Executive functioning in children with specific language impairment

Background: A limited range of evidence suggests that children with specific language impairment (SLI) have difficulties with higher order thinking and reasoning skills (executive functioning, EF). This study involved a comprehensive investigation of EF in this population taking into account the contributions of age, nonverbal IQ and verbal ability. Methods: Ten separate measures of EF were assessed in 160 children: 41 had SLI; 31 had low language/cognitive functioning but did not fulfil the criteria for SLI (low language functioning or LLF); and 88 were typically developing with no language difficulties. Group differences in performance were assessed after controlling for age, nonverbal IQ and verbal ability in a series of regression analyses. Results: Children with SLI and LLF had significantly lower performance than typical children on 6 of the 10 EF tasks once age and nonverbal IQ had been controlled (verbal and nonverbal executive‐loaded working memory, verbal and nonverbal fluency, nonverbal inhibition and nonverbal planning). Performance on these EF tasks remained lower for those in the SLI group even when verbal IQ was entered in the regressions. Conclusions: Children with language impairments showed marked difficulties on a range of EF tasks. These difficulties were present even when adjustments were made for their verbal abilities.     

Neuropsychological functioning in patients with asymptomatic congenital cytomegalovirus infection

Congenital cytomegalovirus (CMV) infection has an affinity for the central nervous system and has been implicated in a variety of neurological impairments. Analysis of cognitive functioning in children with asymptomatic congenital CMV infection, however, has revealed no general intellectual deficits. The present study was designed to explore neuropsychological test performance in these children, compared with healthy control subjects, providing data from more sensitive measures of neurocognitive functioning. The sample consisted of 109 children diagnosed with asymptomatic congenital CMV infection and 173 control subjects who were compared on tests measuring various aspects of perceptual and motor functioning, memory, problem solving, and traditional intelligence measures. Young (41NDASH6 yr) control patients performed significantly better on the Full-Scale but not the Verbal or Performance intelligence quotient (IQ) measures than patients with asymptomatic congenital CMV infection, without accompanying consistent neuropsychological performance differences. However, no IQ or neuropsychological differences were found between groups of older children. The present study adds to the existing literature finding no reliable, lasting differences in IQ scores and adds to our knowledge by finding no reliable, lasting differences in neuropsychological test performance.     

Detection and assessment of stroke in patients with sickle cell disease: neuropsychological functioning and magnetic resonance imaging

Sickle cell disease (SCD) is associated with increased risk of stroke and cognitive impairment. This study describes a retrospective review of 65 patients who underwent routine neuropsychological testing and MRI during treatment at a comprehensive sickle cell center. It was hypothesized that (1) children with no evidence of CVA would perform lower than expected on cognitive tasks compared to population-based normative data, (2) children with strokes and children with silent infarcts would perform lower on cognitive tasks and motor skills as compared to patients with no evidence of CVA, and (3) children with evidence of silent infarcts would perform better than children with known overt strokes. This final hypothesis has not been studied previously, as children with known overt stroke and silent infarct were grouped together. Sixty-five children with SCD who were sent for routine neuropsychological testing and brain MRI were identified via retrospective chart review. Patients had been administered neuropsychological tests to assess cognitive, executive and motor function. Brain MRI was obtained from each patient and was analyzed for evidence of cerebrovascular accident (CVA). Based on MRI analysis, 27% of patients with SCD had experienced a stroke and 13% a silent infarct. The majority (59%) of patients diagnosed with stroke or infarct sustained cortical damage to the frontal lobe. Patients with SCD and no evidence of CVA functioned normally on tests of cognitive ability and achievement, but patients with CVA displayed impairments in cognitive function and comparatively lower scores on verbal and performance scales. Neuropsychological testing can identify impairments in patients with SCD with no known cerebrovascular accident. Investigations of neurocognitive functioning will help characterize patterns of deficits and can inform the ability to implement comprehensive care strategies for patients with SCD and cognitive impairment.     

Evaluation of working memory impairment in children with primary nocturnal enuresis: evidence from event-related functional magnetic resonance imaging

Aim: To assess the working memory and explore the differential activations of brain areas in children with primary nocturnal enuresis (PNE) by performing functional magnetic resonance imaging (fMRI) scans using the categorical N‐Back task. Methods: Thirteen right‐handed PNE children (M/F = 7:6, average age 11.4 ± 0.8 years) and 15 age‐matched, right‐handed, healthy controls (M/F = 9:6, 11.3 ± 1.0 years) were recruited for the study. First, intelligence tests were performed using Chinese Wechsler Young Children Scales of Intelligence in PNE children and controls. The full intelligence quotient (FIQ), verbal IQ (VIQ), performance IQ (PIQ) and memory/caution (M/C) factor were measured. After intelligence tests, event‐related fMRI scans were performed using the categorical N‐Back working memory task on a 3.0T MR scanner. The percent of correct responses (PCR) and the mean reaction time to correct response (mRT) were recorded and compared; fMRI data were analysed using SPM2, the differences in activation were compared with the single subject and between‐group levels. Results: The FIQ, VIQ and PIQ in the PNE group were within the normal range and did not significantly differ from the control group (P > 0.05). The M/C factor was statistically significantly lower in the PNE group (P < 0.05). In the N‐Back test, PNE children had lower PCR and longer mRT than controls (P < 0.05). A between‐group analysis of fMRI data revealed significant attenuation in the left posterior cerebellar lobes of PNE children. Conclusion: PNE children had deficits in working memory, and dysfunction in the left cerebella might be associated with their working memory deficits.     

Arithmetic difficulties in children with cerebral palsy are related to executive function and working memory

Background:  Although it is believed that children with cerebral palsy are at high risk for learning difficulties and arithmetic difficulties in particular, few studies have investigated this issue.
Methods:  Arithmetic ability was longitudinally assessed in children with cerebral palsy in special ( n  =   41) and mainstream education ( n  =   16) and controls in mainstream education ( n  =   16). Second grade executive function and working memory scores were used to predict third grade arithmetic accuracy and response time.
Results:  Children with cerebral palsy in special education were less accurate and slower than their peers on all arithmetic tests, even after controlling for IQ, whereas children with cerebral palsy in mainstream education performed as well as controls. Although the performance gap became smaller over time, it did not disappear. Children with cerebral palsy in special education showed evidence of executive function and working memory deficits in shifting, updating, visuospatial sketchpad and phonological loop (for digits, not words) whereas children with cerebral palsy in mainstream education only had a deficit in visuospatial sketchpad. Hierarchical regression revealed that, after controlling for intelligence, components of executive function and working memory explained large proportions of unique variance in arithmetic accuracy and response time and these variables were sufficient to explain group differences in simple, but not complex, arithmetic.
Conclusions:  Children with cerebral palsy are at risk for specific executive function and working memory deficits that, when present, increase the risk for arithmetic difficulties in these children.     

Do parental ratings on cognition reflect neuropsychological outcome in congenital heart disease?

AIM: To describe the parental view of the cognitive skills of their child with a surgically corrected congenital heart disease (CHD) and compare it to objectified cognitive measures in children with CHD 6-12 years postoperatively. METHODS: Parents completed a questionnaire on several cognitive functions of their child. Children with CHD and healthy controls (n=86, aged 8 years 8 months +/- 1 year 6 months) underwent an abbreviated IQ-testing and a neurodevelopmental assessment. RESULTS: Parents of the children with CHD more frequently indicated lower sustained attention (p<0.05), lower divided attention (p<0.001), more problems with memory and learning skills (p<0.05), and deficient gross motor functioning (p<0.01) compared to the parents of healthy controls. Intellectual and neuropsychological assessment revealed a lower estimated full-scale IQ (p<0.01), worse sensorimotor functioning (p<0.001), and lower performances on language (p<0.001), attention/executive functioning (p<0.05), and memory (p<0.05) in the CHD-group. Several items of the questionnaire were significant predictors for worse neurodevelopmental outcome. CONCLUSION: Overall, the objective and subjective measures on cognitive functioning are in agreement and indicate the presence of neurocognitive deficits in children with CHD. This study endorses the accuracy and usefulness of a parental questionnaire to report on the cognitive functioning of the child and urges the investigation of neurocognitive functioning in children with CHD at follow-up.     

Functional impairments at school age of children with necrotizing enterocolitis or spontaneous intestinal perforation

We aimed to determine motor, cognitive, and behavioral outcome at school age of children who had either necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP). This case-control study included infants with NEC Bell's stage IIA onward, infants with SIP, and matched controls (1996-2002). At school age, we assessed motor skills, intelligence, visual perception, visuomotor integration, verbal memory, attention, behavior, and executive functions. Of 93 infants with NEC or SIP, 28 (30%) died. We included 52 of 65 survivors for follow-up. At mean age of 9 y, we found that 68% of the children had borderline or abnormal scores on the Movement Assessment Battery for Children (versus 45% of controls). Their mean total intelligence quotient (IQ) was 86 ± 14 compared with 97 ± 9 in the controls. In addition, attention and visual perception were affected (p < 0.01 and p = 0.02). In comparison to controls, surgically treated children were at highest risk for adverse outcome. In conclusion, at school age, the motor functions and intelligence of many children with NEC or SIP were borderline or abnormal and, specifically, attention and visual perception were impaired. Children with NEC or SIP form a specific risk group for functional impairments at school age even though the majority does not have overt brain pathology.     

Visuelle Wahrnehmungsstörungen nach kindlichen Schlaganfällen

Background

Although two thirds of children who suffered from perinatal or childhood stroke show visual perceptual disorders, little research has been done on their visual perceptual abilities (VPA).

Material and methods

The Frostigs development test of visual perception for adolescents and adults (Frostigs Entwicklungstest der visuellen Wahrnehmung – Jugendliche und Erwachsene, FEW-JE) and the Wechsler Intelligence Scale for Children-IV (WISC-IV) were used to compare the VPAs of 28 children aged between 9 and 16 years who had suffered a perinatal or childhood stroke with those of a control group. Those children who obtained below average or clinically relevant test results are presented.

Results

Children who had suffered a stroke scored significantly lower than the control group in the FEW-JE and WISC-IV tests accept for the verbal comprehension index. Of the stroke group 46?% scored below average on the FEW-JE, 36?% achieved clinically relevant results and 25?% fell below average on the full scale intelligence quotient (IQ) test.

Conclusion

The identification of visual perceptual disorders after perinatal or childhood stroke can be achieved using the FEW-JE and the WISC-IV tests. The results suggest that VPAs should always be judged in relation to the verbal comprehension index because deficits can have a negative impact on perceptual reasoning, working memory and mental processing speed.     

Functional impairments at school age of preterm born children with late-onset sepsis

Background

Late-onset sepsis is a relatively common complication particularly of preterm birth that affects approximately a quarter of very low birth weight infants.

Aim

We aimed to determine the motor, cognitive, and behavioural outcome at school age of preterm children with late-onset sepsis compared to matched controls.

Study design and subjects

A prospective case-control study that included preterm infants (gestational age < 32 weeks and/or birth weight < 1500 g) admitted to our Neonatal Intensive Care Unit in 2000-2001 with a culture-proven late-onset sepsis, and controls matched for gestational age.

Outcome measures

At school age we assessed motor skills, intelligence, visual perception, visuomotor integration, verbal memory, attention, executive functioning, and behaviour.

Results

At 6-9 years, 21 of 32 children with late-onset sepsis (68%) had borderline or abnormal motor outcome with most problems in fine motor skills. Their total IQ was 89 compared to 98 in controls. In addition, verbal memory and attention were affected compared to controls (0.61 standard deviations (SD), 95% confidence interval (CI) 0.04-1.17, p = 0.033 and 0.94 SD, 95% CI 0.32-1.62, p = 0.011, respectively). Multiple episodes of sepsis and gram-negative sepsis were risk factors for worse cognitive outcome.

Conclusions

At school age, a majority of preterm children with late-onset sepsis had motor problems. Their IQ was considerably lower than matched controls, and memory and attention were specifically impaired. Outcome at school age of preterm children with late-onset sepsis was worse than previously thought.     

Contrasting deficits on executive functions between ADHD and reading disabled children

Background:  The object of this study was to analyze the executive functioning of children with attention deficit hyperactivity disorder (ADHD) or reading disability (RD) independent of their non-executive deficits.
Methods:  Three carefully diagnosed groups of children, aged between 7 and 12 years (35 ADHD, 22 RD and 30 typically developing children), were tested on a wide range of tasks related to five major domains of executive functioning (EF): inhibition, visual working memory, planning, cognitive flexibility, and verbal fluency. Additional tasks were selected for each domain to control for non-executive processing.
Results:  ADHD children were impaired on interference control, but not on prepotent and ongoing response suppression. ADHD showed deficits on visual working memory, planning, cognitive flexibility and phonetic fluency. RD children were impaired on phonetic fluency. The only EF measure that differentiated ADHD from RD was planning.
Conclusions:  The present sample of ADHD children showed several EF deficits, whereas RD children were almost spared executive dysfunction, but exhibited deficits in phonetic fluency.     

Sleep spindle activity in children with obstructive sleep apnea as a marker of neurocognitive performance: A pilot study

Study objectives

To assess spindle activity as possible markers for neurocognitive consequences in children with mild obstructive sleep apnea.

How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism?

BACKGROUND: The objective of this study is to identify intact and deficient cognitive processes in children with attention deficit hyperactivity disorder (ADHD) and children with high functioning autism (HFA). METHOD: Three rigorously diagnosed groups of children aged between 6 and 12 years (54 ADHD, 41 HFA, and 41 normal controls) were tested on a wide range of tasks related to five major domains of executive functioning (EF): inhibition, visual working memory, planning, cognitive flexibility, and verbal fluency. In addition, the role of comorbid oppositional defiant disorder (ODD) and comorbid conduct disorder (CD) in ADHD was investigated by directly comparing 20 children with ADHD and 34 children with comorbid ADHD + ODD/CD. RESULTS: ADHD was associated with EF deficits in inhibiting a prepotent response and verbal fluency. Children with HFA demonstrated deficits in all EF domains, except interference control and working memory. The HFA group showed more difficulties than the ADHD group with planning and cognitive flexibility. The comorbid ADHD + ODD/CD group did not show a distinctive pattern of performance on the EF tests compared to the ADHD group. CONCLUSION: The present study indicates that children with HFA exhibit more generalised and profound problems with EF tasks compared to children with ADHD.     

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目的分析原发性遗尿症(PNE)患儿智力结构,探讨单纯PNE患儿灰质形态学改变状况。方法 2006年10月至2011年8月解放军第463医院儿科就诊的75例右利手PNE患儿(PNE组)及72名正常儿童(对照组),采用中国韦氏儿童智力量表(C-WISC)进行智力测试,计算言语智商(VIQ)、操作智商(PIQ)、总智商(FIQ)、记忆或不分心(M/C)因子等指标;而后进行高分辨率T1WI磁共振成像(MRI)扫描,采用VBM5工具包,对所有被试T1WI图像进行基于体素的形态学分析(VBM),采用t检验进行组间分析,比较单纯PNE患儿脑区激活状况与正常对照组相应脑区灰质密度(GMD)。结果 PNE组FIQ、VIQ和PIQ均正常,与对照组差异无统计学意义(P>0.05)。PNE组M/C因子低于对照组[(100.80±16.83)与(92.73±18.46)],差异有统计学意义(P<0.01);VBM分析表明,PNE患儿小脑左后部及右侧背侧前额叶(dLPFC)灰质密度程度明显低于对照组,差异有统计学意义(P<0.001)。结论 PNE患儿智力结构不平衡,存在注意功能缺陷。左侧小脑及右侧dLPFC功能障碍与其注意功能缺陷有关。     

Risk factors for persisting neurological and cognitive impairments following cerebral malaria

Background

Persisting neurological and cognitive impairments are common after cerebral malaria. Although risk factors for gross deficits on discharge have been described, few studies have examined those associated with persistent impairments.

Methods

The risk factors for impairments following cerebral malaria were determined by examining hospital records of 143 children aged 6–9 years, previously admitted with cerebral malaria, who were assessed at least 20 months after discharge to detect motor, speech and language, and other cognitive (memory, attention, and non‐verbal functioning) impairments.

Results

The median age on admission was 30 months (IQR 19–42) and the median time from discharge to assessment was 64 months (IQR 40–78). Thirty four children (23.8%) were defined as having impairments: 14 (9.8%) in motor, 16 (11.2%) in speech and language, and 20 (14.0%) in other cognitive functions. Previous seizures (OR 5.6, 95% CI 2.0 to 16.0), deep coma on admission (OR 28.8, 95% CI 3.0 to 280), focal neurological signs observed during admission (OR 4.6, 95% CI 1.1 to 19.6), and neurological deficits on discharge (OR 4.5, 95% CI 1.4 to 13.8) were independently associated with persisting impairments. In addition, multiple seizures were associated with motor impairment, age <3 years, severe malnutrition, features of intracranial hypertension, and hypoglycaemia with language impairments, while prolonged coma, severe malnutrition, and hypoglycaemia were associated with impairments in other cognitive functions.

Conclusions

Risk factors for persisting neurological and cognitive impairments following cerebral malaria include multiple seizures, deep/prolonged coma, hypoglycaemia, and clinical features of intracranial hypertension. Although there are overlaps in impaired functions and risk factors, the differences in risk factors for specific functions may suggest separate mechanisms for neuronal damage. These factors could form the basis of future preventive strategies for persisting impairments.     

Minor neurological dysfunction and cognition in 9-year-olds born at term

Background

In children with developmental disorders, motor problems often co-occur with cognitive difficulties. Associations between specific cognitive deficits underlying learning problems and minor neurological dysfunction (MND) are still unknown.

Aims

To assess associations between specific types of MND as clinical markers of non-optimal brain function and performance in specific cognitive domains.

Study design

Part of a randomized controlled trial.

Subjects

Three hundred and forty one 9-year-old children born at term (177 boys, 164 girls).

Outcome measures

Children were neurologically assessed to detect eight types of MND: mild dysfunction in posture and muscle tone, reflexes, coordination, fine manipulative ability, sensory function, cranial nerve function, choreiform dyskinesia and excessive associated movements. Cognitive function in the domains of attention, memory and language was evaluated using the Test of Everyday Attention for Children (TEA-Ch), a developmental neuropsychological assessment (NEPSY) and the Children's Memory Scale.

Results

Fine manipulative disability and coordination problems were associated with lower scores on attention, memory and learning and language, other types of MND were not. Girls with coordination problems performed significantly worse on attention/executive function than those without this dysfunction; however, in boys, such association was absent.

Conclusion

Particularly, fine manipulative disability and coordination problems were associated with worse cognitive function in the domains of attention, learning and memory and language. Previous and present data suggest a minor sex difference in neurocognitive associations: in girls dysfunction of the cerebello-thalamo-cortical pathways may be associated with cognitive deficits, while in boys cognitive impairment may be associated with dysfunction of cortico-striato-thalamo-cortical pathways.     

遗尿症患儿智力水平和智力结构分析

目的：有文献报道原发性夜间遗尿症 (PNE) 患儿存在注意力/记忆力缺陷,并认为这种缺陷可能与患儿的智力情况有关,因此该研究对PNE患儿的智力水平和智力结构进行分析。方法：采用中国韦氏儿童智力量表（C-WISC）对40例PNE患儿的智力结构进行测试,并与40例年龄和性别相匹配的正常儿童进行对照研究。结果：PNE组的总智商（FIQ）、言语智商（VIQ）和操作智商（PIQ）均在正常范围,与对照组比较差异无显著性（P＞0.05）,但数字广度、编码、知识与算术分测验量表分与对照组比较差异有显著性 (P＜0.05);记忆/不分心因子（M/C）与对照组比较差异有显著性 (P＜0.05);两组PIQ与VIQ差值比较,差异无显著性（P＞0.05）。结论：PNE患儿智力水平正常,但智力结构中的记忆/不分心因子存在一定缺陷,提示可能与大脑额叶执行功能异常有关。［中国当代儿科杂志,2007,9（5）：433-435］     

Sleep-disordered breathing symptoms are associated with poorer cognitive function in 5-year-old children

OBJECTIVE: To assess the relation of sleep-disordered breathing (SDB) symptoms in children to neurocognitive function. STUDY DESIGN: A cross-sectional, population-based study of 205 5-year-old children. A parent-completed questionnaire was used to ascertain SDB symptoms, defined as frequent snoring, loud or noisy breathing during sleep, or witnessed sleep apnea. Polysomnography (PSG) data were available in 85% of children. Standardized neurocognitive tests were administered by a trained psychometrist unaware of the children's SDB status. Children with (n=61) and without SDB symptoms were compared using analysis of variance to adjust for demographic and respiratory health variables. RESULTS: Children with SDB symptoms scored significantly lower than those without SDB symptoms on tests of executive function (95.5 vs 99.9 on NEPSY Attention/Executive Core Domain, P=.02; 10.4 vs 11.2 on Wechsler Preschool and Primary Scale of Intelligence, Revised [WPPSI-R] Animal Pegs test, P=.03), memory (96.8 vs 103.0 on NEPSY Memory Domain, P=.02), and general intellectual ability (105.9 vs 111.7 on WPPSI-R Full Scale IQ, P=.02). There were no significant differences on a computerized continuous performance task. These findings persisted when children with PSG evidence of obstructive sleep apnea (OSA) were excluded from analysis. CONCLUSION: Even in the absence of OSA, SDB symptoms are associated with poorer executive function and memory skills and lower general intelligence in 5-year-old children.     

Oily fish intake during pregnancy--association with lower hyperactivity but not with higher full-scale IQ in offspring

Background: Long‐chain omega‐3 polyunsaturated fatty acids are thought to be important for fetal neurodevelopment. Animal studies suggest that a deficiency of omega‐3 fatty acids may lead to behavioural or cognitive deficits. As oily fish is a major dietary source of omega‐3 fatty acids, it is possible that low intake of fish during pregnancy may have adverse effects on the developing fetal brain. Methods: We used the Strengths and Difficulties Questionnaire and the Wechsler Abbreviated Scale of Intelligence to assess behavioural problems and intelligence in 217 nine‐year‐old children. The mothers of these children had participated in a study of nutrition during pregnancy during which fish intake was assessed in early and late gestation. Results: Children whose mothers had eaten oily fish in early pregnancy had a reduced risk of hyperactivity compared to those whose mothers did not eat oily fish: OR .34, 95% CI .15 to .78, after adjustment for potential confounding factors. Children whose mothers had eaten fish (whether oily or non‐oily) in late pregnancy had a verbal IQ that was 7.55 points higher (95% CI .75 to 14.4) than those whose mothers did not eat fish. There were, however, no significant associations between fish intake in pregnancy and other behavioural problems or full‐scale and performance intelligence, after adjustment for potential confounding factors. Conclusions: Although maternal fish intake in pregnancy was associated with hyperactivity scores and verbal IQ in children, in general, how much fish women ate during pregnancy appeared to have little long‐term relation with neurodevelopmental outcomes in their child.     

Neurocognitive function profile in HIV-infected school-age children

OBJECTIVES: Evaluation of neurocognitive function of school-age children with HIV. DESIGN: Cross-sectional observational study. METHODS: Twenty-two children (median age 9.46 years) with perinatally acquired HIV infection were administered a global intelligence test and tests from the Amsterdam Neuropsychological Tasks (ANT) program. The relationship between various patient-, disease- and treatment factors and neurocognitive outcome variables was examined. RESULTS: Compared with age-appropriate norms, mean IQ of the HIV-infected children was in the average range. However, the HIV-infected children performed poorer on several neuropsychological tests compared with age-appropriate norms. Executive function (attentional flexibility, visuospatial working memory) and processing speed emerged as the most sensitive cognitive measures in relation to HIV disease. The correlational analyses resulted in only two significant outcomes, showing that higher CD4% at initiation of highly active antiretroviral therapy (HAART) and longer treatment duration were associated with better working memory function and attentional control, respectively. CONCLUSIONS: These exploratory data suggest that subtle neurocognitive impairments may exist in HIV-infected school-age children, in particular characterized by compromised executive function and slowed information processing. Further research with larger sample sizes is needed to confirm these findings.