'Family first' - feasibility and pilot outcomes of a community intervention for families of children in recovery following brain injury.

PURPOSE: Feasibility and pilot outcomes of a new community-based program for families of children with acquired brain injury (ABI) are presented. Interventions, delivered by home-visiting and teletherapy, were underpinned by problem-solving therapy, narrative meaning making, goal-directed interventions and community system psychoeducation. METHODS: Eighty-three families of children, who had sustained an ABI before 12 years of age, had an average of 13 sessions of the 'Family First' (FF) intervention. A mixed-methods prospective design was employed. Feasibility was evaluated through measures of accessibility and acceptability. Goal attainment scaling and pre-post changes on standardized questionnaires assessed changes in psychosocial adjustment and quality of life. RESULTS: Feasibility analyses suggested engagement and retention of often hard to reach families and children with high psychosocial needs. Qualitative analyses suggested themes related to the accessibility of a unique service ('Nothing else like this out there' and 'Accessible and flexible') which facilitated 'Empowerment' within a family context ('A family affair'). Promising changes on standardized scales of behavior problems, competencies and child and family quality of life were discerned. Increased goal attainment scores were observed. CONCLUSION: The FF program showed feasibility and promise. It impacted positively on the lives of children and families and improved capacity in supporting systems.

The impact of the "Attachment and Biobehavioural Catch-Up" program on attachment related parent behavior-A systematic review.

"Attachment and Biobehavioural Catch-Up" (ABC) is a 10 session home visiting program, grounded in attachment theory. It aims to improve child emotion regulation, attachment and behavioral outcomes through changing caregivers' attachment related behaviors. There is increasing evidence with respect to the effectiveness of ABC in producing positive child outcomes, but the intervention's direct effect on parent outcomes remains unclear. This review examined the association of ABC with attachment related parent outcomes. The PubMed, EMBASE, PyschINFO and SCOPUS databases were searched for relevant studies in August 2021, and again in April 2022. The eligibility criteria for included studies were (1) infants aged 0-27 months at time of the ABC intervention, (2) "at risk" parents, (3) controlled trials published in peer-reviewed journals and (4) utilized a measure of attachment related parent outcomes. Eleven eligible studies were included. The findings showed ABC had a significant small to medium effect on a variety of attachment related parent outcomes among parents presenting with multiple psychosocial risk factors. "Sensitivity" was measured most frequently, with small to medium main effect sizes recorded at follow-up, compared to controls. Implications for the clinical effectiveness of the ABC program in community settings are discussed. Future research should clarify who ABC is most effective for and how it compares to similar interventions.

"El Alcance de Afectividad y Biocounducta" (ABC) es un programa de visita a casa en 10 sesiones, fundamentado en la teoría de la afectividad. Su meta es mejorar en el niño los resultados de la regulación de la emoción, de afectividad y de comportamiento por medio de cambiar el comportamiento relacionado con la afectividad de quien presta el cuidado. La evidencia con respecto a la eficacia de ABC para producir resultados positivos en el niño va en aumento, pero el efecto directo de la intervención sobre el resultado en el progenitor aún no está claro. Esta revisión examinó la asociación entre ABC y los resultados en el progenitor relacionados con la afectividad. Se investigaron los bancos de datos PubMed, EMBASE, PyschINFO y SCOPUS en agosto de 2021 en busca de estudios relevantes, lo cual se hizo otra vez en abril de 2022. Los criterios para elegir los estudios que se incluirían fueron (1) infantes de edad entre 0 y 27 meses al momento de la intervención ABC, (2) progenitores "bajo riesgo," (3) ensayos controlados publicados en revistas de aceptación profesional rigurosa y (4) la utilización de una medida de afectividad relacionada con los resultados en el progenitor. Se incluyeron once estudios que reunían los criterios. Lo que encontramos mostró que ABC tenía un efecto entre significativamente pequeño y medio en cuanto a una variedad de afectividad relacionada con los resultados en el progenitor entre progenitores que presentaban múltiples factores de riesgo sicosociales. La "sensibilidad" fue medida con mayor frecuencia, con anotación de la dimensión de los efectos de pequeños a medianos al momento del seguimiento, en comparación con el grupo de control. Se discuten las implicaciones para la eficacia clínica de ABC en la comunidad. La investigación futura debe aclarar para quién es ABC más eficaz y cómo se compara con intervenciones similares.

"L'attachement et le rattrapage bio-comportemental" (Attachment and Biobehavioural Catch-Up, soit ABC) est un programme de visite à domicile de 10 sessions, basé sur la théorie de l'attachement. Il a pour but d'améliorer la régulation de l'émotion de l'enfant, l'attachement et les résultats de comportement en changeant les comportements liés à l'attachement de la personne prenant soin du bébé. On a de plus en plus de données pour ce qui concerne l'efficacité de l'ABC à donner des résultats positifs pour l'enfant, mais l'effet direct de l'intervention sur le résultat parental n'est pas très clair. Ce compte-rendu a examiné le lien de l'ABC avec les résultats d'attachement liés au parent. Les bases de données PubMed, EMBASE, PyschINFO et SCOPUS ont fait l'objet d'une recherche pour des études pertinentes à ce sujet en août 2021 et à nouveau en avril 2022. Les critères d'éligibilité pour les études inclues ont été (1) bébés âgés de 0-27 mois au moment de l'intervention ABC, (2) parents "à risque", (3) essais contrôlés publiés dans des publications à comité de lecture et (4) ayant utilisé une mesure d'attachement liée aux résultats du parent. Onze études éligibles ont été inclues. Les résultats ont montré que l'ABC avait un effet relativement petit à moyen sur plusieurs résultats du parent liés à l'attachement chez les parents présentant plusieurs risques psychosociaux. La "sensibilité" a été mesurée le plus fréquemment, avec des tailles d'effet de petit à moyen enregistrées au suivi, comparés aux contrôles. Les implications pour l'efficacité clinique de l'ABC dans un contexte de communauté sont discutées. Les recherches futures devraient clarifier pour qui l'ABC est le plus efficace et comment on peut le comparer à des interventions similaires.

Long-term neuropsychological and behavioral outcome of mild and moderate hypoxic ischemic encephalopathy.

BACKGROUND: Outcomes for infants who survive mild-moderate hypoxic ischemic encephalopathy (HIE) into adolescence is relatively uncharted. AIMS: We examined neuropsychological and behavioral outcomes in adolescents with mild and moderate HIE, using both parent and self - informants, and including healthy peers and nearest age siblings as controls. PARTICIPANTS: 23 adolescents with a history of mild-moderate HIE (M age = 14.45 years, SD = 1.03; 14 boys and 9 girls) were recruited from an original cohort of 53. A group of their nearest - age siblings (n = 13), and healthy peers (n = 14) were recruited as controls. OUTCOME MEASURES: A number of neuropsychological sub-tests, taken from the WISC-V.UK, Children's Memory Scale, NEPSY, WIAT-III.UK, Rey Complex Figure Copy Test and British Picture Vocabulary Scale were administered. Behavioral adjustment was assessed using the Strengths and Difficulties Questionnaire and the competence subscales of the Child Behavior Checklist. RESULTS: No differences in neuropsychological and behavioral outcomes were observed between mild and moderate HIE cohorts. Together they had significantly lower scores on tests of attention/executive functioning, verbal reasoning and sensory-motor ability compared to healthy peers, with moderate to large effect sizes. Remedial provision at school was greater in the HIE group. Parents reported elevated levels of peer problems in the HIE group compared to both siblings and healthy peers. Reduced competencies were also observed. CONCLUSIONS: We found evidence that both mild and moderate survivors of HIE experience neuropsychological, school and peer relationship problems in adolescence.

Survey of paediatricians' opinions on a regional paediatric telecardiology service.

AIM: The aim of this study is to evaluate consultant general paediatricians' opinions of a UK paediatric telecardiology service. METHODS: A structured questionnaire was developed and sent to all consultant paediatricians working in a district general hospital in Northern Ireland. RESULTS: Paediatricians (n = 35) regarded the regional paediatric telecardiology service as very useful and of good value for money. Paediatricans in hospitals without access to telecardiology expressed a desire to join the network (86%, 12/14). More frequent use of the paediatric telecardiology service was associated with increased confidence in performing echocardiography and using the telemedicine equipment and a special interest in neonatology. The vast majority of paediatricians (32/35, 91%) believed that there should be a shared clinical responsibility for the patient following a teleconsultation. A total of 33/35 (94%) stated that the telephone costs of the consultation should be paid by the paediatrician but that the professional time of the cardiologist should be paid by the tertiary centre (29/35, 83%). CONCLUSIONS: Paediatricians have consistently positive experiences of a regional paediatric telecardiology service. They believe that clinical responsibility is shared, and there should not be any professional fee for telemedicine activities.

Subarachnoid haemorrhage (SAH): long-term cognitive outcome in patients treated with surgical clipping or endovascular coiling.

PURPOSE: To compare long-term cognitive outcomes of patients treated with surgical clipping or endovascular coiling after subarachnoid haemorrhage (SAH). METHOD: Retrospective matched cohort study assessed neuropsychological functioning at least 12 months after aneurysmal SAH treatment. Fourteen patients treated by endovascular coiling and nine patients treated by surgical clipping participated. After gaining written consent, a comprehensive neuropsychological battery was completed. Standardised tests were employed to assess pre-morbid and current intellectual functioning (IQ), attention, speed of information processing, memory and executive function as well as psychosocial functioning and affect. RESULTS: Treatment groups were not significantly different in terms of age, pre-morbid IQ, time from injury to treatment or time since injury. A significant effect of treatment on full-scale IQ score (p = 0.025), performance IQ (p = 0.045) and verbal IQ score (p = 0.029), all favouring the coiled group was observed. A medium effect size between groups difference in immediate memory (p = 0.19, partial η(2) = 0.08) was also observed. No significant between group differences on attention, executive functioning and speed of information processing measures or mood and psychosocial functioning were noted. Both groups reported increased anxiety and memory, attention and speed of information processing deficits relative to normative data. CONCLUSIONS: Study findings indicate fewer cognitive deficits following endovascular coiling. Cognitive deficits in the clipped group may be due in part to the invasive nature of neurosurgical clipping. Further prospective research with regard to long-term cognitive and emotional outcomes is warranted. IMPLICATIONS OF REHABILITATION: • Treatment of ruptured intracranial aneurysms by either endovascualar coiling or neurosurgical clipping can result in significant long-term physical disability as well as cognitive impairment. • Observed cognitive impairment(s) tend to be less in patients following endovascular coiling. • Following ruptured aneurysm, patients with cognitive impairment report reduced health related quality of life and increased anxiety. • Those with identified cognitive impairment(s) may benefit from cognitive remediation.

The association between childhood trauma and memory functioning in schizophrenia.

OBJECTIVE: Both neurocognitive impairments and a history of childhood abuse are highly prevalent in patients with schizophrenia. Childhood trauma has been associated with memory impairment as well as hippocampal volume reduction in adult survivors. The aim of the following study was to examine the contribution of childhood adversity to verbal memory functioning in people with schizophrenia. METHODS: Eighty-five outpatients with a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnosis of chronic schizophrenia were separated into 2 groups on the basis of self-reports of childhood trauma. Performance on measures of episodic narrative memory, list learning, and working memory was then compared using multivariate analysis of covariance. RESULTS: Thirty-eight (45%) participants reported moderate to severe levels of childhood adversity, while 47 (55%) reported no or low levels of childhood adversity. After controlling for premorbid IQ and current depressive symptoms, the childhood trauma group had significantly poorer working memory and episodic narrative memory. However, list learning was similar between groups. CONCLUSION: Childhood trauma is an important variable that can contribute to specific ongoing memory impairments in schizophrenia.

Psychological processes and histories associated with nonepileptic versus epileptic seizure presentations.

Nonepileptic seizures (NES) provide a clinical challenge as the mechanisms involved remain uncertain. The present study compares 27 participants with confirmed NES presentations with 39 individuals with epileptic seizure (ES) presentations only, on indices of psychopathology, trauma history, dissociative propensity, and attachment style. Psychopathology and dissociation were found to be significantly elevated in the NES group compared with the ES group. No differences were found between groups in terms of trauma history and attachment style. However, trauma history did correlate significantly with psychopathology in the NES group but not in the ES group. Finally, whereas the relationship between psychological variables and seizure frequency was weak within the ES group, trauma history, a fearful attachment dimension, psychopathology, and dissociation predicted seizure frequency in the NES group. Implications for understanding and interventions with NES presentations are discussed.

Neurodevelopmental and respiratory follow-up results at 7 years for children from the United Kingdom and Ireland enrolled in a randomized trial of early and late postnatal corticosteroid treatment, systemic and inhaled (the Open Study of Early Corticosteroid Treatment).

OBJECTIVES: The goals were to compare early school-age neurodevelopmental and respiratory outcomes for children who were treated with either early (<3 days) or delayed selective (>15 days) postnatal corticosteroid therapy and to compare systemic dexamethasone treatment with inhaled budesonide treatment. METHODS: One hundred twenty-seven (84%) of 152 survivors from the United Kingdom and Ireland who were recruited to the Open Study of Early Corticosteroid Treatment, a randomized trial of inhaled and systemic corticosteroid therapy to prevent chronic lung disease, were traced and assessed at a median age of 7 years. Outcome measures were level of disability, presence of cerebral palsy, cognitive ability, behavioral difficulties and competencies, growth, and respiratory symptoms. Results were adjusted for potential confounding variables (gestational age, birth weight, gender, prenatal steroid therapy, method of delivery, Apgar score at 5 minutes, and Clinical Risk Index for Babies score). RESULTS: There were no significant differences among the treatment groups in cognitive ability, behavioral competencies or difficulties, overall disability rates, cerebral palsy, combined outcomes of death or cerebral palsy and death or moderate/severe disability, growth, respiratory morbidity, or diastolic blood pressure. Those assigned to dexamethasone were more likely to have high systolic blood pressure and to have a diagnosis of asthma than were those assigned to budesonide. CONCLUSIONS: Although postnatal steroid therapy has been associated with poor long-term outcomes, this study failed to show significant differences in cognitive function between dexamethasone- and budesonide-allocated groups. There may be increased systolic blood pressure and a greater likelihood of developing asthma in childhood after postnatal dexamethasone treatment.

Cognitive inhibition and interference in dissociative identity disorder: the effects of anxiety on specific executive functions.

Using an experimentally based, computer-presented task, this study assessed cognitive inhibition and interference in individuals from the dissociative identity disorder (DID; n=12), generalized anxiety disorder (GAD; n=12) and non-clinical (n=12) populations. Participants were assessed in a neutral and emotionally negative (anxiety provoking) context, manipulated by experimental instructions and word stimuli. The DID sample displayed effective cognitive inhibition in the neutral but not the anxious context. The GAD sample displayed the opposite findings. However, the interaction between group and context failed to reach significance. There was no indication of an attentional bias to non-schema specific negative words in any sample. Results are discussed in terms of the potential benefit of weakened cognitive inhibition during anxious arousal in dissociative individuals.