Heterogeneity of executive functions among preschool children with psychiatric symptoms.

The aim of the present study was to investigate associations between internalizing and externalizing symptoms and deficits in executive functions (EF) as well as to examine the overall heterogeneity of EFs in a sample of preschool children attending a psychiatric clinic (n = 171). First, based on cut-off points signifying clinical levels of impairment on the parent-completed Child Behavior Checklist (CBCL), children were assigned into groups of internalizing, externalizing, combined or mild symptoms and compared to a reference group (n = 667) with regard to day care teacher ratings of EFs on the Attention and Executive Function Rating Inventory-Preschool (ATTEX-P). Second, latent profile analysis (LPA) was employed to identify distinct subgroups of children representing different EF profiles with unique strengths and weaknesses in EFs. The first set of analyses indicated that all symptom groups had more difficulties in EFs than the reference group did, and the internalizing group had less inhibition-related problems than the other symptom groups did. Using LPA, five EF profiles were identified: average, weak average, attentional problems, inhibitory problems, and overall problems. The EF profiles were significantly associated with gender, maternal education level, and psychiatric symptom type. Overall, the findings suggest that the comparison of means of internalizing and externalizing groups mainly captures the fairly obvious differences in inhibition-related domains among young psychiatric outpatient children, whereas the person-oriented approach, based on individual differences, identifies heterogeneity related to attentional functions, planning, and initiating one's action. The variability in EF difficulties suggests that a comprehensive evaluation of a child's EF profile is important regardless of the type of psychiatric symptoms the child presents with.

Resolving reading disability-Childhood predictors and adult-age outcomes.

We examined frequency of adult-age reading disability (RD) and its childhood predictors among 48 adults (20 to 39 years) with documented childhood RD, and contrasted their cognitive skills, education, and employment with 37 matched controls. Among individuals with childhood RD, more than half had improved in their reading fluency to the level where the set criterion for adult-age RD was not met anymore. More fluent rapid naming, less severe childhood RD, and multiple support providers in childhood together predicted improvement of reading fluency. More fluent naming differentiated the childhood RD participants whose reading fluency had improved by adult-age from those participants whose RD persisted to adult-age. All the individuals with childhood RD performed weaker than the controls in adult-age working memory, processing speed, and verbal skills. Educational level among both RD groups was lower than that among the controls. Unemployment of individuals with persistent adult-age RD (31.6%) was higher than that of individuals with improved adult-age RD (13.8%) or that of the controls (8.1%). According to our findings, rapid naming is one evident factor differentiating individuals with persisted RD from those with ameliorated reading fluency. Also, better adult-age reading fluency has significance for adult-age employment among individuals with childhood RD.

Effectiveness of ENGAGE in reducing difficulties in everyday executive functions among Finnish preschoolers: a randomized controlled trial.

Effective interventions applicable for young preschool-age children are needed to reduce the risk of widespread and sustained adversities that are linked to early executive function (EF) difficulties. This randomized controlled trial (RCT) examined the effectiveness of the play-based ENGAGE intervention in improving behavioral outcomes related to EFs among Finnish preschool-age children with hyperactivity and/or inattention problems. 95 children between 4 and 5 years of age and their parents were randomly assigned to the ENGAGE intervention or a waitlist control group. Parents and early childhood education (ECE) teachers rated the children's EF difficulties and problem behaviors at pre-intervention, post-intervention, and 5-month follow-up. Repeated measures linear mixed modeling was used to examine the effect of ENGAGE on child outcomes. Those receiving ENGAGE exhibited significantly greater decreases in parent-rated attentional problems, hyperactivity/impulsivity, and acting out behaviors than the control group did, with mostly moderate effect sizes. No consistent improvements in the teacher ratings of children's EF related difficulties were found in either group. Low dropout (8%) from the intervention and high acceptability ratings indicated that ENGAGE is a palatable intervention for parents. The present study showed that findings from an earlier RCT on ENGAGE conducted in New Zealand could be generalized to a different cultural setting, as the intervention effectively reduced young Finnish children's EF difficulties in the home context. Extending ENGAGE and other play-based interventions into different everyday contexts of children, such as ECE, could further enhance the beneficial effects on children's EFs and behavior.

Neuropsychological subgroups of adolescents with conduct disorder.

In group-level studies adolescents with conduct disorder (CD) have been found to have deficiencies in verbal and executive functions. Teichner and Golden (2000) addressed the neuropsychological heterogeneity of CD, and hypothesized the existence of six neuropsychologically different subgroups. We used that theoretical basis to identify subgroups among 77 adolescents with CD and 48 controls. Among subjects with CD we identified subjects with no, diffuse, verbal and executive function deficits, but none with specific memory or visuo-spatial deficits. In total, neuropsychological deficits altogether were more common among subjects with CD relative to controls, as were specific verbal deficits. Subgroups did not differ in gender distribution, comorbidity of psychiatric disorders, type or severity of CD, or number of psychosocial risk factors. Among subjects with CD, learning disabilities were common. CD is neuropsychologically a heterogeneous disorder, and neuropsychological deficits should be taken into account in assessing and planning interventions for adolescents with CD.

Psychiatric comorbidity more common among adolescent females with CD/ODD than among males.

Clinicians and researchers have been increasingly concerned on conduct problems among adolescent females. Yet, most research on the issue has been conducted among males. The aim of this study was to characterize conduct disorder (CD) among adolescent females in comparison with males. Family background, symptoms and severity of CD, and psychiatric comorbidity were assessed among Finnish 12-18-year-old females (n=40) with conduct disorder/oppositional defiant disorder (CD/ODD) compared with males (n=37). Data were collected via structured interviews with the subjects and interviews with parents. Lifetime and current Axis I diagnoses (DSM-IV) were assessed using the Structured Clinical Interview (SCID-I) interview. No gender differences were found in the number of CD symptoms or aggressive symptoms. Family adversities, comorbid major depression, anxiety disorders and substance use disorders as well as suicidality were more common, while reading disorder was less common among girls compared with boys. The varied problems and comorbid disorders among females with CD/ODD are important to recognize.

Associations Between Childhood Learning Disabilities and Adult-Age Mental Health Problems, Lack of Education, and Unemployment.

We studied the impact of diverse subtypes of learning disabilities (LD) on adult-age mental health, education, and employment by comparing the LD group ( n = 430) with a matched control group without a known history of LD ( n = 2,149). The clinical archived data were merged with lifelong register data on sickness allowances/disability pensions granted on the basis of psychiatric illnesses, reimbursements for psychoactive medication, having a degree after compulsory education, and having received unemployment allowances. Differences emerged between the LD and control groups in all outcomes, suggesting that a higher proportion of individuals with LD had mental health problems compared to the control group, and a notable share of them had not attained a degree after compulsory education and had been unemployed for an extended period. Subgroup comparisons indicated that math disability (MD) was associated with antidepressant use and unemployment, whereas the reading disability (RD) group showed the least problems with employment. Interactions between subgroup and gender suggested that MD (with/without RD) may pose a higher risk than RD for females, whereas RD seemed to pose a risk for males. The findings suggest the need for researchers, clinicians, and those involved with adult education to consider mental health and educational problems among individuals with LD.

Teacher Ratings of Executive Function Difficulties in Finnish Children with Combined and Predominantly Inattentive Symptoms of ADHD.

School-age children with difficulties in executive functions (EFs) are at risk for substantial academic impairment and poorer developmental outcome. Although Attention Deficit Hyperactivity Disorder (ADHD) is generally associated with weaknesses in EFs, a relatively minimal amount is known about school-related EF difficulties and differences between ADHD subtypes. The present study examined teacher ratings of EF behaviors in 7- to 15-year-old Finnish children with combined symptoms of ADHD (ADHD-C; n = 189), predominantly inattentive symptoms (ADHD-I; n = 25), and no ADHD (n = 691). The teacher ratings showed that both ADHD groups had more EF difficulties than controls. Ratings also indicated specific EF profiles for the ADHD subtypes, students with ADHD-I having more wide-ranging EF difficulties in attention as well as initiation, planning, and execution of actions than children with ADHD-C. According to the present findings, the school-related EF difficulties of children with ADHD-I need to be specifically acknowledged. Teacher ratings seem to be sensitive indicators of EF difficulties and distinguish between different kinds of EF profiles. In clinical practice, rating scales with reliable psychometric properties and normative data relevant to the specific cultural environment should be employed.

Double-Deficit Hypothesis in a Clinical Sample: Extension Beyond Reading.

This study explored the double-deficit hypothesis (DDH) in a transparent orthography (Finnish) and extended the view from reading disabilities to comorbidity of learning-related problems in math and attention. Children referred for evaluation of learning disabilities in second through sixth grade (N = 205) were divided into four groups based on rapid automatized naming (RAN) and phonological awareness (PA) according to the DDH: the double-deficit group, the naming speed deficit-only group, the phonological deficit-only group, and the no-deficit group. The results supported the DDH in that the prevalence and severity of reading disability were greatest in the double-deficit group. Despite the greater prevalence of reading disabilities in single-deficit groups compared to the no-deficit group, the means of reading measures in the single-deficit groups were similar to those of the no-deficit group. The PA single-deficit group was poorer in spelling than the no-deficit group and single-naming-deficit group. Deficits in RAN or PA were primarily linked to reading disabilities but not with math or attention problems. The results supported the DDH partially and indicate that deficits in RAN and PA are specific to reading disabilities.

Rapid serial naming: relations between different stimuli and neuropsychological factors.

We report two studies on rapid serial naming (RSN). Study 1 addressed the relations among RSN tasks comprising different stimuli. Separate components for RSN of alphanumeric and non-alphanumeric stimuli, as well as for tasks in which the stimuli alternated between categories were identified. In Study 2, phonological skills, processing speed, motor dexterity, and verbal fluency were found to explain RSN performance. The studies indicate: (1) that RSN tasks vary in their properties according to the stimuli used and according to the way the tasks are arranged, and (2) that RSN tasks are multi-componented.

Examining methodological variation in response inhibition: The effects of outcome measures and task characteristics on age-related differences.

This study addressed methodological issues common to developmental studies on response inhibition. Age-related differences were investigated using two Stroop-like tasks with different levels of complexity and comparing different outcome measures in a sample of 340 children and adolescents aged 7-15 years. First, speed and accuracy of task performance were examined; the results showing that improvement in speed continued until age 13 in both the basic naming task and the two inhibition tasks. Improvement in accuracy was less consistent and continued until age 9 or 13 years. Second, two different algorithms were employed to control for the effects of basic processes in inhibition tasks. The difference algorithm indicated age-related differences similar to those for speed. The ratio algorithm, however, suggested earlier deceleration of development of response inhibition at 9 or 11 years of age. Factors related to the cognitive requirements and presented stimuli also had an effect on the results. The present findings shed light on the inconsistencies in the developmental studies of response inhibition and demonstrated that the selection of outcome measures and task characteristics are critical because they affect the way development is depicted.

Improving spatial functioning in children with cerebral palsy using computerized and traditional game tasks.

PURPOSE: To examine the effectiveness of combining virtual environment (VE) instruction with additional desk-top tasks, based on the Luria-Vygotsky methodology, for spatial remediation in children having complex motor disabilities restricting movement. METHODS: In Experiment 1, from among children attending for residential rehabilitation, an experimental subgroup had additional spatial training using a VE and corresponding desk-top models. All children were tested at the start and end of training, using four spatial tests. In Experiment 2, larger groups of children (pair-matched for initial performance) were given the same training as in Experiment 1, but experimentals received both VE-based training and supporting tasks designed to improve executive functions and verbal regulation of spatial functioning. Assessment involved a wider range of tests than in Experiment 1. RESULTS: In Experiment 1, both groups showed improvement at retest, but experimentals showed greater improvement. Children beginning with the lowest level of cognitive performance failed to benefit from the additional training. In Experiment 2 the experimental group made significantly greater improvement than controls, irrespective of initial performance level. CONCLUSIONS: VE-based spatial training is effective for children with complex disabilities, particularly when combined with training that remediates cognitive weaknesses.

Borderline intellectual functioning: a systematic literature review.

The literature related to people with borderline intellectual functioning (BIF) was systematically reviewed in order to summarize the present knowledge. Database searches yielded 1,726 citations, and 49 studies were included in the review. People with BIF face a variety of hardships in life, including neurocognitive, social, and mental health problems. When adults with BIF were compared with the general population, they held lower-skilled jobs and earned less money. Although some risk factors (e.g., low birth weight) and preventive factors (e.g., education) were reported, they were not specific to BIF. The review finds that, despite the obvious everyday problems, BIF is almost invisible in the field of research. More research, societal discussion, and flexible support systems are needed.

Rapid automatized naming and learning disabilities: does RAN have a specific connection to reading or not?

This work is an extension of a study by Waber, Wolff, Forbes, and Weiler (2000 ) in which the specificity of naming speed deficits to reading disability (RD) was examined. One hundred ninety-three children (ages 8 to 11) evaluated for learning disabilities were studied. It was determined how well rapid automatized naming (RAN) discriminated between different diagnostic groups (learning impaired [LI] with and without RD) from controls and from each other. Whereas Waber et al. concluded that RAN was an excellent tool for detecting risk for learning disabilities in general, the results of the present study point to a more specific connection between RAN and RD.

Psychosocial adjustment and quality of life after renal transplantation in early childhood.

Psychosocial adjustment and quality of life has been reported good in children after a successful renal transplantation (Tx). There are, however, few reports of using standardized methods in evaluating these issues, particularly in small children. We investigated the psychosocial adjustment in 32 children at school age (mean 9.6 +/- 1.6), who had received a renal Tx under the age of 5 yr, using the Achenbach Child Behavior Checklist with data collected from both parents (CBCL) and teachers (CBCL-TRF). Health-related quality of life (HRQOL) was assessed by interviewing the children using a 17-dimensional (17D) health-related measure and compared to HRQOL of 244 normal school children. The effect of additional diseases and comorbidity on psychosocial adjustment and HRQOL was assessed. The total scores on the CBCL did not differ from normative samples of healthy children. However, somatic complaints and social problems were reported more frequently in boys, and attention problems in both boys and girls. Patients with pathological scores had significantly more comorbidity (p = 0.03) and were more often attending a special school (p = 0.007) than patients with normal scores. The global 17D HRQOL index was significantly lower than measured in healthy controls (94 +/- 5 for controls and 85 +/- 7 for patients, p < 0.0001). It is of crucial importance to further minimize the risk factors leading to comorbidity in children after Tx. HRQOL assessment by the children themselves can be used to direct interventions and support the children's psychosocial adjustment.