infants were allocated to a singing intervention or control group. A certified music therapist supported parents of 48 infants in the intervention group to sing or hum during daily skin-to-skin care (Kangaroo care) from neonatal care until term age. Parents of 26 infants in the control group conducted standard Kangaroo care. At 2-3 years of corrected age, the cognitive and language skills were assessed with the Bayley Scales of Infant and Toddler Development, Third Edition. RESULTS: There were no significant differences in cognitive and language skills between the intervention and control groups at the follow-up. No associations between the amount of singing and the cognitive and language scores were found. CONCLUSION: Parental singing intervention during the neonatal period, previously shown to have some beneficial short-term effects on auditory cortical response in preterm infants at term age, showed no significant long-term effects on cognition or language at 2-3 years of corrected age.

Premature ovarian insufficiency and chance of pregnancy after childhood cancer: A population-based study (the Fex-Can study).

Endocrine complications are a common late effect after childhood cancer. Our study assessed the prevalence and predictors of premature ovarian insufficiency (POI) and prospects of pregnancy in young female survivors. This nationwide study combined registry and survey data for female childhood cancer survivors aged 19 to 40 years, identified through the National Quality Registry for Childhood Cancer in Sweden. Of 1989 approached young women, 1333 (67%) participated by completing a survey. Median age at diagnosis 1981 to 2017 was 6 (range 0-17) and at study 28 (19-40) years. There were two indicators of POI, induced puberty reported in 5.3% and estrogen replacement therapy (ERT) in 9.3% at assessment. In separate logistic regression analyses (P < .001), induced puberty and ERT were significantly predicted by hematopoietic stem cell transplantation (HSCT), abdominal irradiation, central nervous system irradiation and chemotherapy. ERT was also associated with older age at diagnosis. Of the 626 women (48% of responders) who had tried to become pregnant, 25% had undergone fertility investigations and 72% reported having a biological child. Treatment with HSCT was associated with 5.4 times the odds of needing fertility investigations (P < .001). Having a biological child was associated with non-HSCT treatment, but also with ever having had a partner and older age at the time of study (all P < .001). In conclusion, the majority of those female childhood cancer survivors who had tried to conceive were able to successfully give birth. However, a small identifiable group of female survivors are at risk of subfertility and early menopause.

WPPSI-IV and NEPSY-II performance in mono- and bilingual 5-6-year-old children: Findings from The FinSwed Study.

Children's language background relates to their neurocognitive development. Knowledge of this relationship is important as bilingualism is common. However, research regarding language background in relation to performance on cognitive tests such as the WPPSI-IV and NEPSY-II is scarce. The present study compared WPPSI-IV and NEPSY-II performances between 5- and 6-year-old Swedish-speaking monolingual (n = 45) and Swedish-Finnish-speaking simultaneous bilingual (n = 34) children in Finland. The participants were gathered by stratified sampling and were assessed with the Swedish versions of the tests. In profile analyses, a significant monolingual advantage was found in some WPPSI-IV subtests and indexes requiring expressive vocabulary (Vocabulary, Similarities, Picture Naming, and Vocabulary Acquisition Index) and visuospatial skills (Object Assembly and Visual Spatial Index). No group differences were found between mono- and bilingual children in receptive language, visual memory, or fluid intelligence. Additionally, no differences were found on the Full Scale IQ. The performance on the WPPSI-IV Similarities subtest improved in a subgroup of bilinguals when answers in both Swedish and Finnish were accounted for, instead of accepting only answers in Swedish. No significant differences were found between mono- and bilinguals on the language and memory tasks of NEPSY-II. These findings highlight the importance of considering the child's language background when assessing expressive language in young children, as well as the benefits of assessing bilinguals in both of their languages.

Comparison of WPPSI-IV and WISC-V cognitive profiles in 6-7-year-old Finland-Swedish children - findings from the FinSwed study.

The Wechsler scales are among the most widely used tests in cognitive and neuropsychological assessments. When assessing children aged 6:0-7:7 years the clinician can choose between Wechsler Preschool and Primary Scale of Intelligence - Fourth Edition (WPPSI-IV) and Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V). Information about how the tests function and differ in this overlapping age range is limited. Using a between-subjects design, the present study compared the cognitive profiles of typically developing Swedish-speaking children in Finland in this overlapping age range (6:1 - 7:2 years), assessed with the Swedish versions of either WPPSI-IV (n = 38) or WISC-V (n = 24). Profile analyses and one-way ANCOVA were performed to investigate differences in the comparable subtests, indexes and Full Scale IQ. On the subtest level, children assessed with WISC-V had significantly lower scores on the subtests Vocabulary, Matrix Reasoning, and Bug/Symbol Search compared to children assessed with WPPSI-IV. On the index level, scores for the Verbal Comprehension Index and the Fluid Reasoning Index were significantly lower for children assessed with WISC-V. The Full Scale IQ was significantly lower on WISC-V. Taken together, the findings indicate that WPPSI-IV and WISC-V produce partly different cognitive profiles. These differences are important to recognize when choosing which test to use and when interpreting the results of clinical assessments of children in this age group.

Latent class growth analysis identified different trajectories in cognitive development of extremely low birthweight children.

BACKGROUND: Recent longitudinal studies suggest stable cognitive development in preterm children, although with great individual variation. This prospective neurocognitive follow-up study of extremely low birthweight (ELBW, <1000 g) children aimed to characterise groups with different developmental trajectories from preschool to preteen age. METHODS: ELBW children (n=115) born in Finland in 1996-1997 participated in cognitive assessments at a median age of 5.0 years and 11.3 years. A standardised test of intelligence (Wechsler Preschool and Primary Scale of Intelligence-Revised or Wechsler Intelligence Scale for Children-third edition) was administered at both ages. RESULTS: Three ELBW groups with different developmental trajectories over time were identified with latent class growth analysis. Children with average (Full-Scale IQ (FSIQ): 85-115) and below average (FSIQ: <85) intelligence at 5 years of age had significant decreases in intelligence scores by 11 years of age (-11.7 points and -14.9 points, respectively, both p<0.001), while those with above average intelligence (FSIQ: >115) showed stable development (-3.2 points, p=0.250). Multiple linear regression showed that neonatal complications (intraventricular haemorrhage grade 3-4 and blood culture positive sepsis) and maternal education significantly predicted lower intelligence at the second assessment (F(3,106)=7.27, p<0.001, adjusted R2=0.147). CONCLUSIONS: ELBW children represent a heterogeneous patient population in which groups with different cognitive trajectories can be detected. Deterioration may occur particularly in children with initial average or below average cognitive performance at 5 years of age, with neonatal complications and lower maternal education presenting as risk factors. Catch-up in cognitive functions seems more uncommon in the ELBW population, which should be noted in clinical work.

Physical Fitness and Frailty in Males after Allogeneic Hematopoietic Stem Cell Transplantation in Childhood: A Long-Term Follow-Up Study.

PURPOSE AND METHODS: To analyze physical fitness, physical activity and the prevalence of frailty in male long-term survivors of pediatric allogeneic hematopoietic stem cell transplantation (HSCT). We performed a Nordic two-center study of 98 male survivors (mean age 28.7 years, range 18.5-47.0) treated with pediatric allogeneic hematopoietic stem cell transplantation (HSCT) 1980-2010 in denmark or finland. physical fitness was evaluated by the dominant hand grip-strength, timed up-and-go, sit-to-stand, gait speed and two-minute walk tests. RESULTS: Survivors presented significantly lower muscle strength and muscle endurance in the dominant hand-grip strength (median Z-score -0.7, range -4.3-3.9) and sit-to-stand tests (median Z-score -1.5, range -3.5-2.5) compared to age and sex matched normative values of the tests. However, mobility and gait speed were not affected on a group level. The prevalence of frailty (pre-frail 20% or frail 10%) was high among the survivors. In multiple regression analysis, chronic graft-versus-host disease, shorter stature, higher body fat mass and hazardous drinking predicted prefrail/frail status. Common cardiovascular risk factors, such as increased levels of serum triglycerides, higher resting heart rate and diastolic blood pressure, were associated with lower physical fitness. CONCLUSION: Low muscle strength and a high incidence of frailty were observed in survivors of pediatric HSCT. There is a predominant risk of cardiovascular and metabolic diseases in the long-term.

Male Sexual Function after Allogeneic Hematopoietic Stem Cell Transplantation in Childhood: A Multicenter Study.

There are many known endocrine complications after allogeneic hematopoietic stem cell transplantation (HSCT) in childhood including increased risk of biochemical hypogonadism. However, little is known about sexuality in adulthood following childhood HSCT. In this multicenter study, sexual functions and possible risk factors were assessed comprehensively in two national cohorts (Finland and Denmark) of male adult survivors of childhood HSCT. Compared to a healthy control group (n = 56), HSCT survivors (n = 97) reported less sexual fantasies, poorer orgasms, lower sexual activity with a partner and reduced satisfaction with their sex life, even in the presence of normal erectile functions and a similar frequency of autoerotic acts. Of the HSCT survivors, 35% were cohabitating/married and 66% were sexually active. Risk factors for poorer self-reported sexual functions were partner status (not cohabitating with a partner), depressive symptoms, CNS and testicular irradiation. Sexual dysfunction increased by age in the HSCT group with a pace comparable to that of the control group. However, because of the lower baseline level of sexual functions in the HSCT group, they will reach the level of clinically significant dysfunction at a younger age. Hence, male survivors of childhood HSCT should be interviewed in detail about their sexual health beyond erectile functions.

Sexual function in male long-term survivors of childhood acute lymphoblastic leukemia.

BACKGROUND: Infertility, poor semen quality, and gonadal dysfunction are well recognized long-term sequelae in male survivors of childhood acute lymphoblastic leukemia (ALL). However, few studies have investigated adult sexual functioning in these survivors. METHODS: The authors studied 52 male survivors of childhood ALL at a median age of 28.5 years (range, 25-38 years) ≥ 10 years after diagnosis. In addition, 56 men without a history of cancer were recruited for an age-matched control group. The participants completed the Derogatis Interview for Sexual Functioning self-report. To analyze predictive factors for sexual dysfunction, variables assessing sociodemographic background, antileukemia treatment, testicular size, laboratory variables from current serum and semen samples, self-reported depressive symptoms, and self-reported physical functioning were included in multiple regression analyses. RESULTS: ALL survivors had significantly poorer sexual functioning, as measured by the Derogatis Interview for Sexual Functioning self-report, compared with the control group. Survivors had a similar frequency of sexual fantasies, autoerotic acts, and full erection during these activities as the control group, but they had less frequent sexual activity with a sexual partner, poorer self-rated orgasms, and lower satisfaction with their sex life. Predictive factors for poorer sexual functioning were depressive symptoms, the absence of a relationship, and, to a lesser extent, testicular size as an indication of gonadal damage from childhood antileukemia therapy. Older survivors experienced a deeper decline in sexual functioning compared with men in the control group. CONCLUSIONS: Decline in sexual functioning at an early adult age can be regarded as 1 of the late effects of childhood cancer. Monitoring these survivors' sexual health is indicated. Cancer 2016;122:2268-76. © 2016 American Cancer Society.

Parents tend to underestimate cognitive deficits in 10- to 13-year-olds born with an extremely low birth weight.

AIM: This study determined the cognitive outcomes of Finnish children born with an extremely low birth weight (ELBW) and assessed the agreement between their neuropsychological assessment and how their parents evaluated their cognitive difficulties. METHODS: The study focused on 121 children from an ELBW cohort with a mean age of 11.6 years (range 10.3-13.8) and assessed them using a standardised test of intelligence, a neuropsychological test battery and a parental developmental questionnaire. The results were compared with the test norms. RESULTS: ELBW children exhibited global cognitive impairment compared to the test norms, with no differences between children who were small or appropriate for gestational age. Children with average intelligence displayed specific impairment in executive, sensorimotor and visuospatial functions. Corresponding functions in the parental evaluation and neuropsychological assessment were associated, but 16-26% of children scoring under the clinical cut-off value in the neuropsychological test domains were not detected by the parental evaluations. CONCLUSION: Children born with an ELBW faced a high risk of global cognitive impairment at a mean age of 11.6 years, and those with average intelligence were at risk of specific cognitive sequelae. Compared to the neuropsychological tests, up to one-fourth of the parents underestimated their child's cognitive problems.

Risk factors for impaired quality of life and psychosocial adjustment after pediatric heart, kidney, and liver transplantation.

Few studies compare HRQOL and PSA in children who have undergone different types of solid organ Tx. In this cross-sectional study, HRQOL and PSA were assessed in 74 Tx patients (16 heart, 44 kidney, 14 liver) at a mean age of 11.5 (range 6.3-16.7), 7.2 yr post-Tx (range 1.0-15.0). HRQOL was self-assessed using standardized health utility questionnaires (15D-17D). The patients' PSA was evaluated using the Child Behavior Checklist for parents, Youth Self-Report for patients aged 11-16 yr, and Teacher Report Form. Outcomes did not differ significantly between Tx groups. Preadolescents (8-11 yr) reported poorer HRQOL compared with same-age peers (p = 0.020). In contrast, adolescents reported similar HRQOL and PSA compared to the general population. Proxy-reports revealed more PSA problems compared with age expectations (p < 0.01), mainly in internalizing behavior (p < 0.01). Lower HRQOL was associated with shorter follow-up time since Tx, congenital disease, and a psychiatric or neurological diagnosis. PSA problems were associated with family-related variables, neurological diagnosis, shorter follow-up time, and in teacher-reports longer disease duration before Tx. Different pediatric Tx groups have similar outcome. Neurological comorbidity and shorter follow-up time are important risk factors, but the impact of family-related variables on PSA indicate the need of family interventions.

Outcome of pediatric heart transplantation recipients treated with ventricular assist device.

This study was conducted to evaluate the long-term prognosis of pediatric HTx patients treated with VAD before transplantation. The clinical data of six patients bridged to HTx with Berlin Heart EXCOR pediatric device were analyzed retrospectively. Information about graft function, CA results, and EMB findings as well as appearance DSA was collected. Also, information about growth and cognitive function was analyzed. These findings were compared with age-, gender-, and diagnosis-matched HTx patients. During the median follow-up time of four and half yr after HTx, the prognosis including graft function, number of rejection episodes, and incidence of coronary artery vasculopathy, growth and cognitive development did not differ between VAD-bridged HTx patients compared with control patients. In both groups, one patient developed positive DSA titer after HTx. Our single-center experience suggests that the prognosis of pediatric HTx patients treated with VAD before transplantation is not inferior to that of other HTx patients.

Symptoms at presentation in children with sleep-related disorders.

OBJECTIVE: To assess the link between sleep-disordered breathing and cognitive function in children. To identify correlations among polysomnography, upper respiratory infections, or cephalometric as well as rhinometric measures. METHODS: This study is based on a questionnaire survey of snoring in a population cohort of 2100 children. Altogether, 44 snorers and 51 non-snorers participated in this community based clinical study. All children underwent polysomnography, cephalometry and rhinometric measurements. In addition, a standardized test of intelligence (WPPSI-R), a neuropsychological test battery (NEPSY) and a parental questionnaire on behavioral symptoms (CBCL) were administered. RESULTS: Frequently snoring children scored lower in Language functions (Comprehension of Instructions, P=0.01; Speeded naming, P=0.007) and had more internalizing problems, P=0.04 than did the non-snoring group. However, the polysomnography parameters of these snoring children revealed no major sleep-related breathing disorder. OAHI, mean lowest SpO(2) and respiratory effort correlated with Auditory Attention (P<0.05), Body Part Naming (P<0.05) and Memory (P<0.05). Tonsillar size correlated with OAHI (P<0.01) and respiratory effort (P=0.01) and respiratory airflow (P<0.01). In cephalometry, the minimal distance from velum to posterior wall was shorter showing the shorter length among snorers than non-snorers, 5.5mm vs. 6.6mm, respectively (P<0.05). Recurrent upper respirataory infections (URIs) were common among the snoring than non-snoring children (P=0.01). Children suffering recurrent URIs have more somatic complaints than children without recurrent URIs (P<0.01). CONCLUSIONS: Snoring children with apparently normal and/or no obstructive apnea, hypopnea, or marked SpO(2) desaturations appear to suffer impairment in neurocognitive and behavioral functions compared to non-snoring children. These snoring children did not reveal any major abnormalities of polysomnographic parameters, such as sleep-related breathing disorder, including partial upper airway obstruction. Polysomnographic parameters also correlated poorly with neurocognitive test results in these snoring children. The correlations between polysomnography and upper respiratory infections, with cephalometric and rhinometric measures, were also poor.

Neuropsychological profile of children with kidney transplants.

BACKGROUND: Varying results on the cognitive outcome of children who have undergone kidney transplantation (KTx) have raised concern for specific neurocognitive difficulties. METHODS: Fifty children with KTx were assessed at a mean age of 11.1 (SD 3.2; range 6.3-16.4), on average 6.9 (SD 3.6; range 1.0-14.1) years post-operatively. A standardized test of intelligence [Wechsler Intelligence Scale for Children (WISC-III)] and neuropsychological tests from NEPSY-II were administered. The neuropsychological profile of KTx children was compared to that of a control group matched for gender, age and maternal education. RESULTS: The KTx children had a lower intelligence quotient (83.9) than the test norms (100.0, P < 0.001). On neuropsychological assessment, the KTx group scored generally lower than the control group did (P < 0.001). The difference was evident in both the verbal and visuospatial domains, on a sub-test of complex auditory attention, verbal working memory and facial affect recognition. When children with neurological co-morbidity were excluded, the remaining group still scored lower than the controls did on Comprehension of Instructions (P = 0.06), Design Copying (P = 0.007) and Affect Recognition (P = 0.018). A better cognitive outcome was mainly associated with the absence of neurological co-morbidity, younger age, shorter disease duration and sustained kidney function. Children with congenital nephrosis had a similar outcome to those with other diagnoses. CONCLUSIONS: KTx children exhibit a pattern of effects in their cognitive outcome in which both the visuospatial and language domains are affected, but visual memory and simple auditory attention remain intact. Patients without neurological co-morbidity exhibit impairment in receptive language, visuospatial functions and in recognizing emotional states.

Quality of life in adult survivors of pediatric kidney transplantation.

BACKGROUND: There are few studies assessing long-term adult outcome and health-related quality of life (HRQOL) in former pediatric high-risk kidney transplant (TX) recipients. METHODS: Twenty-one patients were assessed at mean age of 21.1 years. Mean age at first TX was 2.4 years. Brain arterial border zone infarcts had been documented in 54% of the children. HRQOL was assessed with the general 15-dimensional (15D) instrument generating an index on a 0 and 1 scale (1 for best). The results were compared with the corresponding childhood 17-dimensional instrument and an adult control group from the general population. Psychosocial adjustment was assessed with the ASEBA Adult Self Report (ASR) and compared with the childhood Child Behavior Checklist assessments. RESULTS: Half of the patients (52%) had a secondary level general or vocational education. The educational outcome was evenly distributed (compulsory vs. secondary) regardless of previous childhood brain ischemia. The ASR Total Problems score was in the normal range for all patients. Four patients had scores in the pathological range for Externalizing or Internalizing Problems. There was a correlation between the childhood Child Behavior Checklist problem scores and the adult ASR scores for Internalizing and Total Problems but not for Externalizing Problems. Their mean 15D HRQOL index was 0.94 and lower than for the control group (0.97, P=0.04). There was a strong correlation between the childhood 17-dimensional and the adult 15D HRQOL index (r=0.63, P=0.003). CONCLUSION: The long-term outcome is fair in former high-risk pediatric TX patients with neurological comorbidity. Childhood psychosocial adjustment and HRQOL may predict the outcome in adults.

Visuospatial impairment in children and adolescents after liver transplantation.

A minority of children with liver transplants exhibit significant delay in global intelligence; others have specific learning disabilities. More specific data on neurocognitive strengths and weaknesses are lacking. Eighteen children aged 7-16 yr, who had undergone LTx in Finland participated in the study. They were assessed on an average 7.6 (s.d. 4.5, range 1.0-15.0) years post-operatively at a mean age of 11.8 (s.d. 3.1, range 7.2-16.1). A standardized test of intelligence (WISC-III), a neuropsychological test battery (NEPSY-II), and a parental questionnaire on the child's development (FTF) were administered. The neuropsychological test profile of the LTx group was compared with that of a matched control group of healthy children. The LTx children achieved on an average normal FSIQ 94.0 and VIQ 99.6. Their Performance Intelligence Quotient (PIQ 88.9, p=0.043) was, however, significantly lower than the population mean. On neuropsychological assessment, the LTx children scored generally lower than the control group (p=0.004), a difference significant in sub-tests assessing visuospatial and visuoconstructive functions and social perception. No differences emerged in sub-tests of attention and executive functions, memory and learning, or language functions. LTx children are at increased risk for impairment in the visuospatial domain.