Perfil Neurocognitivo de una cohorte de menores de edad con vivencias de maltrato infantil / Neuropsychological profile of a cohort of children victims of child abuse

El maltrato infantil (MI) es un problema multidimensional. El estrés crónico producido por dicho fenómeno afecta el desarrollo cerebral de niños, niñas y adolescentes (NNA), incidiendo negativamente en la evolución de diversos aspectos del desarrollo, condicionando su vida futura. El objetivo de este estudio es analizar el desempeño sociocognitivo de NNA que han vivenciado MI, mediante el análisis de las funciones del neurodesarrollo, evaluado con subpruebas de la NEPSY II. Se analizan funciones ejecutivas y percepción social, bases del razonamiento y adaptación social. Se estudia el desempeño de 14 de NNA pertenecientes a un Programa de la Fundación Súmate, cuya Misión es la recuperación de la escolaridad NNA que han visto alterado el curso de su desarrollo por MI. Los resultados dan cuenta de alteraciones cerebrales asociadas al MI, las que se evidencian en un deficitario desarrollo funcional de las variables estudiadas. Existe grave descenso en los procesos y subprocesos del funcionamiento ejecutivo. En relación con la percepción social, la muestra estudiada presenta un mejor desarrollo, el que desciende a medida que aumenta la edad. Las funciones estudiadas tienen directa relación con el razonamiento cognitivo y desarrollo socio adaptativo, bases sobre las que se estructura el desarrollo académico. Los hallazgos, refuerzan la urgencia de abordar esta sensible realidad desde la práctica médica en la atención primaria y especializada. Los resultados también son de utilidad para orientar el desarrollo de políticas públicas que efectivamente contribuyan al progreso de nuestro país.

Abstract. Child maltreatment (MI) is a multidimensional problem. The chronic stress produced by this phenomenon affects the brain development of children and adolescents (NNA), negatively affecting the evolution of various aspects of development, conditioning their future life. The objective of this study is to analyze the sociocognitive performance of children and adolescents who have experienced IM, through the analysis of the performance of neurodevelopmental functions, evaluated through subtests of the NEPSY II. Executive functions and social perception, reasoning bases and social adaptation are studied. The performance of 14 NNA belonging to a Fundación Súmate Program is studied, whose mission is the recovery of NNA schooling that has seen the course of their development altered by IM. The results show brain alterations associated with MI, evidenced in a deficient functional development of the variables studied. There is a serious decline in the processes and threads of executive functioning. In relation to social perception, the studied sample presents a better development, which decreases as age increases. The functions studied are directly related to cognitive reasoning and socio-adaptive development, based on which academic development is structured. The findings reinforce the urgency of addressing this sensitive reality from medical practice in primary and specialized care. The results are also useful to guide the development of public policies that effectively contribute to the progress of our country.

Beyond group differences: Exploring the preliminary signals of target engagement of an executive function training for autistic children.

Understanding both for whom and how interventions work is a crucial next step in providing personalized care to children with autism spectrum disorder (ASD). Autistic children present with heterogeneity both within core ASD criteria and with respect to co-occurring mental health challenges, which may affect their ability to benefit from intervention. In a secondary data analysis of a randomized control trial evaluating an executive function (EF) training with 70 7- to 11-year-old autistic children, we explored: (1) whether co-occurring attention-deficit/hyperactivity disorder (ADHD) features or anxiety features at baseline moderated the extent to which children benefited from the EF training. In other words, we asked, "For whom is training effective?" We also explored: (2) the extent to which changes in a brain-based measure of target engagement predicted the clinical outcomes of the EF training. This is a step towards asking, "How is training effective?" We found that EF training improved behavioral inhibition only for children with clinically significant co-occurring ADHD features. Anxiety features, while prevalent, did not moderate EF training efficacy. Finally, for the EF training group only, there was a significant correlation between pre-to-post change in an EEG-based measure of target engagement, N2 incongruent amplitude during a flanker task, and change in repetitive behaviors, a behavioral outcome that was reported in the parent RCT to have improved with training compared to waitlist control. This study provides preliminary evidence that EF training may differentially affect subgroups of autistic children and that changes at the neural level may precede changes in behavior. LAY SUMMARY: Understanding both for whom and how interventions work will help us provide personalized care to children with autism spectrum disorder (ASD). Autistic children present with many different strengths and challenges. Co-occurring mental health challenges may affect how much autistic children benefit from intervention. We analyzed secondary data from a rigorously designed pilot intervention study, a randomized control trial (RCT), that enrolled 70 7- to 11-year-old autistic children to assess whether a set of computer-based executive function (EF) training games improved their performance. Executive functions include being able to shift between tasks, inhibit a response, and keep information in working memory. In the current study, we explored: (1) whether children's co-occurring attention-deficit/hyperactivity disorder (ADHD) features or anxiety features, measured before the EF training began, affected how much they benefited from the EF training. In other words, we asked, "For whom is training effective?" We also explored: (2) whether children's brain-based changes in EF predicted their performance in everyday life (e.g., parent report on a survey). This is a step toward asking, "How is training effective?" We found that EF training improved children's inhibition ability, but only for children with clinically significant ADHD features. While many children in our sample also had anxiety features, we found that anxiety levels did not affect how well the EF training worked. Finally, for children who received the EF training, changes in a brain-based measure of conflict monitoring (i.e., being able to noticing differences in stimuli) predicted changes in children's repetitive behaviors. This study provides early evidence that EF training may be more effective for some autistic children than others, especially those with ADHD features.

A preliminary randomized, controlled trial of executive function training for children with autism spectrum disorder.

LAY ABSTRACT: Executive function, which is a set of thinking skills that includes stopping unwanted responses, being flexible, and remembering information needed to solve problems, is a challenge for many children on the autism spectrum. This study tested whether executive function could be improved with a computerized executive function training program under the guidance of a coach who reinforced the use of executive function skills. Seventy children with autism spectrum disorder from age 7 to 11 years of age participated in the study. They were randomly assigned to receive training or to a waiting group. The tests most likely to determine whether the training may be effective were chosen from a larger battery before the study started and included one task measuring brain responses, two measures of executive function in the lab, and a parent questionnaire. Changes in social functioning and repetitive behaviors were also explored. All children assigned to training completed the program and families generally reported the experience was positive. Brain responses of the training group changed following training, but not within the waiting group during a similar time period. Children who received training did not exhibit behavioral changes during the two the lab-based tasks. Parent report on questionnaires indicated that neither group showed a significant change in their broad use of executive function in other settings. Yet, children who received training were reported to have fewer restricted and repetitive behaviors following training. These initial findings suggest that short executive function training activities are feasible and may improve some functioning of school-aged children on the autism spectrum.

Metacognitive scaffolding boosts cognitive and neural benefits following executive attention training in children.

Interventions including social scaffolding and metacognitive strategies have been used in educational settings to promote cognition. In addition, increasing evidence shows that computerized process-based training enhances cognitive skills. However, no prior studies have examined the effect of combining these two training strategies. The goal of this study was to test the combined effect of metacognitive scaffolding and computer-based training of executive attention in a sample of typically developing preschoolers at the cognitive and brain levels. Compared to children in the regular training protocol and an untrained active control group, children in the metacognitive group showed larger gains on intelligence and significant increases on an electrophysiological index associated with conflict processing. Moreover, changes in the conflict-related brain activity predicted gains in intelligence in the metacognitive scaffolding group. These results suggest that metacognitive scaffolding boosts the influence of process-based training on cognitive efficiency and brain plasticity related to executive attention.

Influence of the SLC6A3-DAT1 Gene on Multifaceted Measures of Self-regulation in Preschool Children.

Development of self-regulation, the capacity to voluntarily modulate thoughts, emotions and actions is strongly related to the maturation of the dopamine-mediated executive attention network (EAN). The attention control processes associated with the EAN greatly overlap with efficiency of the executive functions and are correlated with measures of effortful control. Regulation of dopamine levels within the EAN, particularly in the basal ganglia is carried out by the action of dopamine transporters. In humans, the SLC6A3/DAT1 gene carries out the synthesis of the DAT protein. The 10-repeat allele has been associated with an enhanced expression of the gene and has been related to ADHD symptoms. Little is known about the impact of DAT1 variations on children's capacity to self-regulate in contexts that impose particular demands of regulatory control such as the school or home. This study defines a multi-domain phenotype of self-regulation and examines whether variations of the DAT1 gene accounts for individual differences in performance in 4-5 year old children. Results show that presence of the 10r allele is related to a diminished ability to exert voluntary regulation of reactivity. These findings shed light on the neurobiological mechanisms underlying individual differences in self-regulation during childhood.

Enhanced efficiency of the executive attention network after training in preschool children: immediate changes and effects after two months.

Executive attention is involved in the regulation of thoughts, emotions and responses. This function experiences major development during preschool years and is associated to a neural network involving the anterior cingulate cortex and prefrontal structures. Recently, there have been some attempts to improve attention and other executive functions through training. In the current study, a group of 5 years old children (n=37) were assigned to either a training-group who performed ten sessions of computerized training of attention or a non-trained control group. Assessment of performance in a range of tasks, targeting attention, intelligence and regulation of affect was carried out in three occasions: (1) before, (2) after, and (3) two months after completion of training. Also, brain function was examined with a high-density electroencephalogram system. Results demonstrate that trained children activate the executive attention network faster and more efficiently than untrained children, an effect that was still observed two months after without further training. Also, evidence of transfer of attention training to fluid intelligence and, to a lesser degree, to regulation of affect was observed. Results show that efficiency of the brain system underlying self-regulation can be enhanced by experience during development, providing opportunities for curricular improvement.

Recognition by familiarity is preserved in Parkinson's without dementia and Lewy-Body disease.

OBJECTIVE: The retrieval deficit hypothesis states that the lack of deficit in recognition often observed in patients with Parkinson's disease is because of the low retrieval requirements of the task, given that these patients have retrieval and not encoding deficits. To test this hypothesis we investigated recognition memory by familiarity in Parkinson's patients and in patients with Lewy Bodies disease and Parkinson with dementia. METHOD: We analyzed to what extent the experimental groups were able to recognize by familiarity in a typical yes/no recognition memory task. The experimental groups were patients with early nondemented Parkinson's disease, advanced nondemented Parkinson's disease, demented Parkinson's patients, and patients with dementia with Lewy Bodies. We compared their performance with a group of young and another group of old healthy participants. The estimation of familiarity was made by analyzing recognition of word targets and distractors consisting of combinations of different letters in comparison with a condition in which targets and distractors were composed of similar letters, even though subjects were unaware of the independent variable. RESULTS: The results indicate that familiarity was used at the same level by controls, patients with early Parkinson's disease and patients with dementia with Lewy Bodies. Although late Parkinson patients also used familiarity, its effect was only marginally significant. Patients with Parkinson's disease and dementia were not capable of using familiarity in recognition memory. CONCLUSIONS: Our results support the retrieval deficit hypothesis as Parkinson's patients without dementia show no deficit in a situation in which the retrieval requirements are minimal.

Elección y sustitución de estímulos entre el alcohol y el alimento en ratas: una explicación del consumo de drogas desde el contexto de la economía conductual / Cohice and substitution of stimuli between the alcohol and the food in rats: An explanation of the drug consumption from the context of the behavioral economy

Esta investigación pretendió determinar si el consumo de drogas podía ajustarse a una explicación de tipo económico conductual en dos ratas de laboratorio, estableciendo cómo los organismos eligen entre diferentes alternativas de bienes de acuerdo con el precio de acceso a cada una y al ingreso del que disponen y cómo se puede dar un proceso de sustitución entre el alcohol (etanol) y el alimento líquido (sacarina). El procedimiento constó de tres fases, iniciando por moldeamiento de la respuesta operante, luego una fase de libre acceso a los bienes y por último, la fase de restricción de los bienes para evaluar la conducta de elección y sustitución en un laberinto radial. Los resultados encontrados demostraron que las ratas lograron sustituir la sacarina que fue un bien preferido por el etanol, en la medida en que los precios de ésta aumentaron y los del etanol se mantuvieron en un programa de razón fija uno (RF1), verificando así la hipótesis de trabajo.

This research pretended to find if the consumption of drugs could to adjust a explanation behavioral economics in two rats of laboratory, establishing how the subjects choose between different options of reinforcement with the price each one and income available and how is the substitution between alcohol (etanol) and liquid food (sacharine). The procedure had three phases, began with sheaping of the operant response, after a phase of access free to goods and the last phase of constrain, to evaluate the choice and substitution behavior in labyrinth. This results demonstrated that the rats substituted the sacharine by the etanol, when the prices of saccharine increasing and etanol was in ratio schedule FR1, verifying the work hypothesis