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.

Neurocognitive performance of children with higher functioning autism spectrum disorders on the NEPSY-II.

This study examined patterns of strengths and weaknesses in the neurocognitive performance of children with higher functioning autism spectrum disorder (ASD). The participants were 30 children with higher functioning ASD ranging from 6 to 11 years, and 60 typically developing (TD) children, who were matched with the children with higher functioning ASD in terms of age, gender, and maternal education. The TD children were drawn from the Finnish standardization sample for the NEPSY-II. The cognitive abilities of the children with higher functioning ASD were assessed with the WISC-III, and the neurocognitive performance of the children with higher functioning ASD and TD children on the NEPSY-II was compared. The children with higher functioning ASD were found to have strengths in verbal reasoning skills with respect to the population mean and weaknesses in set-shifting, verbal fluency, and narrative memory in comparison with the TD children. Minor weaknesses were also observed in facial memory and fine and visuomotor skills.

Preschoolers' recognition of emotional expressions: relationships with other neurocognitive capacities.

We cross-sectionally examined the development of the ability to recognize facial expressions of emotions in preschool-aged children and the relationship between this ability and other neurocognitive capacities, that is, attention/executive functions, language, memory/learning, sensorimotor functions, theory of mind, and visuospatial processing. Children aged 3 to 6 years with no significant developmental deficits (N = 370) were assessed with a nonverbal matching task of emotion recognition ability: The Affect Recognition subtest from the NEPSY-II. The relationship between emotion recognition ability and other neurocognitive capacities was analyzed using correlation, regression, and commonality analyses. The results showed that (a) emotion recognition ability improved with age-this development decelerating mildly between ages 5 and 6-(b) emotion recognition ability correlated with all other neurocognitive capacities, and (c) language, attention/executive functions, and theory of mind were significant predictors of emotion recognition ability in the regression analysis. As revealed by the commonality analysis, and in contrast to most previous studies, language was the most important predictor of nonverbal emotion recognition ability. These results suggest that nonverbal emotion matching is an early maturing skill that develops in relation to other neurocognitive capacities, especially linguistic ability.

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.

Neurocognitive development in 5- to 16-year-old North American children: a cross-sectional study.

Executive functions are thought to be the latest functions to mature. However, this view has not been tested by assessing simultaneously memory, perception of emotions, visuospatial perception, and visuoconstructional skills. NEPSY II norm data from 1000 5- to 16-year-old U.S. children were obtained. Fifteen NEPSY II subtests with no floor or ceiling effects in any age group and no major changes in task type were selected. The 16-year level was attained at age 12 to 13 in all subtests with two exceptions: social perception (age 10 to 11) and narrative memory (age 14). Trend analyses showed that development was rapid in the age range 5 to 9 years followed by a deceleration in the rate of development. Peak performances were reached at 14 to 16 years but later in some subtests representing executive functions, verbal memory, and visuospatial performance. Thus, the study specified developmental time tables of neurocognitive functions. It demonstrated that not only executive functions but also verbal memory and visuospatial performance continue to develop beyond age 16.

Neurocognitive functioning in adolescents with autism spectrum disorder.

There is a paucity of research studying comprehensive neurocognitive profiles of adolescents with higher functioning autism spectrum disorders (ASD). This study compared the neurocognitive profiles of higher functioning adolescents with ASD (n = 30, mean age 13.5) with that of typically developing adolescents (n = 30; mean age 13.7). Adolescents with ASD demonstrated a significantly higher mean Verbal Intelligence Quotient compared to the standardized mean. However, the ASD group had significantly lower scores than the control group on the subtests Auditory Attention and Response Set, Memory for Faces, Visuomotor Precision, and Design Copying. Thus, particular strengths were seen in verbal reasoning, while weaknesses were observed in auditory attention, facial recognition memory, and visuomotor functions in adolescents with ASD.

Does simultaneous bilingualism aggravate children's specific language problems?

AIM: There is little data on whether or not a bilingual upbringing may aggravate specific language problems in children. This study analysed whether there was an interaction of such problems and simultaneous bilingualism. METHODS: Participants were 5- to 7-year-old children with specific language problems (LANG group, N = 56) or who were typically developing (CONTR group, N = 60). Seventy-three children were Swedish-Finnish bilingual and 43 were Swedish-speaking monolingual. Assessments (in Swedish) included tests of expressive language, comprehension, repetition and verbal memory. RESULTS: Per definition, the LANG group had lower scores than the CONTR group on all language tests. The bilingual group had lower scores than the monolingual group only on a test of body part naming. Importantly, the interaction of group (LANG or CONTR) and bilingualism was not significant on any of the language scores. CONCLUSIONS: Simultaneous bilingualism does not aggravate specific language problems but may result in a slower development of vocabulary both in children with and without specific language problems. Considering also advantages, a bilingual upbringing is an option also for children with specific language problems. In assessment, tests of vocabulary may be sensitive to bilingualism, instead tests assessing comprehension, syntax and nonword repetition may provide less biased methods.

Adaptive behaviour in children and adolescents with foetal alcohol spectrum disorders: a comparison with specific learning disability and typical development.

Foetal alcohol spectrum disorders (FASD) is a leading cause of intellectual disability in the western world. Children and adolescents with FASD are often exposed to a double burden in life, as their neurological sequelae are accompanied by adverse living surroundings exposing them to further environmental risk. In the present study, the adaptive abilities of a group of children and adolescents with FASD were examined using the Vineland Adaptive Behaviour Scales (VABS) and compared to those of a group of IQ-matched children with specific learning disorder (SLD) as well as with typically developing controls (CON). The results showed significantly different adaptive abilities among the groups: Children with FASD performed worse than IQ-matched children with SLD, who in turn performed worse than typically developing children on all domains (communication, daily living skills and socialization) on the VABS. Compared to the other groups, social skills declined with age in the FASD group. These results support previous studies of adaptive behaviour deficits in children with FASD and provide further evidence of the specificity of these deficits. On a societal level, more efforts and resources should be focused on recognizing and diagnosing FASD and supporting communication skills, daily living skills and most of all social skills across diagnostic groups within FASD. Without adequate intervention, adolescents and young adults with FASD run a great risk of marginalization and social maladjustment, costly not only to society but also to the lives of the many young people with FASD.

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.

Neurocognitive development and behavioral outcome of 2-year-old children with univentricular heart.

Recent advances in the treatment of children with severe congenital heart defects, such as hypoplastic left heart syndrome (HLHS) and other forms of univentricular heart (UVH), have significantly improved their survival rates. However, these children are at risk for various neurodevelopmental deficits. The aim of the present study was to assess cognitive development, expressive language, and behavior in 30-month-old children with univentricular heart. The participants were 22 children with HLHS, 14 with UVH, and 41 healthy control subjects. The Bayley Scales of Infant Development II, MacArthur Communicative Development Inventories, and Child Behavior Checklist were used for assessments. The results revealed that children with HLHS exhibited a significantly lower mean mental development index, more delays in expressive language functions, and more behavioral problems than did the control children. Two children with HLHS (9%) had mental development indexes below 50, indicating significantly delayed performance. The children with UVH differed from the control children with respect to their lower mean mental development index. These findings suggest that at the age of 30 months, neurodevelopmental deficits are especially prevalent in children with HLHS. Thus, early developmental screening, intervention, and neuropsychological follow-up until school age is recommended particularly for the children with HLHS.

Risk factors for behavioural problems in foetal alcohol spectrum disorders.

AIM: To examine risk and protective factors associated with behavioural problems of children and adolescents following prenatal alcohol exposure. METHODS: A total of 73 children and adolescents with foetal alcohol spectrum disorders (FASD) were assessed for internalizing, externalizing and total behavioural problems using the Child Behavior Checklist. Linear regression models were used to determine the effects of diagnostic and environmental risk and protective factors on behaviour, while controlling for age, sex and IQ. RESULTS: Length of time spent in residential care was the most pervasive risk factor associated with internalizing, externalizing and total behavioural problems. A low dysmorphology score was related to more internalizing and total problems. CONCLUSIONS: Children and adolescents prenatally exposed to alcohol faced greater risk of substantive behavioural problems (i) if they were less visibly alcohol affected and (ii) the longer time they had spent in residential care. The results underscore the clinical importance of appropriate services and care for less visibly affected children with FASD and highlight the need to attend to children with FASD being raised in institutions.

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.

Cognitive and neuropsychological outcomes at 5 years of age in preterm children born in the 2000s.

AIM: The aim of this study was to assess the cognitive level and neuropsychological performance at 5 years of age in children with a very low birthweight (VLBW; birthweight <1501 g) born in 2001 to 2003. METHOD: A regional cohort of 97 children with a VLBW (mean gestational age 28 wks [SD 3 wks]; mean birthweight 1054 g [SD 259 g]; 50 male; 47 female) and a comparison group of 161 healthy children born at term (mean gestational age 40 wks [SD 1 wks]; mean birthweight 3644 g [SD 446 g]; 80 male; 81 female) were included in this study. At 5 years of age (SD 2 mo) cognitive level was assessed with the Wechsler Preschool and Primary Scale of Intelligence - revised and neuropsychological performance was assessed using NEPSY II. RESULTS: The mean intelligence of the VLBW group corresponded to the normative mean of 100 but was lower than the mean of the low-risk comparison group (p<0.001). Neuropsychological performance was also significantly poorer than that of the comparison group. In NEPSY II, 25% of the VLBW group had a significantly impaired performance in one of 11 subtests and 33% had a significantly impaired performance in more than one, while 19% of the comparison group had a significantly impaired performance in one subtest and 10% had a significantly impaired performance in more than one. INTERPRETATION: The mean cognitive capacity of the VLBW cohort corresponded to the normative mean. However, assessments of cognitive level only at preschool age do not provide the information on neuropsychological deficit that is necessary for planning adequate educational support.

Neurocognitive function of pediatric heart transplant recipients.

BACKGROUND: Pediatric heart transplant recipients exhibit cognitive delays, as evident in assessments of their general intelligence. Less is known about their specific neurocognitive impairments. METHODS: All 19 children in Finland aged 6 to 16 years who had undergone heart transplantation (HTx) participated. Of these, 12 (63%) had cardiomyopathy (CM) and 7 (37%) had congenital heart disease (CHD). They were assessed on average 5.5 (SD, 3.6) years post-operatively at a mean age of 12.0 (SD, 3.1) years. A standardized test of intelligence (Wechsler Intelligence Scale for Children [WISC]-III), a neuropsychological test battery (NEPSY-II), and a parental developmental questionnaire (FTF) were administered. The neuropsychological test profile of the HTx group was compared with that of a matched control group. RESULTS: HTx children had a lower mean Performance Intelligence Quotient (PIQ; 82.2, p = 0.001) and Full-Scale IQ (FSIQ; 85.6, p = 0.004) compared with population norms. HTx children scored generally lower than the control group on the neuropsychological tests (p = 0.002). Seven patients with pre-HTx neurologic sequelae (n = 6) or extreme prematurity (n = 1) had lower mean FSIQ (72.1) than did children without major pre-HTx risk factors (93.5, p = 0.012). The latter group scored below average on only 1 of 6 WISC-III sub-tests and 2 of 10 NEPSY-II sub-tests, all measuring visuoconstructional performance. CONCLUSIONS: Children without major neurologic risk factors pre-HTx may have normal general intelligence after HTx but deficits in the visuoconstructional domain.

The Attention and Executive Function Rating Inventory (ATTEX): Psychometric properties and clinical utility in diagnosing ADHD subtypes.

This study presents a new inventory, the Attention and Executive Function Rating Inventory (ATTEX), and examines the psychometric properties and the clinical utility of ATTEX in identifying the attention deficit hyperactivity disorder combined type (ADHD-C) and the ADHD predominantly inattentive type (ADHD-I) in school environments. A normative sample of Finnish 7- to 15-year-old children and adolescents (N = 701) and a clinical sample consisting of children with ADHD-C (N = 190) and ADHD-I (N = 25) were examined with the ATTEX and the ADHD Rating Scale-IV. The ATTEX and its scales had good internal consistency reliability (0.67-0.98) and criterion validity (0.68-0.95). Normative data was provided for the total normative sample and for boys and girls separately. Gender differences were noted in the ATTEX scores, boys having consistently higher scores on all ATTEX scales. The effect of age was significant only for one of the ten scales, the Motor hyperactivity scale, 7-year-olds having more problems of hyperactivity than 14-year-olds. Lower parent education level and the child's learning difficulties were related to higher ratings of EF problems in ATTEX. When different cutoff scores for boys and girls were applied, ATTEX was sensitive in identifying children with attention deficit disorders. In addition, ATTEX was accurate in differentiating children with ADHD-I from children with ADHD-C. In this Finnish sample, ATTEX showed solid psychometric properties and could be used as a reliable tool in the diagnostic evaluation of ADHD-C and ADHD-I.

Relations between brain volumes, neuropsychological assessment and parental questionnaire in prematurely born children.

The objective of this study is to assess the relationship between brain volumes at term equivalent age and neuropsychological functions at 5 years of age in very low birth weight (VLBW) children, and to compare the results from a neuropsychological assessment and a parental questionnaire at 5 years of age. The study group included a regional cohort of 97 VLBW children and a control group of 161 children born at term. At term equivalent age, brain magnetic resonance imaging (MRI) was performed on the VLBW children, and analysed for total and regional brain volumes. At 5 years of age, a psychologist assessed the neuropsychological performance with NEPSY II, and parents completed the Five to fifteen (FTF) questionnaire on development and behaviour. The results of the control group were used to give the age-specific reference values. No significant associations were found between the brain volumes and the NEPSY II domains. As for the FTF, significant associations were found between a smaller total brain tissue volume and poorer executive functions, between a smaller cerebellar volume and both poorer executive functions and motor skills, and, surprisingly, between a larger volume of brainstem and poorer language functions. Even after adjustment for total brain tissue volume, the two associations between the cerebellar volume and the FTF domains remained borderline significant (P = 0.05). The NEPSY II domains Executive Functioning, Language and Motor Skills were significantly associated with the corresponding FTF domains. In conclusion, altered brain volumes at term equivalent age appear to affect development still at 5 years of age. The FTF seems to be a good instrument when used in combination with other neuropsychological assessment.

Mood is associated with snoring in preschool-aged children.

OBJECTIVE: To study emotional and behavioral problems and sleep and cognitive performance in snoring and nonsnoring 3- to 6-year-old children. METHODS: As part of an epidemiological study of sleep disordered breathing (SDB) in preschool-aged children, 43 snorers and 46 nonsnorers participated in a clinical study. Their parents completed the Child Behavior Checklist (CBCL). The children were assessed with Wechsler Preschool and Primary Scale of Intelligence, Revised and subtests of the Developmental Neuropsychological Assessment (NEPSY-A) representing aspects of attention, language skills, sensorimotor functions, memory, and learning. RESULTS: On the CBCL snoring children had significantly more parent reported internalizing symptoms (p < .05) than the nonsnoring children, especially symptoms of anxious/depressed mood (p < .01) and emotional reactivity (p < .05). More children from the snoring group than from the nonsnoring group (22 vs 11%) scored in the subclinical or clinical range on the internalizing scale. Interestingly, no significant difference between the groups was found in the amount of externalizing symptoms. The amount of sleep problems other than snoring was higher in the snoring than in the nonsnoring group (p < .01). On tests measuring auditory attention (p < .01) and language skills (verbal IQ, p < .05), the snoring group performed worse than the nonsnoring group. CONCLUSIONS: Our results support the view that SDB should be considered a possible risk factor for mood disorder symptoms and impaired cognitive performance in children.

Neurocognitive test profiles of extremely low birth weight five-year-old children differ according to neuromotor status.

The neurocognitive outcome of children born with extremely low birth weight (ELBW) is highly variable due to the complexity of morbidity. So far, no study has compared comprehensive neuropsychological test profiles in groups with different neuromotor status. In a national cohort of ELBW children neuropsychological test profiles were assessed in 4 groups defined according to a neurological examination at 5 years of age: normal neuromotor status (N = 56), motor coordination problems (N = 32), multiple subtle neuromotor signs including both motor coordination problems and deviant reflexes (N = 20), and spastic diplegia (N = 12). The neurocognitive assessment included a test of intelligence, the Wechsler Primary and Preschool Scale of Intelligence-Revised (WPPSI-R) and 14 subtests of attention and executive functions, verbal functions, manual motor functions, visuoconstructional functions and verbal learning (NEPSY). The children with normal neuromotor status performed within the average range; children with motor coordination problems had widespread impairment; and children with spastic diplegia and children with multiple minor neuromotor signs had uneven test profiles with stronger verbal results but weaknesses in attention and executive functions, and in manual motor and visuoconstructional tasks. In conclusion, very preterm children with neuromotor signs, including motor coordination problems, are at risk for neurocognitive impairment, in spite of average intelligence. More impaired children have more irregular test profiles. Follow-up and neuropsychological assessment of very preterm children with minor neuromotor signs are therefore indicated.

Language profiles of monolingual and bilingual Finnish preschool children at risk for language impairment.

BACKGROUND: A large proportion of children are exposed to more than one language, yet research on simultaneous bilingualism has been relatively sparse. Traditionally, there has been concern that bilingualism may aggravate language difficulties of children with language impairment. However, recent studies have not found specific language impairment (SLI) or language-related problems to be increased by bilingualism. AIMS: The topic of bilingualism and its effects has high actuality in Finland, where increasing numbers of children in the country's 6% Swedish-speaking minority grow up in bilingual families, where one parent's primary language is Swedish and the other's Finnish. The present study aimed at exploring the influence of such bilingualism on the language profiles of children from this population at risk for language impairment (LI). METHODS & PROCEDURES: Participants were recruited from a language screening of 339 children from kindergartens with instruction only in Swedish, from the Swedish-speaking parts of Finland. Of these children, 33 (9.7%) were defined as a Risk Group for LI, whereas 48 non-risk children were randomly selected to form a control group. When subdividing the children according to home language, 35 were found to be monolingual, Swedish-speaking, and 46 were Swedish-Finnish bilingual. The children underwent neuropsychological assessment during their preschool year. Assessment methods included subtests from the Wechsler Primary and Preschool Scale of Intelligence - Revised and the NEPSY Developmental Neuropsychological Assessment. OUTCOMES & RESULTS: A repeated-measures multiple analysis of covariance (MANCOVA) showed a significant effect of risk of LI on the NEPSY language scores. The effect of home language was not significant and there was no interaction between home language and risk for LI. Non-verbal IQ was controlled for. Across groups, bilingual children scored lower than monolingual children only on measures of vocabulary and sentence repetition. CONCLUSIONS: Although a slight general cost of bilingualism was found in the language profile of the six-year olds in this study, a bilingual background was not associated with more severe language problems in the LI Risk Group. Thus, there would seem to be no need to shield language-impaired children from opportunities for dual language learning.

Language impairment is reflected in auditory evoked fields.

Specific language impairment (SLI) is diagnosed when a child has problems in producing or understanding language despite having a normal IQ and there being no other obvious explanation. There can be several associated problems, and no single underlying cause has yet been identified. Some theories propose problems in auditory processing, specifically in the discrimination of sound frequency or rapid temporal frequency changes. We compared automatic cortical speech-sound processing and discrimination between a group of children with SLI and control children with normal language development (mean age: 6.6 years; range: 5-7 years). We measured auditory evoked magnetic fields using two sets of CV syllables, one with a changing consonant /da/ba/ga/ and another one with a changing vowel /su/so/sy/ in an oddball paradigm. The P1m responses for onsets of repetitive stimuli were weaker in the SLI group whereas no significant group differences were found in the mismatch responses. The results indicate that the SLI group, having weaker responses to the onsets of sounds, might have slightly depressed sensory encoding.