Early numerical cognition in deaf and hearing children: Closer than expected? / Cognición numérica temprana en niños sordos y oyentes: ¿más cercana de lo esperado?

Abstract Deaf students show a significant delay in their understanding of numeracy and measurement concepts as well as verbal problem solving. There is still no consensus about the origin of this delay but several studies have shown that deaf people show differences in basic numerical skills and executive function (EF), which could underlie the differences in the way they learn and develop their cognitive abilities. Children have the innate ability to estimate and compare numerosities without using language or numerical symbols. The ability to discriminate large numerosities depends on the approximate number system (ANS), a cognitive system believed to be governed by a neural circuit within the intraparietal sulcus. Researchers hypothesize that the ANS underlies the development of arithmetic and there is data supporting the contribution of the ANS for math achievements. Little is known about the approximate number system of deaf children at early ages. Deaf and hearing preschool children were compared in terms of specific cognitive functions shown to be important for success in mathematics. Executive functions and symbolic and nonsymbolic magnitude comparison abilities of 7 deaf children and 14 hearing children aged 4-7 years (M = 69.90 months, SD = 11.42), were compared. To do so, neuropsychological assessments for school-aged children were adapted into Portuguese Sign Language. Significant group differences were found in abstract counting as well as in symbolic and nonsymbolic magnitude comparisons. These findings suggest that deaf children are less competent in these early numeracy skills than are their hearing peers.

Resumen La cognición de los sordos ha sido objeto de numerosos estudios que buscan comprender cómo los niños y adultos sordos procesan la información. Dichos estudios han demostrado que las personas sordas muestran diferencias en las habilidades numéricas y la función ejecutiva (FE), lo que podría ser la base de las diferencias conocidas en la forma en que las personas sordas aprenden y desarrollan sus habilidades cognitivas. Se han encontrado diferencias entre estudiantes sordos y oyentes en varias áreas de razonamiento numérico, en matemática y en la eficiencia en el procesamiento de representaciones numéricas como la comparación de magnitud. En las tareas de comparación de magnitud, los resultados dependían de si se estaban haciendo comparaciones simbólicas (números arábigos) o no simbólicas (puntos). En un estudio, los niños sordos fueron más lentos que sus compañeros oyentes en las tareas de comparación de magnitud simbólica, pero no en las tareas no simbólicas. Sin embargo, en un estudio más reciente, también se encontraron diferencias en las tareas no simbólicas. Se considera que la capacidad para comparar y discriminar grandes numerosidades depende del sistema numérico aproximado (ANS, Approximate Number System), un sistema cognitivo que se cree está gobernado por un circuito neuronal dentro del surco intraparietal. Los investigadores plantean la hipótesis de que el ANS subyace en cierta medida al desarrollo de la aritmética. Hay algunos datos que apoyan esta hipótesis: por ejemplo, las diferencias individuales en la agudeza del ANS se correlacionan positivamente con las habilidades numéricas y los logros futuros en matemática. Por otro lado, se ha encontrado un deterioro en la agudeza del ANS en niños con discapacidades de aprendizaje matemático. En consecuencia, los investigadores han propuesto que el ANS contribuye a la aparición de conceptos numéricos que los niños requieren para la competencia básica en el conteo y las comparaciones de magnitud simbólica. Otros han sugerido que la asociación entre la agudeza en la comparación de magnitud no simbólica y el rendimiento en matemática está moderada por factores de dominio general como las funciones ejecutivas (FE), en particular el control inhibitorio. En general, no está claro si existen diferencias en la agudeza de comparación de magnitud simbólica y no simbólica en niños sordos más pequeños y en qué medida se relacionan con las FE. El estudio actual examina la agudeza de las representaciones numéricas simbólicas y no simbólicas en niños sordos en edad preescolar e investiga la posible influencia del funcionamiento ejecutivo en estas habilidades matemáticas básicas. Se recolectaron datos de 21 niños portugueses del área de Lisboa, siete de los cuales eran sordos congénitamente y 14 tenían audición normal; los niños tenían entre 4 y 7 años de edad (M = 69.9 meses, DT = 11.42). Se seleccionaron tareas para medir lo siguiente: (a) FE, (b) memoria de trabajo, (c) lenguaje y (d) habilidades numéricas tempranas. Se empleó la tarea Shape School Task para evaluar FE. Se administró la versión portuguesa de la tarea de tapping de bloques de Corsi para evaluar la amplitud visuoespacial. Se desarrolló una tarea de comparación de puntos para examinar la capacidad de los niños de decidir instantáneamente cuál de las dos matrices de puntos es más grande utilizando el software Panamath. Se utilizaron dos tareas para evaluar la capacidad de los niños para producir palabras numéricas en un contexto cardinal y el Numeracy Screener para medir su capacidad para comprender la magnitud numérica simbólica. Los resultados indicaron que los niños sordos mostraron retrasos en las capacidades de comparación de magnitud simbólica y no simbólica. En las FE solo se encontraron diferencias en una tarea que implicaba una combinación de conmutación e inhibición; por lo demás, su función ejecutiva era comparable a la de los niños no sordos.

Patterns of Parental Reactions to Their Children's Negative Emotions: A Cluster Analysis with a Clinical Sample.

Parents' emotion socialization practices are an important source of influence in the development of children's emotional competencies This study examined parental reactions to child negative emotions in a clinical sample using a cluster analysis approach and explored the associations between clusters of parents' reactions and children's and parents' adjustment. The sample comprised 80 parents of Portuguese children (aged 3-13 years) attending a child and adolescent psychiatry unit. Measures to assess parental reactions to children's negative emotions, parents' psychopathological symptoms, parents' emotion dysregulation, and children's adjustment were administered to parents. Model-based cluster analysis resulted in three clusters: low unsupportive, high supportive, and inconsistent reactions clusters. These clusters differed significantly in terms of parents' psychopathological symptoms, emotion dysregulation, and children's adjustment. A pattern characterized by high supportive reactions to the child's emotions was associated with higher levels of children's adjustment. On the other hand, an inconsistent reactions pattern was associated with the worst indicators of children's adjustment and parental emotion dysregulation. These results suggest the importance of supporting parents of children with emotional and behavioural problems so that they can be more responsive to their children's emotional manifestations.

Looking for the Brain Inside the Initial Teacher Training and Outreach Books in Portugal.

The fascination with brain research is widespread, and school teachers are no exception. This growing interest, usually noticed by the increased supply of short-term training or books on how to turn the brain more efficient, leads us to think about their basic training and outreach resources available. Little is known about what the official Initial Teacher Training (ITT) offers concerning the brain literature and if it meets scientific standards. Also, what are the science communication materials that teachers can access to learn about the developing brain remain undiscussed. First, we examined the ITT courses taught in Portuguese Higher Education, both in public and private institutions, to identify the syllabus with updated neuroscientific knowledge. Second, we searched for the neuroscience-related books published in the last 6 years through the National Library of Portugal database. Thirty ITT courses and 35 outreach publications were reviewed through a rapid review methodology. Our results showed an absence of curricular units indicating in their programs that brain research, and its relationship with learning, would be taught in a representative and updated way. In contrast, the number of brain-related books for educators increased in Portugal, corroborating the demand for this field of study by these professionals. Based on the literature that shows how misunderstandings about the brain have increased in school contexts, our discussion recognizes that science outreach could be a way to increase the scientific literacy of school teachers with the research community working more in this direction, but, since a previous problem seems to be unsolved, there is an urgent need for specialized attention to the development of training curricula for future kindergarten and elementary school teachers.

Unveiling teachers' beliefs on visual cognition and learning styles of deaf and hard of hearing students: A Portuguese-Swedish study.

Vision is considered a privileged sensory channel for deaf and hard of hearing (DHH) students to learn, and, naturally, they recognize themselves as visual learners. This assumption also seems widespread among schoolteachers, which led us to analyse the intersection between teachers' beliefs on deaf and hard of hearing students' academic achievement, visual skills, attentional difficulties, and the perceived importance of image display in class. An online survey was designed to analyse the beliefs of the schoolteachers about the deaf and hard of hearing students learning in educational settings from Portugal and Sweden. Participated 133 teachers, 70 Portuguese and 63 Swedish, from the preschool to the end of mandatory education (ages 3-18) with several years of experience. The content analysis and the computed SPSS statistical significance tests reveal that surveyed teachers believe that deaf and hard of hearing students have better visual skills when compared with their hearing peers yet show divergent beliefs about visual attentional processes. Within the teachers' perceptions on learning barriers to DHH students, the distractibility and cognitive effort factors were highlighted, among communicational difficulties in class. Conclusions about the prevalence of learning misconceptions in teachers from both countries analysed, corroborate previous studies on neuromyths in education, and bring novelty to Deaf Education field. The work of translation of scientific knowledge, teacher training updating, and partnership between researchers and educators are also urgently needed in special education.

Primary spinal epidural lymphoma: a rare entity with an ambiguous management.

Lymphomas are malignant lymphoid tumours arising from lymphocytic cells. They usually develop in the lymphoid tissues and can spread to other organs; however, primary extra-nodal locations such as the spinal epidural space are less common. The authors report the case of a primary diffuse large B-cell lymphoma of the thoracic spine in a 65-year-old man, who presented to the emergency department with signs of upper motor neuron lesion. The patient underwent surgery in order to decompress the spinal cord. The treatment was concluded with six cycles of chemotherapy with methotrexate, rituximab, cyclophosphamide, vincristine and prednisone followed by radiotherapy. At the 24-month follow-up, no signs of epidural lesion or bone contrast enhancement were observed in thoracic spine MRI. Surgical decompression is recommended in patients with signs of spinal cord injury in order to prevent irreversible neurological damage and is related to high rates of disease-free survival.

Stuttering Impact: A Shared Perception for Parents and Children?

BACKGROUND/AIMS: Previous research has provided information about how school-aged children perceive their own stuttering; however, less is known about how stuttering is perceived by their parents. The ways that parents view their children's stuttering could influence how the children themselves react to it. This study proceeds to assess how parents' perceptions of the impact of stuttering relate to the perceptions of children. METHOD: Participants were 50 children who stutter aged 7-12 years (mean = 9.10; SD = 1.7) and their parents, recruited from different cities in Portugal. The European Portuguese version of the Overall Assessment of the Speaker's Experience of Stuttering was administered to the children, and an adapted version of the tool was administered to their parents. RESULTS: Both parents and children showed generally similar overall impact ratings, typically falling in the mild and moderate ranges. Differences were observed in families with a history of stuttering: for those families, a comparison of parents' and children's scores revealed, in some domains, that parents perceived the impact of stuttering to be greater than the children did, especially related with children's reactions to stuttering and their quality of life. CONCLUSION: Knowledge about how parents perceive the impact of stuttering on their children is important because families can play a key role in helping children cope with stuttering. These findings highlight the benefits of using an individualized treatment approach for each child that focuses on their perceptions, as well as on those of the parents, in order to address negative attitudes toward children's stuttering.

Temperament, Executive Functioning, and Anxiety in School-Age Children Who Stutter.

The purpose of this study was to examine temperament dimensions, executive functioning ability, and anxiety levels in school-age children who stutter and their non-stuttering peers. Participants were 100 Portuguese children aged 7 to 12 years (M = 9.13; SD = 1.70), including 50 children who stutter and 50 children who do not stutter. Analyses, which were performed separately for younger and older participants, sought to identify correlations between key variables. Temperament was evaluated through a parent questionnaire, executive functioning was evaluated through children's responses on a performance test, and anxiety level was assessed through a self-perception scale. On the temperament measure, comparisons between children who stutter and their non-stuttering peers revealed that older children who stutter exhibited significantly higher scores on the Anger/Frustration, Impulsivity, and Sadness subscales, and lower averages on the Attention/Focusing, Perceptual sensitivity, and Soothability/Falling Reactivity subscales. On the executive functioning task, comparisons revealed that the group of younger children who stutter exhibited significantly higher average execution times than their non-stuttering peers. There were no statistically significant differences in anxiety between children who stutter and children who do not stutter, and there were no statistically significant correlations between temperament factors and measures of executive functioning. Children who stutter experienced lower ability to orient attention and greater emotional reactivity compared with their non-stuttering peers. Significant correlations were found between executive functioning and age and among the temperament factors themselves. These results, which support the need for a multidimensional view of stuttering, were interpreted in the context of the Dual Diathesis - Stressor model. Findings indicate that temperament and executive functioning abilities may contribute to the development of stuttering.

Why Does Brain Trauma Research Fail?

Traumatic brain injury (TBI) represents a major health care problem and a significant social and economic issue worldwide. Considering the generalized failure in introducing effective drugs and clinical protocols, there is an urgent need for efficient treatment modalities, able to improve devastating posttraumatic morbidity and mortality. In this work, the status of brain trauma research is analyzed in all its aspects, including basic and translational science and clinical trials. Implicit and explicit challenges to different lines of research are discussed and clinical trial structures and outcomes are scrutinized, along with possible explanations for systematic therapeutic failures and their implications for future development of drug and clinical trials. Despite significant advances in basic and clinical research in recent years, no specific therapeutic protocols for TBI have been shown to be effective. New potential therapeutic targets have been identified, following a better understanding of pathophysiologic mechanisms underlying TBI, although with disappointing results. Several reasons can be pinpointed at different levels, from inaccurate animal models of disease to faulty preclinical and clinical trials, with poor design and subjective outcome measures. Distinct strategies can be delineated to overcome specific shortcomings of research studies. Identifying and contextualizing the failures that have dominated TBI research is mandatory. This review analyzes current approaches and discusses possible strategies for improving outcomes.

The Unknown Cause of Pott's Puffy Tumor ­ Importance of Early Diagnose

Pott's puffy tumor (PPT) is characterized by swelling of the glabelar region and osteomyelitis of the frontal bone, owing to a subperiosteal pseudoinflammatory tumor responsible for the detachment of the pericranium from the outer table of the skull. Nowadays, the incidence of PPT is very low, so this entity is frequently underdiagnosed. The late treatment and identification of PPT are strongly associated with intracranial complications, which could jeopardize the life of the patient. In the literature, PPT is described as a complication of frontal head trauma or of chronic sinusitis. There are a few cases reported in patients with frontal insect bites or in recreational nasal drug users, such as cocaine or methamphetamines. In the present case report, the authors describe the case of a 40-year-old male who was submitted to a frontal sebaceous cyst surgery. In the postoperative period, he developed an infectious process compatible with PPT. After an extensive review of the literature, no similar cases were identified. Therefore, in the opinion of the authors, sebaceous cyst surgery should be included in the short list of risk factors for the development of PPT.

Executive functioning of Portuguese preschoolers in the Shape School test: A cross cultural study.

The Shape School is a neuropsychological test of executive functions (EF) for preschool-aged children. The purposes of this study were: (a) to adapt the use of the Shape School for European Portuguese preschool children and (b) to examine the cultural sensitivity of this test comparing the performance of Portuguese sample and U.S. normative sample. The executive functioning of 233 typically developing children aged 3 to 5 years old (M = 57.52; SD = 10.25; in months) was analyzed and according to our results, the adapted version was appropriate to obtain the discrimination among age-groups. Portuguese and American preschoolers show similar EF profiles. It was possible, in both samples, to note the sensitivity of the measurement to age-related differences, with the older age groups outperforming the younger. Therefore, the Portuguese version of the Shape School was considered suitable for research and clinical purposes.

[National Post Hospital Care Project and length of hospitalization of patients with stroke 2010-2011]. / Rede Nacional de Cuidados Continuados e Tempo de Internamento dos Doentes com Acidente Vascular Cerebral 2010-2011.

INTRODUCTION: The National Post Hospital Care Project was created to provide a continuity of care after hospitalization or to functionally dependent people. Currently there is a great difficulty in the integration of patients. The objective of this paper is to compare the impact of the referral to the Project versus being discharged home, in the length of stay of stroke patients between 2010 and 2011. MATERIAL AND METHODS: Retrospective study of patients admitted to the Neurology Infirmary A and Stroke Unit of Coimbra's University Hospital, in 2010 and 2011. The cases analyzed were 1 209, featuring demographic data, length of stay, Rankin Score (mRS) and destination after discharge. The data was analyzed comparing the two years concerning the length of stay of stroke patients referred to the Project and those discharged home, given the their Rankin Score. RESULTS: In 2011, the number patients referred to the National Post Hospital Care Project was higher, 23.5% compared to 21.4%. The length of stay for the same Rankin Score of the patients referred to National Post Hospital Care Project, remained higher than those discharged home: for a Rankin Score of 1: 11, versus 26 days for the Project; Rankin Score 2: 13, versus 29 days for the project; Rankin Score 3: 13, versus 23 days for the Project; Rankin Score 4: 17, to 33 days for the Project, Rankin Score 5: 27, versus 39 days to the Project. After comparison between the length of stay of patient discharged of and those referred to the National Post Hospital Care Project, it was estimated that the referral represented an hospitalization excess of 1 718 days in 2010 and 1 198 days in 2011. CONCLUSION: The National Post Hospital Care Project is unable to meet the actual needs although the waiting time has reduced, possibly due to the increased number of beds and the possibility of patients waiting at home.

Introdução: A Rede Nacional de Cuidados Continuados Integrados surgiu para proporcionar a continuação de cuidados após internamento ou para pessoas funcionalmente dependentes. Actualmente há uma grande dificuldade na integração dos doentes no domicílio ou em estruturas de retaguarda. Pretende-se comparar o impacto da referenciação para a Rede Nacional de Cuidados Continuados Integrados versus alta para domicílio, no tempo de internamento dos doentes com Acidente Vascular Cerebral, entre 2010 e 2011.Material e Métodos: Estudo retrospectivo envolvendo os doentes internados na Neurologia A e Unidade de Acidente Vascular Cerebral dos Hospitais da Universidade de Coimbra, naquele anos. Analisaram-se 1 209 processos, incluídos 819, caracterizados demograficamente, tempo de internamento, Score de Rankin modificado e destino pós-alta. Compararam-se os dados, relativamente ao tempo de internamento dos doentes com Acidente Vascular Cerebral, referenciados para a Rede Nacional de Cuidados Continuados Integrados e os com alta para domicílio, atendendo ao Score de Rankin final.Resultados: Em 2011, aumentaram os doentes referenciados para a Rede Nacional de Cuidados Continuados Integrados, 23,5% comparativamente 21,4%. Em 2011 o tempo de internamento, para um mesmo Score de Rankin, da população referenciada manteve-se superior: para um Rankin de 1: 11 dias para domicílio, 26 dias para os doentes referenciados; para um Rankin de 2: 13 dias para domicílio, 29 dias para a rede; para Rankin de 3: 13 dias para domicílio, 23 dias para referenciados; para um Rankin de 4: 17 dias para domicílio, 33 dias para Rede; e para um Rankin de 5: 27 dias para domicílio, 39 dias para Rede. Comparando com os tempos de internamento da população com alta para domicílio, estima-se que tenha representado mais 1 718 dias de internamento, em 2010 e1 198 dias, em 2011.Conclusão: A Rede Nacional de Cuidados Continuados Integrados é incapaz de responder às necessidades actuais, embora o tempo de espera tenha reduzido, devido ao aumento do número de camas e da possibilidade dos doentes aguardarem vaga no domicílio.