The effectiveness of an online-based psychosocial program for parents of children with neurodevelopmental disorders - a randomized controlled trial.

To evaluate the impact of exercise therapy combined with family intervention on attention and executive function in children diagnosed with attention deficit and hyperactivity disorder (ADHD). This retrospective cohort study involved children diagnosed with ADHD and split them into two groups: the conventional treatment group (n=68) and the behavioural therapy combined with family intervention group (n=72). The intervention group received behavioural therapy combined with family intervention in addition to medication, while the conventional treatment group received medication and health education. Various assessment indicators were used to evaluate attention and executive function, physical activity levels, emotional regulation, social functioning, school performance, parental stress levels, parent-child relationship quality and parental knowledge about ADHD. Statistical analysis was conducted to compare the outcomes between the two groups. Postintervention attention function scores, executive function scores, social functioning and school performance scores were significantly higher in the behavioural therapy combined with family intervention group compared with the conventional treatment group. Postintervention parental stress levels were significantly lower in the intervention group, and parent-child relationship quality and parental knowledge about ADHD were significantly higher compared with the conventional treatment group. Correlation analysis demonstrated a positive relationship between the intervention and postintervention attention and executive functioning, social functioning, school performance and parental outcomes. The findings suggest that exercise therapy combined with family intervention has the potential to improve attention and executive function, social functioning, school performance, parental well-being, and family dynamics in children with ADHD.

The family context has been identified as an important predictor of the development of children's executive function (EF). An emerging line of research demonstrates that parents' own EF is linked to their caregiving behaviours and their children's EF. However, researchers have yet to explore the extent to which parental EF is related to specific caregiving practices in the home that may be supportive of children's EF. In this study, we examined the extent to which parental EF is associated with children's EF and explored the role of general parenting practices as well as EF‐specific parenting activities in this relation using a sample of 197 preschoolers (50.3% male and 84.3% Caucasian) and their parents in the United States. Multivariate regressions indicated that parental EF was related to children's EF above and beyond general parenting and EF‐specific practices (β = .22, p = .003, CI [0.07, 0.36]). Additionally, a significant indirect relation emerged between parental EF and children's EF through EF‐specific activities (β = .04, CI [0.01, 0.10]). The potential importance of the family context for EF development and study implications are discussed.Highlights The purpose was to examine the associations among parent's EF, children's EF, and general parenting and EF‐ specific practices. Parent's engagement in EF‐specific activities mediated the relation between parental EF and children's EF Parent's own EF skills as well their engagement in EF‐specific activities may promote the development of children's EF.

For many years, researchers studied executive functions (EFs) in the laboratory with a focus on understanding an individual child's development and brain processes in a controlled environment. Building on this foundational research, there is a growing interest in EFs in the context of a child's dynamic, social world, and the contextual and compositional factors influencing EF development. This paper provides a descriptive view of EFs in 1112 K-3 children from six schools in Phoenix, AZ, USA. The study's goals were to examine (1) variation in EF scores between and within schools and classrooms, (2) predictors of variation in children's spring EF scores, and (3) individual and compositional predictors of children's spring EF scores. Our findings indicate greater variation in children's EF within schools than between, with very little or no variation arising from differences between schools. Though we observed greater variation within classrooms than between them, a notable amount of variance in children's spring EF scores appears to arise from differences between classrooms. Classroom-level variables, including a fall leave-out classroom mean (without the students' own score) and the number of children in the top or bottom grade-level quartiles in each classroom, were significant predictors of variation in spring EF scores as well as in fall to spring changes in EF. In some cases, the classroom variables were stronger predictors than individual fall scores. Findings suggest that understanding variation and cultivating growth in EF skills requires intervention, measurement, and analytic approaches that extend beyond the individual to include compositional features of the classroom environment. RESEARCH HIGHLIGHTS: Variation in children's EF scores (n=1112 children) was greater within schools (n=6 schools) than between, with very little or no variance arising from differences between schools. While variance was greater within classrooms than between (n=67 classrooms), a notable amount of variance in children's spring EF scores appears to arise from differences between classrooms. Classroom-level variables (e.g., leave-out mean, number of children in the top or bottom grade-level quartiles in each classroom) were significant predictors of variation and of changes in spring EF outcomes. In some cases, the classroom variables were stronger predictors of spring EF than individual fall scores.

ObjectivesTo assess the relationships between (1) environmental and demographic factors and executive function (EF) in preschool children with congenital heart disease (CHD) and controls and (2) clinical and surgical risk factors and EF in preschool children with CHD. Study DesignAt 4-6 years of age, parents of children with CHD (n=51) and controls (n=124) completed the BRIEF-P questionnaire and the Cognitively Stimulating Parenting Scale (CSPS). Multivariable general linear modelling assessed the relationship between BRIEF-P composite scores (Inhibitory Self-Control Index [ISCI], Flexibility Index [FI], and Emergent Metacognition Index [EMI]) and group (CHD/control), sex, age at assessment, gestational age (GA), index of multiple deprivation (IMD) and CSPS scores. The relationships between CHD type, surgical factors and brain MRI injury rating (BIR) and ISCI, FI, and EMI scores were assessed. ResultsPresence of CHD, age at assessment, sex, and IMD were not associated with EF scores. Lower GA was associated with higher ISCI and FI scores, and age at assessment was associated with lower FI scores. Group significantly moderated the relationship between CSPS and EF, such that CSPS significantly predicted EF in children with CHD (ISCI: p=0.0004; FI: p=0.0015; EMI: p=0.0004) but not controls (ISCI: p=0.2727; FI: p=0.6185; EMI: p=0.3332). There were no significant relationships between EF scores and surgical factors, CHD type, or BIR. ConclusionsSupporting parents to provide a cognitively stimulating home environment may improve EF in children with CHD. The home and parenting environment should be considered when designing intervention studies aimed at improving EF in this patient group.

Executive functioning (EF) is associated with various aspects of school achievement and cognitive development in children and adolescents. There has been substantial research investigating associations between EF and other factors in young children, such as support processes and parenting, but less research has been conducted about external factors relating to EF in older children and adolescents. Therefore, the present study investigates one possible factor that could correlate with EF in school-age children and adolescents: parenting behavior. The cross-sectional study design gathered data from 169 children in primary schools, middle-schools, and Gymnasien, and their corresponding parents. All children underwent a standardized task to measure EF, the computer-based Erikson Flanker task, which evaluates EF as a function of error rates and response time. A self-report questionnaire was used to assess parenting behavior. Multilevel analysis was implemented to test the effects of parenting behavior on EF in school-age children. The results show significant associations between various parenting behaviors and children's EF: High scores on parental involvement or parental responsibility are associated with low error rates on the Erikson Flanker task, whereas high parental scores on inconsistent discipline are associated with high error rates. These correlations between parenting behavior and EF remained significant despite controlling for child age, maternal education, family income, and baseline performance (i.e., congruent trials on the Erikson Flanker task). No associations were found between parental behavior and reaction time on the Erikson Flanker task. These results indicate the important association between parenting behaviors and EF skills in school-age children, and foster the necessity to inform parents about ways in which they can optimally support their children's cognitive development.

Structural equation models were used to examine pathways from maternal depression and early parenting to children's executive function (EF) and externalizing behaviours in the first nationally representative study to obtain direct assessments of children's kindergarten EF skills (i.e., the Early Childhood Longitudinal Study Kindergarten Class of 2010–2011). Preliminary analyses revealed that maternal depression was negatively related to children's EF and positively related to children's externalizing behaviour problems. However, the negative association between maternal depression and children's EF was completely mediated by maternal parenting practices (i.e., warmth and home learning stimulation). Furthermore, there was an indirect effect from maternal parenting practices to children's externalizing behaviour problems through EF, such that children with stronger EF skills had fewer externalizing behaviour problems. Findings provide support for a family process model in which warm, cognitively stimulating parenting supports children's EF, which in turn decreases externalizing behaviours.Highlights This study examined pathways from parent mental health to children's executive function (EF) and behaviour problems. Maternal depression was negatively related to children's EF and positively related to children's behaviour problems. The negative association between maternal depression and children's EF was completely mediated by maternal parenting. There was an indirect effect from maternal parenting to children's behaviour problems through EF.

Purpose state: Determine the efficacy of Move-it-to-improve-it (Mitii™), a multi-modal web-based program, in improving Executive Function (EF) in children with unilateral cerebral palsy (UCP).Method: Participants (n = 102) were matched in pairs then randomized to: intervention (Mitii™ for 20 weeks; n = 51; 26 males; mean age = 11 years 8 months (SD = 2 years 4 months); Full Scale IQ = 84.65 (SD = 15.19); 28 left UCP; GMFCS-E&R (I = 20, II = 31) or waitlist control (n = 50; 25 males; mean age = 11 years 10 months (SD = 2 years 5 months); Full Scale IQ = 80.75 (SD = 19.81); 20 left UCP; GMFCS-E&R (I = 25, II = 25). Mitii™ targeted working memory (WM), visual processing (VP), upper limb co-ordination and physical activity. EF capacity was assessed: attentional control (DSB; WISC-IV); cognitive flexibility (inhibition and number-letter sequencing DKEFS); goal setting (D-KEFs Tower Test); and information processing (WISC-IV Symbol Search and Coding). EF performance was assessed via parent report (BRIEF). Groups were compared at 20 weeks using linear regression (SPSS 21).Results: There were no significant between group differences in attentional control (DSB; p = 0.20;CI= −0.40,1.87); cognitive flexibility (Inhibition, p = 0.34; CI= −0.73,2.11; number/letter sequencing, p = 0.17; CI= −0.55,2.94); problem solving (Tower; p = 0.28; CI= −0.61,2.09), information processing (Symbol; p = 0.08; CI= −0.16, 2.75; Coding; p = 0.07; CI= −0.12,2.52) or EF performance (p = 0.13; CI= −10.04,1.38).Conclusion:In a large RCT, MitiiTM did not lead to significant improvements on measures of EF or parent ratings of EF performance in children with UCP.Implications for rehabilitationA large RCT of the multi-modal web based training; Move It to Improve It (MitiiTM) improves motor processing, visual perception, and physical capacity but does demonstrate statistically significant improvements or clinical significance in executive function in children with mild to moderate unilateral cerebral palsy (UCP).MitiiTM training completed by an intervention group was highly variable with few children reaching the target dosage of 60 h. Technical issues including server and internet connectively problems lead to disengagement with the program.Web-based training delivered in the home has the potential to increase therapy dose and accessibility, however, MitiiTM needs to be tailored to include tasks involving goal-setting, more complex problem solving using multi-dimensional strategies, mental flexibility, switching between two cognitively demanding tasks, and greater novelty in order to increase the cognitive component and challenge required to drive changes in EF.

To examine the association between brain magnetic resonance imaging (MRI) characteristics and executive function and bimanual performance in children with unilateral cerebral palsy (CP). Clinical MRI brain scans were classified as: (1) predominant pathological pattern (normal, white matter injury [WMI]; grey matter injury; focal vascular insults [FVI]; malformations; or miscellaneous); and (2) focal lesions (frontal, basal ganglia, and/or thalamus). Assessments included: (1) bimanual performance; (2) unimanual dexterity; and (3) executive function tasks (information processing, attention control, cognitive flexibility, and goal setting) and behavioural ratings (parent). From 131 recruited children, 60 were ineligible for analysis, leaving 71 children (47 males, 24 females) in the final sample (mean age 9y [SD 2y], 6y-12y 8mo). Brain MRIs were WMI (69%) and FVI (31%); and frontal (59%), thalamic (45%), basal ganglia (37%), and basal ganglia plus thalamic (21%). Bimanual performance was lower in FVI versus WMI (p<0.003), and with frontal (p=0.36), basal ganglia (p=0.032), and thalamic/basal ganglia lesions (p=0.013). Other than information processing, executive function tasks were not associated with predominant pattern. Frontal lesions predicted attention control (p=0.049) and cognitive flexibility (p=0.009) but not goal setting, information processing, or behavioural ratings. Clinical brain MRI predicts cognitive and motor outcomes when focal lesions and predominate lesion patterns are considered. What this paper adds Early brain magnetic resonance imaging (MRI) predicts bimanual performance and cognitive outcomes. Brain MRI may identify children requiring targeted interventions. Basal ganglia with/without thalamic lesions predicted bimanual performance. Frontal lesions were associated with attention control and cognitive flexibility. Brain MRI predominant patterns predicted motor, not cognitive outcomes, other than information processing.

Introduction This study examines executive functions and occupational performances of children with medulloblastoma and children with typical development. The aim was to compare the executive function and occupational performance levels of children with medulloblastoma and children with typical development and to investigate the relationship between the executive function and occupational performance levels of children with medulloblastoma. Method Parents of 105 children (6–12 years) completed the Childhood Executive Function Inventory. A total of 105 children were administered the Canadian Occupational Performance Measurement to obtain information on occupational performance areas. Executive functions and occupational performance levels of children with medulloblastoma ( n = 52) and typical development ( n = 53) were compared. Correlation analysis was conducted between the executive functions and occupational performances of children with medulloblastoma. Results Executive function and occupational performance levels of children with medulloblastoma were lower than those with typical development. Significant relationships were found between the executive functions and occupational performances of children with medulloblastoma ( p &lt; 0.05, p &lt; 0.001). Conclusion It is clear that the executive functions of children with medulloblastoma significantly affect their occupational performance level. Client-centered, occupation-oriented cognitive therapy interventions prepared according to occupational therapy theories and models might be useful to increase the occupational performance level of children with medulloblastoma.

ObjectiveTo understand the working mechanism and the relationships among the quality of teacher-child interaction (TCI), children's comprehensible vocabulary (CV) and executive function (EF).MethodsUsing stratified sampling, 900 children (boys 50.2%) and 60 preschool teachers were recruited from 4 places in China for testing, and five measurement tools, including the Classroom Assessment Scoring System (CLASS), the Peabody Picture Vocabulary Test (PPVT-R), the Stroop test, a card sorting task, and the Wechsler Intelligence Scale for Children (WISC-IV), were used.ResultsFor every additional unit of TCI, EF increases by 0.55 units; For every additional unit of EF, CV increases by 0.55 units; For every additional unit of CV, EF increases by 0.55 units; For every additional unit of CV, TCI increases by 0.38 units; For every additional unit of TCI, CV increases by 0.38 units. In the Model of TCI-EF-CV, the estimated value of TCI and the total effect of comprehensible vocabulary is 0.18; Z = 9.84, which is significantly greater than 1.96 at the bias-corrected 95% confidence interval and at the percentile 95% confidence interval (0.15, 0.23), both of which do not contain 0. The direct effect of TCI and CV is significant and indirect effects account for 39%. In the Model of TCI-CV-EF, the total effect of TCI on executive function is 0.09 (Z = 6.14), the direct effect is not significant with bias-corrected 95% confidence interval and 95% confidence interval (−0.01, 0.03), both of which include 0.ConclusionThere are two-way effects among children's EF and CV, TCI and CV. EF plays a mediating role in the influence of TCI on CV. TCI positively predicts children's EF, but this mainly depends on CV. Therefore, TCI plays a positive role in the development of children's CV and EF.

The aim of this study is twofold: To examine if deafness is invariably associated with deficits in executive function (EF) and to investigate the relationship between sign language proficiency and EF in deaf children of deaf parents with early exposure to a sign language. It is also the first study of EF in children acquiring Polish Sign Language. Even though the mothers of the deaf children (N = 20) had lower levels of education compared with the mothers of a hearing control group, the children performed similarly to their hearing peers (N = 20) on a variety of EF task-based assessments. Only in the Go/No-go task were weaker inhibition skills observed in younger deaf children (6-9years) compared with hearing peers, and this difference was not seen in older children (10-12years). Hence, deafness does not necessarily impair EF; however, attentional and inhibition abilities may be acquired via a different route in deaf children. Sign language receptive skills predicted EF in deaf children. In conclusion, we highlight the importance of deaf parenting building the scaffolding for EF in deaf children.

There are multivariate influences on the development of children's executive function throughout the lifespan and substantial individual differences can be seen as early as when children are 1 and 2years of age. These individual differences are moderately stable throughout early childhood, but more research is needed to better understand their origins. To some degree, individual differences in executive function are correlated between mother and child, but no research to date has examined these associations prior to when children are preschool age, nor have any studies considered the role of fathers' and mothers' executive function in tandem. Here, we use a sample of 484 families (Mothers 89.2% white; Fathers 92.5% white) in three countries (UK, USA, Netherlands) to investigate the role of each parents' executive function on the development of children's (49.7% female) executive function from 14 (M = 14.42, SD = 0.57) to 24 (M = 24.47, SD = 0.78) months, as well as parenting practices that underlie these associations. Results of structural equation models suggest stability in some-but not all-components of executive function and growing unity between components as children age. We replicate extant findings such that mothers' executive function predicts children's executive function over and above stability and extend these findings to include associations between father and child skills. We find an additive role of fathers' EF, similar in magnitude to the role of mothers' EF. Finally, for both mothers and fathers we find that sensitivity and autonomy supportive practices mediate the relations between parents' and children's executive function.

Exergames are promising exercise tools for improving health. To the best of our knowledge, no systematic review has compared the effects of commercial exergames and conventional exercises on improving executive functions (EFs) in children and adolescents. This study aimed to investigate the effects of commercial exergames and conventional exercises on improving EFs in children and adolescents. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 5 randomized controlled trial (RCT) databases (PubMed, Web of Science, Scopus, PsycINFO, and SPORTDiscus) were searched from their inception to July 7, 2022, to identify relevant RCTs. The Cochrane Collaboration tool was used to evaluate the risk of bias for each study. GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) was used to evaluate the overall quality of evidence. In total, 8 RCTs including 435 children and adolescents were included in the analysis. Commercial exergames had no significant benefit on overall EFs compared to conventional exercises (Hedges g=1.464, 95% CI -0.352 to 3.280; P=.06). For core EFs, there was no evidence to suggest that commercial exergames are more beneficial for improving cognitive flexibility (g=0.906, 95% CI -0.274 to 2.086; P=.13), inhibitory control (g=1.323, 95% CI -0.398 to 3.044; P=.13), or working memory (g=2.420, 95% CI -1.199 to 6.038; P=.19) than conventional exercises. We rated the evidence for overall EFs, cognitive flexibility, inhibitory control, and working memory as being of very low quality due to inconsistency (large heterogeneity) and imprecision (low number of people). Additionally, no effects of the intervention were observed in the acute and chronic groups. We do not have strong evidence to support the benefit of commercial exergaming on EFs because we did not observe a Hedges g close to 0 with tight CIs. Further research is needed to confirm this hypothesis. PROSPERO CRD42022324111; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=324111.

Effects of acute moderate-intensity exercise on executive function in children with preterm birth: A randomized crossover study

BackgroundThe effects of open and closed skill exercise interventions for executive function in children and adolescents have received widespread attention. Open skill refers to the skill of performing motor tasks in an unpredictable environment; closed skill refers to the skill of performing motor tasks in a stable environment. However, the results of related studies are currently controversial and Meta-analysis is urgently needed.MethodsAfter computer searches of CNKI, Wan-Fang, VIP, WOS, PubMed, and EBSCO databases, two researchers independently screened articles, extracted information, and evaluated the quality of the articles. This study was statistical analyzed using Stata 16.0 software.ResultsA total of 31 articles were included, including 2988 typical children. Open, closed, continuous and sequential skills all improved executive function in typical children to varying degrees, but open and sequential skills were more effective in improving executive function, particularly in the former in the working memory (SMD=-0.833, P < 0.001) and in the latter in the inhibitory control (SMD=-0.834, P < 0.001) and cognitive flexibility (SMD=-0.903, P < 0.001). Long-term, moderate- intensity interventions were better than acute, vigorous-intensity interventions for executive function, with long-term interventions reflected in working memory (SMD=-0.579, P < 0.001) and moderate-intensity interventions reflected in all three dimensions of executive function (P < 0.01). Intervention periods, intervention intensity and continuous and sequential skills classified by action structure play a significant moderating role. Better results for long-term, sequential structural action interventions based on open skills (P < 0.001); better results for acute, moderate intensity, sequential structural action interventions based on closed (P < 0.05). Whereas intervention intensity had a non-significant moderating effect in the open skills intervention, both moderate and vigorous intensity had a significant effect on executive function (P < 0.001).ConclusionOpen and closed skills have different levels of facilitation effects on executive function in typical children, but open skills are more effective. The facilitation effects of open and closed skills were moderated by the qualitative characteristics and action structure of the intervention.