Predictors of outcome three years after diagnosis of first episode psychosis.

This study aimed to determine which of demographic/premorbid, psychiatric or neuropsychological factors best predict functional outcome at 3 years after a first episode of psychotic illness. This will, it is hoped, identify prognostic indicators of longer term outcomes, as well as targets for rehabilitation. The Western Sydney First Episode Psychosis Project collected data on young people (aged 13 to 25) presenting with newly diagnosed psychosis at baseline and 3-year follow-up (n=52). Outcome was measured using the Role Functioning Scale (RFS) and the Clinical Global Impression Scale--severity of illness measure (CGI-S). Multiple regression analyses were performed to identify baseline predictors of outcome. The Premorbid Social Adjustment Scale in Adolescence (PSAS-Adolescent) and the Verbal Comprehension Index from the WAIS-III were found to be the two significant predictors for RFS, with only the former (PSAS-Adolescent) predicting CGI-S. Demographic and neuropsychological measures relating to premorbid functioning were the best predictors of long-term outcome in first episode psychosis, with baseline psychiatric symptoms not contributing.

An examination of lexical and sublexical reading skills in children with neurofibromatosis type 1.

Neurofibromatosis type 1 (NF1) is an inherited neurocutaneous disorder associated with a high frequency of cognitive and learning difficulties. Based on discrepancies between IQ and academic achievement, approximately 17% of children with NF1 have been classified as having reading impairments. In this study, the lexical and sublexical reading skills of children with NF1 (n = 30) were examined using the Castles' Word/Non-Word Test (modified version), together with measures of neuropsychological functioning and academic achievement. Twenty children (67%) demonstrated deficits in one or more reading subskills, with 75% of these meeting criteria for phonological dyslexia and 20% classified with mixed dyslexia. These findings indicate that a large proportion of children with NF1 may be characterized by a specific difficulty with the sublexical procedure, suggesting a difficulty employing spelling-to-sound rules to assemble a pronunciation when reading. In line with previous studies, the present findings also suggest that discrepancy-based methods may not be sufficiently sensitive to identify children who experience reading difficulties.

Use of the everyday memory questionnaire with children.

The Everyday Memory Questionnaire (EMQ; Sunderland, Harris, & Baddeley, 1983) was examined for its suitability to assess children's memory. The parents of 226 school children (6-12 years) completed the EMQ in relation to their own children. A subset of these children (N = 101), in 6, 8 and 10 years age groups, completed subtests of the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990). Comparison of EMQ and WRAML data found aspects of verbal memory correlated moderately with the EMQ in the 10 years age group. There were no meaningful correlations in the 8 years age group. In the 6 years age group aspects of visual memory correlated moderately with the EMQ. The diagnostic utility of the EMQ for children was assessed by comparing the school group to children diagnosed with ADHD and/or learning disorders. Diagnostic indicators revealed the EMQ to have high sensitivity (89%) but poor positive predictive power, identifying 40% of the school group as having memory deficits. Negative predictive power (confirming a negative diagnosis) was high. Validity data suggested that the EMQ could be useful with children at least as young as 10 years and further research needs to be conducted to establish the utility of the EMQ in clinical groups with primary memory deficits.

An investigation of neuronal integrity in severe paediatric traumatic brain injury.

Magnetic Resonance Spectroscopy (MRS) and its association with neuropsychological functioning was examined in the chronic injury phase of paediatric traumatic brain injury (TBI). Fifteen children, aged 10-16 years, with severe TBIs were compared with 15 controls, matched for age and gender. The TBI group was found to have significantly lower levels of -acetyl aspartate (NAA) and Choline (Cho) in the right frontal lobe and generally displayed reduced performances on neuropsychological tests. A correlation between metabolites and reaction times was also obtained. Findings indicate a role of proton MRS as a measure of neuronal integrity following severe paediatric TBI and suggest a potential association of MRS with specific neuropsychological impairments.

The nature and frequency of cognitive deficits in children with neurofibromatosis type 1.

OBJECTIVE: To assess the frequency and severity of specific cognitive deficits in children with neurofibromatosis type 1 (NF1) in a large unbiased cohort. METHODS: Extensive cognitive assessments were performed in 81 children with NF1 ages 8 to 16 years and their performance was compared with that of 49 unaffected sibling controls. RESULTS: Eighty-one percent of the children with NF1 had moderate to severe impairment in one or more areas of cognitive functioning. Although 51% of children with NF1 performed poorly on tasks of reading, spelling, and mathematics, specific learning disabilities (as defined by IQ-achievement discrepancies) were present in only 20% of the children. Sustained attention difficulties were present in 63% of children with NF1, with 38% of children with NF1 fulfilling the diagnostic criteria for attention deficit-hyperactivity disorder. The NF1 neuropsychological profile is characterized by deficits in perceptual skills (visuospatial and visuoperceptual), executive functioning (planning and abstract concept formation), and attention (sustained and switching). Interestingly, both verbal and visual memory was unaffected in NF1 children, and their memory skills were in general stronger than their level of general intellectual function. Although both expressive and receptive language skills were significantly impaired in NF1 children, they appeared to be relatively better preserved than visuospatial abilities once IQ is taken into account. CONCLUSION: There is an extremely high frequency of cognitive problems in children with neurofibromatosis type 1, making cognitive dysfunction the most common complication to affect quality of life in these children.