Young children's performance on a design fluency task: longitudinal data on total number of designs, clustering and switching, and regression-based norms.

INTRODUCTION: Design fluency (DF) tasks are commonly used to assess executive functions such as attentional control, cognitive flexibility, self-monitoring and strategy use. Next to the total number of correct designs, the standard outcome of a DF task, clustering and switching can help disentangle the processes underlying DF performance. We present the first longitudinal study of 4-8-year-old children's developmental DF trajectories. METHOD: At initial enrollment, children (n = 228) were aged between 4.05 and 6.88 years (M = 5.18, SD = 0.59) and attended Dutch primary schools. The DF task was administered at three time points, each time point separated by approximately 1 year. Data were analyzed using mixed regression for total number of correct designs and switching, and mixed logistic regression analysis for clustering. RESULTS: The total number of correct designs increased linearly across the three time points. Across all time points, children made very few clusters, and most clusters consisted of only 3 designs. Clustering only increased at the third assessment compared to the two previous assessments. Switching increased up to the second assessment, but not after that. The number of switches was highly correlated with the total number of correct designs at all time points (r = 0.78 to r = 0.85). These developmental trajectories were similar for all children regardless of their baseline age. Normative data are given for the total number of correct designs and switching. CONCLUSIONS: Children as of age 4 onwards can perform a DF task. For children as young as 4-8 years old, computing clustering, and switching measures is of limited value to study cognitive processes underlying DF performance, next to the total number of correct designs. There were no sex differences on any of the DF outcomes. Level of parental education (LPE) was positively associated with the total number of correct designs and switching.

Further validation of a new ADHD screening questionnaire measuring parents' explanations (time processing, cognition, and motivation) of inattention symptoms in their school-aged children.

The triple pathway model suggests that different neuropsychological factors underlie symptoms of inattention (i.e., time, cognition and/or motivation problems). However, screening instruments asking individuals to judge the link between these neuropsychological factors and inattention are lacking. The recently developed screening questionnaire, PASSC, aims to examine these factors possibly causing inattention by asking parents to indicate to what extent their child experiences inattention symptoms and to what extent different neuropsychological factors explain this inattention. The present study extends prior validation research of the PASSC by examining associations between PASSC inattention explained by time, cognition, and/or motivation and children's performance on tests measuring these same three constructs. Results indicated positive correlations between PASSC inattention explained by time and less accurate performance on a time discrimination test, and between PASSC inattention explained by cognition and more working memory errors as well as higher attention switching costs. Furthermore, children whose parents indicated that their inattention was best explained by cognition showed higher switching costs than children whose inattention was best explained by motivation. This support for construct validity of the PASSC is limited to two PASSC explanations (i.e., time, cognition) and a subset of tests (i.e., time discrimination, attention switching, memory span). Future research should focus on integrating PASSC and performance test results to differentiate between children with attention problems but different underlying neuropsychological problems. Concluding, the PASSC can be a promising screening tool to identify inattention in children and the underlying explanation indicated by parents.

Psychometric properties of the Children's Time Awareness Questionnaire (CTAQ): A study on the validity of a Dutch 20-item questionnaire measuring time awareness in children.

This study investigates the validity of Children's Time Awareness Questionnaire (CTAQ), a 20-item task for assessing children's time awareness. The CTAQ was administered to a group of typically developing children (n = 107) and children with any developmental problems reported by parents (non-typically developing children, n = 28), aged 4-8 years old. We found some support for a one-factor structure (EFA), yet the explained variance is relatively low (21%). Our proposed structure of two additional subscales, i.e., "time words" and "time estimation," was not supported by (confirmatory and exploratory) factor analyses. In contrast, exploratory factor analyses (EFA) indicated a six-factor structure, which needs further investigation. We found low, yet non-significant correlations between CTAQ scales and caregiver reports on children's time awareness, planning and impulsivity, and no significant correlations between CTAQ scales and scores on cognitive performance tasks. As expected, we found that older children have higher CTAQ scores than younger children. Non typically developing children had lower scores on CTAQ scales, compared to typically developing children. The CTAQ has sufficient internal consistency. The CTAQ has potential to measure time awareness, future research is indicated to further develop the CTAQ and enhance clinical applicability.

The influence of sensory processing tools on attention and arithmetic performance in Dutch primary school children.

Behavior caused by nonoptimal sensory processing possibly affects school performance. Sensory processing is the ability of the nervous system to process and modulate sensory input and to give an appropriate response. Children with nonoptimal sensory processing are sometimes given tools that are expected to help them concentrate better and achieve better school performance. However, whether these tools are effective and whether the effects depend on children's sensory processing are unknown. To investigate this, a randomized controlled trial was executed. Children attending Grade 2 (N = 271) performed a sustained attention test (the Bourdon-Vos test) and an arithmetic test once a week 4 weeks in a row with a different sensory processing tool every session: tangle, wobble cushion, earmuffs, or nothing (control condition). Sensory processing was assessed with the Sensory Profile NL. To test the effects of sensory processing tools on the Bourdon-Vos and arithmetic test performance, mixed-model analyses were executed. Negative effects of the use of the tangle, earmuffs, and wobble cushion on the Bourdon-Vos total, the use of the tangle and wobble cushion on the Bourdon-Vos correct, and the use of the tangle on the arithmetic test were shown. When children's sensory processing pattern was considered, a negative effect of the use of all tools was shown on the Bourdon-Vos correct for children who already received an optimal amount of stimuli. Considering these results, more research is needed to investigate the effect of longer-term personalized sensory processing tool use on attention and arithmetic performance of children.

Rationale and description of BrainLevel: Computerized repeated practice with strategy use instruction for children with acquired brain injury.

OBJECTIVE: In this paper, we provide the rationale behind and a description of BrainLevel, a new cognitive rehabilitation intervention for children with acquired brain injury. RATIONALE: Children with acquired brain injury frequently report cognitive problems and consequently problems in participation, psychosocial functioning, family functioning and quality of life. Computerized repeated practice of specific cognitive tasks (so-called 'brain training') improves performance on those specific or highly similar tasks, but rarely leads to better daily life functioning. Adding strategy use instruction as an intervention component, with the aim to transfer task-specific effects to other contexts, may yield positive effects on cognitive and daily life functioning of children with acquired brain injury. DESCRIPTION OF THE NEW INTERVENTION: In BrainLevel, computerized repeated practice is offered via the online training programme BrainGymmer. For the strategy use instruction, we developed a protocol to provide and practice function-specific and metacognitive strategies. The intervention period is 6 weeks, during which children train five times per week for 30 minutes per day at home with BrainGymmer. Additionally, they attend a weekly 45-minute strategy use instruction session on the basis of our protocol with a cognitive rehabilitation specialist. DISCUSSION: BrainLevel is innovative in combining computerized repeated practice with strategy use instruction as cognitive rehabilitation for children with acquired brain injury. Currently, we are investigating the effectiveness of BrainLevel. In this paper, possible adaptations to tailor BrainLevel to other games or contexts, or to incorporate novel scientific insights, for example regarding optimal intervention duration and intensity, are discussed.

Case management after acquired brain injury compared to care as usual: study protocol for a 2-year pragmatic randomized controlled superiority trial with two parallel groups.

BACKGROUND: People with acquired brain injury may suffer from cognitive, emotional and behavioural changes in the long term. Continuity of care is often lacking, leading to a variety of unmet needs and hindering psychosocial functioning from the occurrence of brain injury up to years thereafter. Case management aims to prevent (escalation of) problems and to facilitate timely access to appropriate services. In other populations, case management has shown to improve psychosocial well-being. In this study, we aim to evaluate the feasibility of case management after acquired brain injury and its effectiveness and cost-effectiveness, compared to care as usual. METHODS: This is a pragmatic randomized controlled superiority trial with two parallel groups and repeated measures in adults with ABI and their family, taking place between November 2019 and December 2021 in three provinces in the Netherlands. Participants will be randomly allocated to either the case management group, receiving case management from hospital discharge up to 2 years thereafter, or the control group, receiving care as usual. Effectiveness will be evaluated every 6 months for 18-24 months by patient-reported psychosocial well-being (Hospital Anxiety and Depression Scale (HADS), Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) restriction subscale and the Life Satisfaction Questionnaire (LiSat)), self-management (Patient Activation Measure (PAM)) and care needs (Longer-term Unmet Needs after Stroke (LUNS)). Family outcomes include self-efficacy (Carer Self-Efficacy Scale (CSES)), caregiver burden (Caregiver Strain Index (CSI)), psychosocial well-being (LiSat, HADS), family needs (Family Needs Questionnaire (FNQ)). Feasibility will be evaluated using qualitative methods, assessing fidelity, dose delivered, dose received, reach, recruitment and context. Cost-effectiveness will be determined by the EQ-5D-3L and service use. DISCUSSION: At the moment, there is no integrated health care service for people with acquired brain injury and their family members in the long term. If case management is shown to be feasible and (cost)-effective, it could bridge the gap between patients' and families' needs and the available services. TRIAL REGISTRATION: Netherlands Trial Register NL8104 . Registered on 22 October 2019.

Assessing participation of children with acquired brain injury and cerebral palsy: a systematic review of measurement properties.

AIM: To examine which instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) align with attendance and/or involvement constructs of participation; and to systematically review measurement properties of these instruments in children with ABI or CP, to guide instrument selection. METHOD: Five databases were searched. Instruments that quantified 'attendance' and/or 'involvement' aspects of participation according to the family of participation-related constructs were selected. Data on measurement properties were extracted and methodological quality of the studies assessed. RESULTS: Thirty-seven instruments were used to assess participation in children with ABI or CP. Of those, 12 measured attendance and/or involvement. The reliability, validity, and responsiveness of eight of these instruments were examined in 14 studies with children with ABI or CP. Sufficient measurement properties were reported for most of the measures, but no instrument had been assessed on all relevant properties. Moreover, most psychometric studies have marked methodological limitations. INTERPRETATION: Instruments to assess participation of children with ABI or CP should be selected carefully, as many available measures do not align with attendance and/or involvement. Evidence for measurement properties is limited, mainly caused by low methodological study quality. Future studies should follow recommended methodological guidelines. WHAT THIS PAPER ADDS: Twelve instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) aligned with attendance/involvement. Seven instruments have some psychometric evidence supporting their use with children with CP. For children with ABI, only the Child and Adolescent Scale of Participation has shown preliminary evidence of measurement properties.

Does strategy instruction on the Rey-Osterrieth Complex Figure task lead to transferred performance improvement on the Modified Taylor Complex Figure task? A randomized controlled trial in school-aged children.

OBJECTIVE: Providing children with organizational strategy instruction on the Rey Osterrieth Complex Figure (ROCF) has previously been found to improve organizational and accuracy performance on this task. It is unknown whether strategy instruction on the ROCF would also transfer to performance improvement on copying and the recall of another complex figure. METHODS: Participants were 98 typically developing children (aged 9.5-12.6 years, M = 10.6). Children completed the ROCF (copy and recall) as a pretest. Approximately a month later, they were randomized to complete the ROCF with strategy instruction in the form of a stepwise administration of the ROCF or again in the standard format. All children then copied and recalled the Modified Taylor Complex Figure (MTCF). All productions were assessed in terms of organization, accuracy and completion time. RESULTS: Organization scores for the MTCF did not differ for the two groups for the copy production, but did differ for the recall production, indicating transfer. Accuracy and completion times did not differ between groups. Performance on all measures, except copy accuracy, improved between pretest ROCF and posttest MTCF production for both groups, suggesting practice effects. CONCLUSION: Findings indicate that transfer of strategy instruction from one complex figure to another is only present for organization of recalled information. The increase in RCF-OSS scores did not lead to a higher accuracy or a faster copy or recall.

Age-dependent differences in the impact of paediatric traumatic brain injury on executive functions: A prospective study using susceptibility-weighted imaging.

Childhood and adolescence represent sensitive developmental periods for brain networks implicated in a range of complex skills, including executive functions (EF; inhibitory control, working memory, and cognitive flexibility). As a consequence, these skills may be particularly vulnerable to injuries sustained during these sensitive developmental periods. The present study investigated 1) whether age at injury differentially affects EF 6 months and 2 years after TBI in children aged 5-15 years, and 2) whether the association between brain lesions and EF depend on age at injury. Children with TBI (n = 105) were categorized into four age-at-injury groups based on previous studies and proposed timing of cerebral maturational spurts: early childhood (5-6 years, n = 14), middle childhood (7-9 years, n = 24), late childhood (10-12 years, n = 52), and adolescence (13-15 years, n = 15). EF were assessed with performance-based tasks and a parent-report of everyday EF. TBI patients' EF scores 6 months and 2 years post-injury were compared to those of typically developing (TD) controls (n = 42). Brain lesions were identified using susceptibility weighted imaging (SWI). Results indicated that inhibitory control performance 2 years post-injury was differentially affected by the impact of TBI depending on age at injury. Follow-up analyses did not reveal significant differences within the age groups, preventing drawing strong conclusions regarding the contribution of age at injury to EF outcome after TBI. Tentatively, large effect sizes suggest that vulnerability is most apparent in early childhood and adolescence. Everyday inhibitory control behaviour was worse for children with TBI than TD children across childhood and adolescence at the 2-year assessment. There was no evidence for impairment in working memory or cognitive flexibility after TBI at the group level. Given small group sizes, findings from analyses into correlations between EF and SWI lesions should be interpreted with caution. Extent, number and volume of brain lesions correlated with adolescent everyday EF behaviour 6 months post-injury. Taken together, the results emphasize the need for long-term follow-up after paediatric TBI during sensitive developmental periods given negative outcomes 2-year post injury. Inhibitory control seems to be particular vulnerable to the impact of TBI. Findings of associations between EF and SWI lesions need to be replicated with larger samples.

Searching for effective components of cognitive rehabilitation for children and adolescents with acquired brain injury: A systematic review.

AIM: Cognitive rehabilitation is of interest after paediatric acquired brain injury (ABI). The present systematic review examined studies investigating cognitive rehabilitation interventions for children with ABI, while focusing on identifying effective components. Components were categorized as (1) metacognition and/or strategy use, (2) (computerized) drill-based exercises, and (3) external aids. METHODS: The databases PubMed (including MEDLINE), PsycInfo, and CINAHL were searched until 22nd June 2017. Additionally, studies were identified through cross-referencing and by consulting experts in the field. RESULTS: A total of 20 articles describing 19 studies were included. Metacognition/strategy use trainings (five studies) mainly improved psychosocial functioning. Drill-based interventions (six studies) improved performance on tasks similar to training tasks. Interventions combining these two components (six studies) benefited cognitive and psychosocial functioning. External aids (two studies) improved everyday memory. No studies combined external aids with drill-based interventions or all three components. CONCLUSION: Available evidence suggests that multi-component rehabilitation, e.g. combining metacognition/strategy use and drill-based training is most promising, as it can lead to improvements in both cognitive and psychosocial functioning of children with ABI. Intervention setting and duration may play a role. Conclusions remain tentative due to small sample sizes of included studies heterogeneity regarding outcome measures, intervention and therapist variables, and patient characteristics.

The role of early intervention in improving the level of activities and participation in youths after mild traumatic brain injury: a scoping review.

Mild traumatic brain injury in children can lead to persistent cognitive and physical symptoms which can have a negative impact on activities and participation in school and at play. Preventive treatment strategies are preferred because these symptoms are often not recognized and therefore not treated adequately. In this review clinical studies investigating interventions directed at pediatric mild traumatic brain injury are summarized, and clinical recommendations and directions for the future are provided. Results show that the literature is scarce and more high quality studies are needed. Information and education about the injury and its consequences are recommended, with additional follow-up consultation, including individualized advice and reassurance. The interventions should be family-centered and, ideally, the return to activity and participation should be graded and done step-by-step.

Impulsivity and overeating in children in the absence and presence of hunger.

Overweight children appear to be more responsive to environmental, hedonic cues and easily overeat in the current obesogenic environment. They are also found to overeat in the absence of hunger, and this overeating seems related to impulsivity: impulsive participants are more prone to external eating. However, some studies showed that impulsive adults are also more prone to hunger cues: impulsive participants overate especially when feeling hungry. This would mean impulsive people are more reactive to both external and internal cues. The overeating was limited to palatable high energy-dense foods: hunger made them fancy a snack. In the current study, we wanted to test the interaction between impulsivity, hunger and consumption of food type in children. Impulsivity was measured in 88 children between the ages of 7 and 9. Next, half of the participants performed a taste test before their own regular lunch and half of the participants immediately after their lunch. During the taste test, low, medium and high energy-dense food items were presented. Results showed that impulsive children ate more high energy-dense foods than low impulsive children, both before and after their lunch. No differences were found on low or medium energy-dense foods. Impulsive children therefore showed normal sensitivity for internal hunger and satiety cues, but abnormal response to high energy-dense foods. This might render them vulnerable to tasty temptation in the environment and to weight gain in their future.

Analysis of young children's abilities to cluster and switch during a verbal fluency task.

To investigate developmental changes that take place in verbal fluency (VF) performance during early childhood, a VF task was administered to 225 healthy, Dutch-speaking children aged between 4.14 and 6.89 years. Three categories of VF outcome measures were included: i.e., word productivity, mean cluster size, and number of switches. Age influenced performance on all VF outcome measures linearly; i.e., older children produced more words, made longer clusters, and switched more. Higher levels of intelligence were associated with increased VF word productivity, but not with measures of switching and clustering. When leaving intelligence out of these analyses, we additionally found an interaction between level of parental education (LPE) and sex on total word productivity, i.e., girls with parents who had lower LPE produced fewer words than the other children. Furthermore, a similar interaction of LPE and sex was found for the number of switches: i.e., girls who had parents with lower LPE made fewer switches than the other children. Findings suggest that even in 4 to 6-year-old children important changes take place over time in VF and in processes underlying successful performance. Attention should be paid to age-extrinsic factors, such as LPE and sex, since these have been found to influence VF performance in young children.