Psychological and cognitive functioning in children and adolescents with congenital heart disease: a meta-analysis

OBJECTIVE: Findings in the literature are inconsistent on the impact of congenital heart disease (CHD) on the psychological and cognitive functioning of children and adolescents. The aim of the present study was to systematically review this empirical body of literature. METHODS: We conducted a meta-analysis to review studies on behavior problems and cognitive functioning in CHD. RESULTS: Only older children and adolescents with CHD displayed an increased risk of overall, internalizing, and to a lesser extent externalizing behavior problems. In addition, patients with severe CHD exhibited lower cognitive functioning than patients with less severe CHD, specifically with respect to performance intelligence. Moreover, decreased cognitive functioning remained relatively stable across different age groups. CONCLUSIONS: Children with severe heart disease may benefit from interventions specifically targeting perceptual organizational abilities, such as visual-spatial abilities. Moreover, older children and adolescents with CHD may benefit from psychological interventions reducing anxiety symptoms and depression.     

学业成绩与内化行为问题的预测关系:一年的追踪研究

目的:探讨学业成绩与内化行为问题的预测关系。方法:使用同伴提名、自我报告以及学校记录对小学四年级到初中二年级787名儿童进行为期一年的追踪研究,采用结构方程模型进行交叉滞后分析,考察学业成绩与内化行为问题的相互预测关系。结果:①在前后测之中,学业成绩都与孤独感、抑郁感和社会退缩行为呈显著负相关,与一般自我价值感呈显著正相关;②交叉滞后模型结果显示,前测学业成绩可以预测后测内化行为问题,而前测内化行为问题不能预测后测学业成绩。结论:在学习成绩与内化行为问题的预测关系中,先前学业成绩对后来内化行为问题的预测力比先前内化行为问题对后来学业成绩的预测力更强。     

Early Childhood Internalizing Problems in Mexican- and Dominican-Origin Children: The Role of Cultural Socialization and Parenting Practices

This study examined mother- and teacher-rated internalizing behaviors (i.e., anxiety, depression, and somatization symptoms) among young children using longitudinal data from a community sample of 661 Mexican and Dominican families and tested a conceptual model in which parenting (mother's socialization messages and parenting practices) predicted child internalizing problems 12 months later. Children evidenced elevated levels of mother-rated anxiety at both time points. Findings also supported the validity of the proposed parenting model for both Mexican and Dominican families. Although there were different pathways to child anxiety, depression, and somatization among Mexican and Dominican children, socialization messages and authoritarian parenting were positively associated with internalizing symptoms for both groups.     

The relationship between dimensions of classroom and family environments and the self-concept,satisfaction, and achievement of grade 7 and 8 students

This study examined the relationships between dimensions of classroom and family environments and various aspects of the adaptation of grade 7 and 8 students. Classroom climates providing support and structure were consistently associated with high levels of student scholastic self-concept and satisfaction with teacher. Families with high degrees of parent-child interaction and climates providing support and structure were generally associated with high levels of self-concept (peer, scholastic, and general), satisfaction with family, and, to a lesser extent, achievement. There was some evidence that gains in self-concept and achievement over the course of the school year were related to classroom or family environment variables. Students with the highest levels of scholastic self-concept had both classroom and family environments high in support and structure. The results provided partial support for invitational learning theory, which postulates that environments which provide structure, along with support and nurturance, invite affective and intellectual growth in students.     

Honing in on the Social Difficulties Associated With Sluggish Cognitive Tempo in Children: Withdrawal,Peer Ignoring,and Low Engagement

Sluggish cognitive tempo (SCT) symptoms are associated with social difficulties in children, though findings are mixed and many studies have used global measures of social impairment. The present study tested the hypothesis that SCT would be uniquely associated with aspects of social functioning characterized by withdrawal and isolation, whereas attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms would be uniquely associated with aspects of social functioning characterized by inappropriate responding in social situations and active peer exclusion. Participants were 158 children (70% boys) between 7–12 years of age being evaluated for possible ADHD. Both parents and teachers completed measures of SCT, ADHD, ODD, and internalizing (anxiety/depression) symptoms. Parents also completed ratings of social engagement and self-control. Teachers also completed measures assessing asociality and exclusion, as well as peer ignoring and dislike. In regression analyses controlling for demographic characteristics and other psychopathology symptoms, parent-reported SCT symptoms were significantly associated with lower social engagement (e.g., starting conversations, joining activities). Teacher-reported SCT symptoms were significantly associated with greater asociality/withdrawal and ratings of more frequent ignoring by peers, as well as greater exclusion. ODD symptoms and ADHD hyperactive-impulsive symptoms were more consistently associated with other aspects of social behavior, including peer exclusion, being disliked by peers, and poorer self-control during social situations. Findings provide the clearest evidence to date that the social difficulties associated with SCT are primarily due to withdrawal, isolation, and low initiative in social situations. Social skills training interventions may be effective for children displaying elevated SCT symptomatology.     

Depression and anxiety 3 months post stroke: prevalence and correlates.

This study examined prevalence of depression and anxiety as well as the relationships of age, gender, hemisphere of lesion, functional independence, and cognitive functioning (i.e., memory, attention/impulsivity, cognitive speed) to depression and anxiety at 3 months post stroke in 73 individuals. Prevalence of moderate to severe depression and anxiety in the sample were high (22.8 and 21.1%, respectively), with co-morbidity in 12.3% of cases. In regression analysis, 74.6% of variance in depression was explained, with significant relationships between increased depression and younger age, reduced cognitive speed, poorer verbal memory, left hemisphere lesion, and increased impact of interference (Stroop ratio). Left hemisphere of lesion also contributed to prediction of anxiety, as did cognitive speed, explaining 50.7% of the variance. The findings suggest that individuals with left hemisphere lesions may be particularly at risk of developing depression and anxiety after stroke, with younger individuals also at heightened risk of depression. While age and hemisphere of lesion contributed, cognitive performance explained the greatest proportion of variance in both depression and anxiety (51.3 and 38.5%, respectively). The findings suggest that cognition and mood are linked over and above physical independence and that both should be addressed as part of the rehabilitative process.     

Children's Coping Assistance: How Parents,Teachers, and Friends Help Children Cope After a Natural Disaster

Identified 129 third- through fifth-grade girls (screened from 232) via peer nominations and behavioral observations as fitting into one of four peer status groups (popular, rejected, neglected, or average) and two withdrawal status groups (withdrawn or not withdrawn). Subjects, parents, and teachers completed questionnaire measures of depression and anxiety. Rejected and withdrawn girls showed more internalizing problems as reported by girls and their teachers compared to peers. The combination of rejection and withdrawal was associated with more internalizing behaviors. Neglected girls did not differ from peers on depression or anxiety; nor was the combination of neglect and withdrawal associated with increased scores on dependent measures.     

The relations among depression in fathers, children's psychopathology, and father-child conflict: a meta-analysis

Research on parental depression is beginning to recognize the importance of studying fathers in relation to maladaptive outcomes in their offspring. Paternal depression is hypothesized to correlate with internalizing and externalizing psychopathology in children and adolescents and to compromise adaptive parent-child relationships (e.g., increased conflict). In the present paper, meta-analytic procedures were applied to this literature to address the magnitude and direction of covariation between paternal depression and children's functioning. In addition, we tested whether variation in findings could be accounted for by study characteristics. Results indicated that paternal depression was significantly related to offspring internalizing and externalizing psychopathology and father-child conflict. Larger effects for internalizing symptoms were associated with the use of community samples and symptom rating scales of internalizing problems.     

Does asthma or treatment with theophylline limit children's academic performance?

BACKGROUND. Asthma is a major cause of morbidity in childhood, restricting activity and causing absences from school. Theophylline, although effective in managing chronic asthma, has been reported to cause deficits in cognitive functioning and school performance. We therefore examined the effect of asthma and its treatment on academic achievement in a large, representative population of school-age children; matched sibling controls were used for comparison. METHODS. We identified 255 consecutive children with asthma (mean age, 12.0 years) who had taken nationally standardized scholastic achievement tests administered routinely by the schools. One hundred one of these children had siblings without asthma with whom comparisons could be made in reading, mathematics, and a composite measure of achievement. RESULTS. Academic achievement among the children with asthma was similar to normative standards in Iowa and higher than national standards, as reflected in a mean composite T-score of 57.1 (expected mean [+/- SD], 50 +/- 10). For the 101 children with sibling controls, composite T-scores were 58.3 for the children with asthma and 57.5 for the siblings. Eighty-five of these 101 children with asthma were receiving daily maintenance medication for chronic asthma; 72 of these were receiving theophylline. The mean composite T-scores were 58.5 for the theophylline-treated patients and 58.4 for their siblings without asthma. None of the differences between the children with asthma and the sibling controls were statistically significant. CONCLUSIONS. Academic achievement among children with asthma, at least those whose status is closely monitored in a structured treatment program, generally appears to be unaffected by asthma or by its treatment with appropriate doses of theophylline.     

The neuropsychological phenotype of velocardiofacial syndrome (VCFS): relationship to psychopathology.

Children with velocardiofacial syndrome (VCFS; N=14) and a comparison group of siblings (N=8) underwent comprehensive neuropsychological assessment to examine the relationship between cognitive functioning and psychopathology. Significant group differences were obtained on tests of full scale and verbal intellectual functioning and perceptual-motor skills. With the exception of performance on tests of attention and executive functioning, children with VCFS displayed a profile consistent with nonverbal learning disability (NLD). However, within group comparisons revealed significantly poorer visuospatial intellectual and nonverbal memory functioning in sibling controls as well. No significant group differences were obtained on tests of motor speed, academic, language, attention, memory, or executive functioning, with significant variability in children with VCFS frequently accounting for the lack of robust differences. Parent-report measures revealed profiles consistent with ADHD. No clinically significant symptoms of psychosis, depression or anxiety were noted on either self- or parent-report measures. Wisconsin Card Sorting Test performance was found to be highly and negatively correlated with the Thought Problems subscale of the Child Behavior Checklist (CBCL) for VCFS children only, suggesting a possible at-risk indicator for later onset psychopathology.     

Phenotypic and behavioral genetic covariation between elemental cognitive components and scholastic measures

The study subjected nine elementary cognitive task variables from the Cognitive Assessment Tasks (CAT) and three scholastic measures from the Metropolitan Achievement Test (MAT) to phenotypic and behavioral genetic structural equation modeling based on data for 277 pairs of same sex monozygotic (MZ) and dizygotic (DZ) twins from the Western Reserve Twin Project. Phenotypic and behavioral genetic covariation between certain elemental cognitive components and scholastic performance was examined to determine (a) whether these elemental cognitive components contribute substantially to the variance of scholastic performance; (b) whether such contributions vary across different domains of school knowledge or from specific domains to a general aptitude; (c) the behavioral genetic composition of the elemental cognitive components and the scholastic variables; and (d) how the association between the cognitive components and scholastic performance is genetically and environmentally mediated. The results of the study showed that as much as 30% of the phenotypic variance of scholastic performance was accounted for by the CAT general factor, which was presumably related to mental speed. A mainly genetic covariation was found between the mental speed component and scholastic performance, although each of the two variables was strongly influenced by both heritability and common family environment. The magnitude and etiology of the covariation were largely invariant whether mental speed was related to a common scholastic aptitude or to individual achievement measures covering different knowledge domains. Taken in conjunction with previous findings that mental speed has a substantial genetic correlation with psychometric g, and psychometric g has a mostly genetic covariation with scholastic achievement, the findings of the present study seems to point to a more global picture; namely, there is a causal sequence that starts from mental speed as the explanatory factor for both psychometric g and scholastic performance, and the etiology of the causal link is chiefly genetic.     

Schizophrenic-like neurocognitive deficits in children and adolescents with 22q11 deletion syndrome.

22q11.2 Deletion Syndrome (22q11DS) is the most common genetic microdeletion syndrome affecting humans. The syndrome is associated with general cognitive impairments and specific deficits in visual-spatial ability, non-verbal reasoning, and planning skills. 22q11DS is also associated with behavioral and psychiatric abnormalities, including a markedly elevated risk for schizophrenia. Research findings indicate that people with schizophrenia, as well as those identified as schizoptypic, show specific cognitive deficits in the areas of sustained attention, executive functioning, and verbal working memory. The present study examined such schizophrenic-like cognitive deficits in children and adolescents with 22q11DS (n = 26) and controls (n = 25) using a cross-sectional design. As hypothesized, 22q11DS participants exhibited deficits in intelligence, achievement, sustained attention, executive functioning, and verbal working memory compared to controls. Furthermore, deficits in attention and executive functioning were more pronounced in the 22q11DS sample relative to general cognitive impairment. These findings suggest that the same pattern of neuropsychological impairment seen in patients with schizophrenia is present in non-psychotic children identified as at-risk for the development of schizophrenia based on a known genetic risk marker.     

Anxiety, depression, psychotropic drug use and cognitive impairment

BACKGROUND: Numerous studies have shown that anxiety and depression are related to cognitive impairment, but the concomitant association between anxious symptoms, depressive symptoms and cognitive function has not been investigated, and, most studies have not considered psychotropic drug use as a possible confounding factor. METHODS: We assessed the independent association between depression, anxiety, psychotropic drug use and cognitive performance in 457 men and 659 women, aged 59-71 years living in the community. Data on demographic background, occupation, medical history, drug use and personal habits were obtained using a standardized questionnaire. The Spielberger Inventory Trait and the Center for Epidemiologic Study-Depression (CES-D) scales were used to evaluate anxious and depressive symptomatology respectively. Cognitive assessment included six traditional tests covering the main areas of cognitive functioning. RESULTS: In men, anxious and depressive symptomatologies had independent significant associations with most cognitive abilities, independent of psychotropic drug use. In women, the association between anxiety or depression and cognitive functioning was less strong and disappeared after adjustment for psychotropic drug use. Psychotropic drug use was associated with lower cognitive scores in both sexes. In men with high CES-D scores, we found positive correlations between anxiety level and cognitive scores. CONCLUSIONS: The study showed that anxiety, depression and psychotropic drug use were significantly and independently associated with cognitive functioning in elderly men. The high prevalence of psychotropic drug use in women with or without psychological disorders may explain its major effect in women. Results suggested that anxiety may partly compensate for some negative effects of depression on cognitive functioning.     

Child behavior problems and family functioning as predictors of adherence and glycemic control in economically disadvantaged children with type 1 diabetes: a prospective study

OBJECTIVE: This prospective study examined how child behavior problems and family functioning predict adherence behavior and glucose regulation (glycemic control) in a sample of economically disadvantaged children. METHODS: Children with type 1 diabetes (N = 116; 58.6% African American) were assessed for externalizing and internalizing behavior problems and family adaptability and cohesion and followed for a mean of 3.8 years. Glycemic control (glycosylated hemoglobin [HbA1c]) was assessed at baseline and follow-up, and adherence was assessed at follow-up. RESULTS: Analyses controlled for baseline HbA1c and years to follow-up. Multivariate analyses indicated that better adherence was predicted by high family cohesion. Better glycemic control was predicted by high family cohesion, the absence of externalizing behavior problems, and the presence of internalizing behavior problems. In addition, tests of moderation indicated that better follow-up glycemic control occurred among girls from high cohesion families and younger children from low adaptability families. Although better adherence predicted better glycemic control, adherence did not mediate the relationships of behavior problems or family functioning with glycemic control. CONCLUSIONS: A child's behavior problems and family functioning may influence both adherence to the diabetes regimen and glycemic control several years later, suggesting the potential value of interventions that address child behavior and family functioning.     

Personality of parents with bipolar disorder and interpersonal functioning among their offspring: a prospective 10-year study

A comparison of offspring of parents with bipolar disorder (OBD) and offspring of parents with no mental disorder (ONMD) showed that parents' neuroticism was associated with internalizing and externalizing problems among their children. The present study examined whether parents' neuroticism predicted poor interpersonal functioning among offspring 10 years later and whether the problems observed in middle childhood mediated the association between parents' neuroticism and offspring functioning. When offspring were in middle childhood, parents completed the revised NEO Personality Inventory and rated the child's behavior on the Child Behavior Checklist. Ten years later, 65 OBD and 59 ONMD completed interviews assessing mental disorders and interpersonal and noninterpersonal functioning. High neuroticism and low agreeableness in parents predicted poor interpersonal functioning in their offspring in late adolescence-early adulthood. The offspring's externalizing and internalizing problems in middle childhood partially mediated the association between parents' personality and offspring interpersonal functioning. Moreover, the association between parents' neuroticism and offspring internalizing problems was stronger among the OBD than the ONMD. Overall, the results suggested an intergenerational transmission of risk whereby high neuroticism and low agreeableness in parents were associated with behavioral problems among offspring in middle childhood that, in turn, predicted poor interpersonal functioning 10 years later.     

Specificity of cognitive structure in depression and social phobia: a comparison of interpersonal and achievement content

BACKGROUND: The comorbidity between the mood and anxiety is extensive and it is probable that individuals with these disorders share a number of cognitive characteristics. However, comorbidity rates with depression are not uniform among the various anxiety disorders. This study examined the common and distinguishing features of self-schematic structure in major depressive disorder and social anxiety compared to other anxiety disorders in general and to no psychiatric disturbance. METHODS: Participants completed the Psychological Distance Scaling Task, which provided an index of the cognitive organization of positively and negatively valenced interpersonal and achievement self-referent content. RESULTS: The depression and social phobia groups were statistically equivalent on all indices of cognitive organization, and showed greater interconnectedness among interpersonal negative content than both control groups, and less interconnectedness among both positive interpersonal and achievement content than did nonpsychiatric controls. Psychiatric groups were equivalent on negative achievement content but showed greater interconnectedness than controls. LIMITATIONS: This study had a modest sample size and the findings are constrained to females. CONCLUSIONS: Negative interpersonal content is more densely interconnected in individuals with social phobia and depression compared with both other anxiety disorder and nonpsychiatric controls. In addition, both social phobia and depression were associated with less interconnected positive content. These findings are indicative of similarities in the way self-schematic content may be organized in individuals with depression and social phobia. Theoretical explanations of these results and future research directions are discussed.     

Brief report: intellectual and academic functioning in pediatric chronic kidney disease

OBJECTIVE: Examine the intellectual and academic functioning in children with chronic kidney disease (CKD). METHODS: Using a cross-sectional design, children with CKD (n = 30) were compared to matched controls (n = 41) on measures of intelligence, achievement, and rates of learning disabilities (LD) variously defined. RESULTS: Children with CKD were at higher risk for grade retention (p < .001) and absenteeism (p < .01), and evidenced mild impairments on measures of intelligence (p < .001), math (p < .01), reading (p < .05), and satisfied criteria for a low achievement definition of LD (p < .01) more frequently than control group participants. Renal function was a significant predictor (p < .02) of intellectual and academic scores in the CKD group. CONCLUSIONS: Educational and psychosocial supports are critical for children with CKD, and it may be important to monitor their cognitive functioning and academic progress over time.     

Intellectual and academic outcome following closed head injury in children and adolescents: Research strategies and empirical findings

The literature on intellectual and academic outcome after closed head injury in children and adolescents is reviewed. The research strategies and variables used to evaluate recovery are considered in terms of empirical findings and methodological issues. It is argued that assessment of outcome must take place within the context of an understanding of the child's premorbid behavioral and cognitive functioning. In addition, more fine‐grained tests of cognition other than global IQ measures should be utilized to tap subtle information processing, problem solving, and scholastic achievement deficits resulting from traumatic brain injury.     

Cognitive functioning and emotion processing in breast cancer survivors and controls: An ERP pilot study

Diagnosis and treatment of breast cancer is a very emotionally aversive and stressful life event, which can lead to impaired cognitive functioning and mental health. Breast cancer survivors responding with repressive emotion regulation strategies often show less adaptive coping and adverse outcomes. We investigated cognitive functioning and neural correlates of emotion processing using ERPs. Self‐report measures of depression, anxiety, and fatigue, as well as hair cortisol as an index of chronic stress, were assessed. Twenty breast cancer survivors (BCS) and 31 carefully matched healthy controls participated in the study. After neuropsychological testing and subjective assessments, participants viewed 30 neutral, 30 unpleasant, and 30 pleasant pictures, and ERPs were recorded. Recognition memory was tested 1 week later. BCS reported stronger complaints about cognitive impairments and more symptoms of depression, anxiety, and fatigue. Moreover, they showed elevated hair cortisol levels. Except for verbal memory, cognitive functioning was predominantly in the normative range. Recognition memory performance was decreased in cancer survivors, especially for emotional contents. In ERPs, survivors showed smaller late positive potential amplitudes for unpleasant pictures relative to controls in a later time window, which may indicate less elaborative processing of this material. Taken together, we found cognitive impairments in BCS in verbal memory, impaired emotional picture memory accuracy, and reduced neural activity when breast cancer survivors were confronted with unpleasant materials. Further studies and larger sample sizes, however, are needed to evaluate the relationship between altered emotion processing and reduced memory in BCS in order to develop new treatment strategies.