Developmental Neuropsychological Assessment Research Articles

325 Attention Problems in Very Low Birth Weight Preschoolers

AimsTo compare very low birth weight (VLBW) children’s performance on attention measurements at preschool age to term-born peers, and to assess associated risk factors.MethodsAttention was assessed in 151 VLBW preschoolers...

An Analysis of Select Emerging Executive Skills in Perinatally HIV-1-Infected Children

This study examined the effect of perinatal HIV-1 infection on emerging executive skills in children (n = 161) ages 8 to 12 years. HIV-positive (n = 76) and HIV-negative (n = 85) children were eligible to participate. The HIV-positive children included those who had experienced a CDC Class C event (greater severity, n = 22) and those who were HIV-positive but who had not experienced a CDC Class C event (less severity, n = 54). Measures of emerging executive functions completed by the children included subtests from the Developmental Neuropsychological Assessment (NEPSY), the Trail-Making Test-Part B, and a subtest from the Woodcock-Johnson Battery-Revised. Ratings of executive functions were obtained from caretakers using the Behavior Rating Inventory of Executive Functions. Generalized estimating equations methods, discriminate analyses, and global deficit score analyses were performed to determine whether differences emerged between the three clinical groups while using strict controls. The present results revealed significant group differences in unadjusted mean scores measuring executive functioning. However, such differences did not remain statistically significant when moderating variables were taken into consideration in the models. The apparent deficit in executive functioning for the HIV-positive children was found to be largely due to differential psychosocial and environmental factors rather than HIV disease and its severity, and in this cohort, the effects of HIV-1 infection on emerging executive functions appeared to be negligible when controlling for treatment and moderating psychosocial variables.

An examination of the relationship between motor coordination and executive functions in adolescents

Research suggests important links between motor coordination and executive functions. The current study examined whether motor coordination predicts working memory, inhibition, and switching performance, extending previous research by accounting for attention-deficit-hyperactivity disorder (ADHD) symptomatology and other confounding factors, in an adolescent normative sample. Ninety-three adolescents (38 females, 55 males) aged 12 to 16 years (mean age 4y 2mo, SD 1y 1mo) were assessed on the Movement Assessment Battery for Children-2 (MABC-2), Wechsler Intelligence Scale for Children-IV, N-back task, the inhibition subtest from the NEPSY-II: A Developmental Neuropsychological Assessment, second edition, and the parent-rated Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour Questionnaire. The MABC-2 total score accounted for a significant proportion of the variance in visuospatial working memory (p=0.041) but not for verbal working memory. The MABC-2 aiming and catching component, however, was found to account for unique variance in both verbal (p=0.019) and visuospatial working memory (p=0.016). The MABC-2 total score was found to account for a significant proportion of the variance in inhibition total completion time (p=0.017). Finally, balance skills accounted for unique variance in a NEPSY-II inhibition total errors variable (p=0.020). The results provide support for an overlap between motor coordination and executive functions, which has important practical implications. The study also suggests shared mechanisms underpinning the relationship between these areas, including possible cerebellar involvement.

Psychomotor and cognitive impairments of children with CHARGE syndrome: Common and variable features

Objective: We aimed to understand the mechanisms and sources of learning difficulties in children with CHARGE syndrome who attend school and to determine any specific developmental characteristics. Method: We analyzed the psychomotor and cognitive functions of eight children from 7 to 13 years old with classical CHARGE syndrome by using the Wechsler Intelligence Scale for Children (WISC), the Neuropsychomotor test (NP-MOT), and several subtests of the Developmental neuropsychological assessment (NEPSY) and Kaufman Assessment Battery for Children (K-ABC) instruments. Results: The IQ range was from 54 to 92. The main weaknesses related to three domains: static and dynamic postural control, visuospatio-constructive abilities, and both sequential processing and selective attention. The main strengths were in holistic perception, semantic competencies, logical reasoning and planning skills, with axial and peripheral hypotonia. The extent of psychomotor and cognitive deficits was not associated with severity of sensorial deficiencies. We discuss the multiple causal mechanisms of psychomotor and cognitive difficulties. Conclusion: We found a persistent and homogeneous psychomotor profile and specific cognitive difficulties in 8 children with CHARGE syndrome despite their large range of IQs. Highlighting these specific impairments is important to understand the nature and mechanisms of CHARGE for adapting educational and rehabilitation methods. These problems may be explained by sensory deficits, as well as dysfunction in integrating and/or regulatory regions of the brain.

ADHD Predominantly Inattentive Subtype With High Sluggish Cognitive Tempo

Objective: The authors investigate differences in the neuropsychological and behavioral profiles of two groups of children with ADHD, one with predominantly inattentive subtype of ADHD (PI) and high sluggish cognitive tempo (SCT; n = 19) and another formed by the rest of the sample (children with ADHD combined subtype and children with PI and low SCT scores; n = 68). Method: Instruments included Wechsler Intelligence Scale for Children and subtests from Developmental Neuropsychological Assessment, Conners’ Continuous Performance Test, Behavior Rating Inventory of Executive Function, and Achenbach’s Child Behavior Checklist for ages 6 to 18. Results: PI with high SCT had fewer problems with sustained attention, and more internalizing problems, anxiety/depression, and withdrawn/depressed behavior, and more executive problems with self-monitoring than the rest of the ADHD sample. Conclusion: This study supports revising subtype’s criteria and further studying the hypothesis that ADHD with high SCT constitutes a separate clinical entity.

Perinatal cortical growth and childhood neurocognitive abilities

This observational cohort study addressed the hypothesis that after preterm delivery brain growth between 24 and 44 weeks postmenstrual age (PMA) is related to global neurocognitive ability in later childhood. Growth rates for cerebral volume and cortical surface area were estimated in 82 infants without focal brain lesions born before 30 weeks PMA by using 217 magnetic resonance images obtained between 24 and 44 weeks PMA. Abilities were assessed at 2 years using the Griffiths Mental Development Scale and at 6 years using the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), the Developmental Neuropsychological Assessment (NEPSY), and the Movement Assessment Battery for Children (MABC). Analysis was by generalized least-squares regression. Mean test scores approximated population averages. Cortical growth was directly related to the Griffiths Developmental Quotient (DQ), the WPPSI-R full-scale IQ, and a NEPSY summary score but not the MABC score and in exploration of subtests to attention, planning, memory, language, and numeric and conceptual abilities but not motor skills. The mean (95% confidence interval) estimated reduction in cortical surface area at term corrected age associated with a 1 SD fall in test score was as follows: DQ 7.0 (5.8-8.5); IQ 6.0 (4.9-7.3); and NEPSY 9.1 (7.5-11.0) % · SD(-1). Total brain volume growth was not correlated with any test score. The rate of cerebral cortical growth between 24 and 44 weeks PMA predicts global ability in later childhood, particularly complex cognitive functions but not motor functions.

Sleep quality and cognitive performance in 8-year-old children

Objective The present study examined how sleep duration and sleep quality are associated with cognitive performance in 8-year-old children using standardized neurocognitive tests. Methods Two hundred ninety children aged 7.4–8.8 years participated in the study. Sleep duration and quality were measured using actigraphs and the Sleep Disturbance Scale for Parents. Cognitive performance was measured using four subtests of the Wechsler Intelligence Scale for Children III, the Beery Developmental Test of Visual-Motor Integration (VMI), and the Narrative memory subtest of the Developmental Neuropsychological Assessment for Children. Results When adjusting for age, sex, and maternal education, shorter sleep duration, but not sleep quality, was associated with lower visuospatial abilities ( p-values ⩽0.043). Sleep duration and quality were not associated with verbal abilities ( p-values ⩾0.18). With regard to the individual test results, shorter sleep duration was associated with worse performance in Visual-Motor Integration ( p = 0.028), and when excluding children with high depression scores the same was also true with Block Design ( p-values ⩽0.047). Moreover, poor sleep efficiency was associated with worse performance in Similarities ( p = 0.004). Conclusions In a community sample of 8-year-old children, those who slept less or had poorer sleep quality had lower test scores in cognitive tasks, particularly those pertaining to visuospatial performance, although the association was not very strong.

Neurocognitive functioning of preschool children with uncomplicated epilepsy

Only few studies are available on the cognitive functioning of preschool children with uncomplicated epilepsy. The aim of this study was to describe the neurocognitive functioning of 3-6-year-old children with uncomplicated epilepsy. A subgroup of children with uncomplicated epilepsy from a population based cohort of preschool children with active epilepsy (N=64) participated in the study. The neurocognitive functioning of these children (N=13) was compared to that of matched healthy controls (N=13). The Wechsler's Primary and Preschool Scale of Intelligence - Revised and the Developmental Neuropsychological Assessment were administered. The intellectual functioning of the children with uncomplicated epilepsy was within normal range, but differed significantly from that of healthy controls, which was contrary to expectations. Statistically significant differences emerged between the study and the control group in Verbal IQ and Full Scale IQ, but no differences were found in Performance IQ. The children with uncomplicated epilepsy also had minor neurocognitive difficulties in verbal short-term memory (p<.01) compared to healthy children. The result suggests that uncomplicated epilepsy in preschool children may interfere with language and verbal short-term memory functions. Further studies with detailed neuropsychological assessments and follow-up time are needed to gain more insight into the developmental course of children with uncomplicated epilepsy. Also, because of the developmental risks reported in this study, psychological screening and detailed neuropsychological assessment are recommended in clinical practice.

Maternal Licorice Consumption and Detrimental Cognitive and Psychiatric Outcomes in Children

At critical phases of brain development, elevated concentrations of glucocorticoids are detrimental. Maintenance of low glucocorticoid levels during these periods of brain development is ensured by the action of the placental enzyme 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2), which catalyzes the rapid inactivation of maternal cortisol. A constituent of licorice, glycyrrhiza, inhibits this enzyme, thereby raising fetal glucocorticoid brain levels. In preclinical studies with rodent models, consumption of licorice was shown to have detrimental affective and cognitive effects. Licorice consumption is common among young women in several countries. A previous study in pregnant women reported that prenatal exposure to a high level of glycyrrhiza was associated with a slightly shorter duration of gestation. This study was designed to investigate whether prenatal overexposure to glucocorticoids through maternal consumption of licorice had detrimental effects on cognitive and behavioral performance and other measures of brain function in 321 Finnish children 8.1 years of age. These children had been healthy singletons delivered at 35 to 42 weeks of gestation. Cognitive function and psychiatric assessment were measured using components of several established tests including the Wechsler Intelligence Scale for Children III, the Children's Developmental Neuropsychological Assessment, the Beery Developmental Test of Visual-Motor Integration, and the Child Behavior Checklist. Compared with children of mothers who consumed 0-low glycyrrhiza (0-249 mg/wk), those of mothers who consumed high amounts (≥500 mg/wk) scored -0.38, -0.41, -0.31, and -0.34 standard deviations lower in cognitive tests evaluating vocabulary, similarities, block design, and narrative memory tests, respectively (P < 0.03). High maternal consumption of glycyrrhiza was associated with significantly increased psychiatric symptoms; these included increases in externalizing symptoms (P < 0.04) and in attention, rule-breaking and aggression problems (odds ratios, 3.43, 2.15, and 2.74, respectively, P < 0.05). These findings show that high maternal licorice consumption during pregnancy is associated with poorer cognitive performance and a number of psychiatric symptoms in offspring 8.1 years of age. The investigators recommend that pregnant woman should be advised to avoid foodstuffs containing excessive amounts of glycyrrhiza.

Maternal Licorice Consumption and Detrimental Cognitive and Psychiatric Outcomes in Children

Overexposure to glucocorticoids may link prenatal adversity with detrimental outcomes in later life. Glycyrrhiza, a natural constituent of licorice, inhibits placental 11-beta-hydroxysteroid dehydrogenase type 2, the feto-placental "barrier" to higher maternal levels of cortisol. The authors studied whether prenatal exposure to glycyrrhiza in licorice exerts detrimental effects on cognitive performance (subtests of the Wechsler Intelligence Scale for Children III as well as the Children's Developmental Neuropsychological Assessment and the Beery Developmental Test of Visual-Motor Integration) and psychiatric symptoms (Child Behavior Checklist) in 321 Finnish children 8.1 years of age born in 1998 as healthy singletons at 35-42 weeks of gestation. In comparison to the group with zero-low glycyrrhiza exposure (0-249 mg/week), those with high exposure (>or=500 mg/week) had significant decrements in verbal and visuospatial abilities and in narrative memory (range of mean differences in standard deviation units, -0.31 to -0.41; P < 0.05) and significant increases in externalizing symptoms and in attention, rule-breaking, and aggression problems (range of odds ratios, 2.15 to 3.43; P < 0.05). The effects on cognitive performance appeared dose related. Data are compatible with adverse fetal "programming" by overexposure to glucocorticoids and caution against excessive intake of licorice-containing foodstuffs during pregnancy.

Dietary patterns in infancy and cognitive and neuropsychological function in childhood

Trials in developing countries suggest that improving young children's diet may benefit cognitive development. Whether dietary composition influences young children's cognition in developed countries is unclear. Although many studies have examined the relation between type of milk received in infancy and subsequent cognition, there has been no investigation of the possible effect of variations in the weaning diet. We studied 241 children aged 4 years, whose diet had been assessed at age 6 and 12 months. We measured IQ with the Wechsler Pre-School and Primary Scale of Intelligence, visual attention, visuomotor precision, sentence repetition and verbal fluency with the Developmental Neuropsychological Assessment (NEPSY), and visual form-constancy with the Test of Visual Perceptual Skills. In sex-adjusted analyses, children whose diet in infancy was characterised by high consumption of fruit, vegetables and home-prepared foods ('infant guidelines' dietary pattern) had higher full-scale and verbal IQ and better memory performance at age 4 years. Further adjustment for maternal education, intelligence, social class, quality of the home environment and other potential confounding factors attenuated these associations but the relations between higher 'infant guidelines' diet score and full-scale and verbal IQ remained significant. For a standard deviation increase in 'infant guidelines' diet score at 6 or 12 months full-scale IQ rose by .18 (95% CI .04 to .31) of a standard deviation. For a standard deviation increase in 'infant guidelines' diet score at 6 months verbal IQ rose by .14 (.01 to .27) of a standard deviation. There were no associations between dietary patterns in infancy and 4-year performance on the other tests. These findings suggest that dietary patterns in early life may have some effect on cognitive development. It is also possible that they reflect the influence of unmeasured confounding factors.

Mood Is Associated With Snoring in Preschool-Aged Children

To study emotional and behavioral problems and sleep and cognitive performance in snoring and nonsnoring 3- to 6-year-old children. As part of an epidemiological study of sleep disordered breathing (SDB) in preschool-aged children, 43 snorers and 46 nonsnorers participated in a clinical study. Their parents completed the Child Behavior Checklist (CBCL). The children were assessed with Wechsler Preschool and Primary Scale of Intelligence, Revised and subtests of the Developmental Neuropsychological Assessment (NEPSY-A) representing aspects of attention, language skills, sensorimotor functions, memory, and learning. On the CBCL snoring children had significantly more parent reported internalizing symptoms (p < .05) than the nonsnoring children, especially symptoms of anxious/depressed mood (p < .01) and emotional reactivity (p < .05). More children from the snoring group than from the nonsnoring group (22 vs 11%) scored in the subclinical or clinical range on the internalizing scale. Interestingly, no significant difference between the groups was found in the amount of externalizing symptoms. The amount of sleep problems other than snoring was higher in the snoring than in the nonsnoring group (p < .01). On tests measuring auditory attention (p < .01) and language skills (verbal IQ, p < .05), the snoring group performed worse than the nonsnoring group. Our results support the view that SDB should be considered a possible risk factor for mood disorder symptoms and impaired cognitive performance in children.

Narrative skills, cognitive profiles and neuropsychiatric disorders in 7–8‐year‐old children with late developing language

A community-representative sample of screened and clinically examined children with language delay at 2.5 years of age was followed up at school age when their language development was again examined and the occurrence of neuropsychiatric/neurodevelopmental disorder (attention deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD)) was documented. (1) To determine whether these 7-8-year-old children with a history of language delay have deficits in narrative skills compared with the age norms of standardized tests; and (2) to analyse if there is a relationship between narrative outcome, cognitive profile, and neuropsychiatric diagnosis. Twenty-one children recruited from a community sample and with a history of language delay underwent an in-depth multidisciplinary examination at 7-8 years of age. Their narrative and cognitive skills were examined using the Bus Story Test, the Narrative Memory Subtest from the Developmental Neuropsychological Assessment (NEPSY), and The Wechsler Intelligence Scale for Children III (WISC-III). The three measures of the Bus Story Test (information, sentence length, and subordinate clauses) were below age norms for all 21 children, of whom 13 also had a neuropsychiatric diagnosis, i.e. ADHD and/or ASD. Half of the children with language delay had problems on Bus Story Test Information and on the Narrative Memory subtest independently of co-occurrence of neuropsychiatric disorder. The only difference across the children with language delay pure and those who had language delay plus ADHD or language delay plus ASD was on Freedom from Distractibility, where children with ADHD and ASD scored low. In addition, children with ASD had a much lower overall cognitive level (FSIQ) and poorer results on Processing Speed. Swedish children with late developing language at 2.5 years of age have persisting difficulties with oral narrative skills at age 7-8 years. However, almost none of the children with language delay had problems when responding to story-related questions--irrespective of whether or not they had an additional diagnosis of ADHD or ASD. Thus, asking story-related questions may be a good intervention strategy when working with these children. Because narrative difficulties are a reflection of linguistic, cognitive and/or pragmatic/social difficulties, it is important for clinicians of different specialties to work in close collaboration in order to establish a reliable measure that can be used in clinical assessment. Poor results on the WISC-III Kaufman Freedom from Distractibility factor had a strong relationship with a neuropsychiatric diagnosis (not just ADHD), whereas poor results on Bus Story Test Information or NEPSY Narrative Memory (measured as Free Recall) did not. Narrative problems were present among the language delay children even in the presence of adequate speech and verbal comprehension. Thus, narrative assessment may be a useful tool for identifying children with more persistent subtle language and pragmatic problems who are at risk for academic failure.

Placental Lesions as Predictors of Cerebral Palsy and Abnormal Neurocognitive Function at School Age in Extremely Low Birth Weight Infants (&lt;1 kg)

Extremely low birth weight (ELBW) infants (<1 kg) have high rates of neurodisability. Although previous studies have implicated placental lesions in adverse short-term neurologic outcomes in this population, none have assessed their effects in these children once they reach school age. We conducted a secondary analysis of placental pathology in a cohort study of inborn singleton ELBW infants born between 1992 and 1995 and evaluated for cerebral palsy (CP) and abnormal neurocognitive testing at 8 years of age (N = 129). The neurocognitive tests were the Kaufman Assessment Battery for Children (K-ABC) and 6 subtests of the NEPSY: A Developmental Neuropsychological Assessment. We found that placental lesions associated with maternal vascular underperfusion (increased syncytial knots and acute atherosis) were risk factors for CP, while villous edema was associated with low scores on both neurocognitive tests. Histologic chorioamnionitis (HCA) was not predictive of outcome in the population as a whole, but a severe fetal vascular response was associated with a lower NEPSY score in the subpopulation with HCA (N = 69). Placentas with increased syncytial knots, villous edema, and those with neither finding constituted nonoverlapping subgroups with distinct pathologic and perinatal characteristics. Among infants with villous edema (N = 25), those with neurologic impairment had lower gestational ages and more severe degrees of HCA. However, by logistic regression these other factors were not independent risk factors for abnormal neurocognitive testing, and only HCA with a severe fetal vascular response decreased the association of villous edema with low test scores for NEPSY, but not K-ABC.

Neuropsychological Performance in School-Aged Children with Surgically Corrected Congenital Heart Disease

As surgical management of children with congenital heart disease (CHD) advanced, developmental outcome became the main focus of contemporary research. In this study, we specify the cognitive profile of children with CHD, 6 to 12 years postoperatively. Patients with CHD (n = 43, mean age 8 years, 8 months) and healthy controls (n = 43, mean age 8 years, 11 months), were examined with an abbreviated intelligence scale (Wechsler Intelligence Scale for Children-3rd edition, Dutch version) and a developmental neuropsychological assessment battery (NEPSY [a developmental NEuroPSYchological assessment]). We identified significantly lower scores for the CHD group on Estimated Full Scale IQ (P < .01). Neuropsychological assessment revealed lower scores for the CHD group on the cognitive domains of Sensorimotor Functioning (P < .001), Language (P < .001), Attention and Executive Functioning (P < .05), and Memory (P < .05). Children with CHD displayed more impulsive test behavior than healthy peers. No differences on IQ or cognitive domains were found between the cyanotic and the acyanotic CHD group. Six to 12 years postoperatively, children with CHD display a neuropsychological profile with mainly mild motor deficits and subtle difficulties with language tasks. Attention/executive functioning and memory also appear involved but to a lesser degree. Long-term follow-up of children with surgically corrected CHD, even when hemodynamically successful, is warranted, as they are at risk for neurodevelopmental delay at school age.

Neuropsychological outcomes in children of mothers with epilepsy

The study investigated the nature of the effects of maternal epilepsy on cognitive performance of the offspring. One hundred fifty-four children of mothers with epilepsy aged 5 to 11 years (study group), along with 130 control children, comparable with respect to IQ, socio-economic status, age, and gender underwent a neuropsychological assessment using subtests from the NEPSY: A Developmental Neuropsychological Assessment, tapping attentional, auditory-verbal, visuomotor, fine motor, and memory abilities. The study group scored significantly lower than the controls on measures of attention, memory, and fine-motor function. Deficits were more marked in but not limited to the subset of the study group exposed to maternal medication in utero. Group differences on auditory attention were found only in younger children. Valproate-exposed children obtained lower scores on sentence repetition, as well as on the more demanding part of a test of auditory attention, than other children in the study group, suggesting weaknesses in working memory in the former subgroup. Confounding by maternal epilepsy type and polytherapy complicate interpretation of this finding. Differences between subsets of children not exposed to anti-epileptic drugs in utero and controls suggest that both drug exposure and genetic factors may contribute to cognitive deficits associated with maternal epilepsy.

Neuropsychologic Performance of Children with Epilepsy on the NEPSY

Neuropsychologic test scores from a group of children with epilepsy were compared to the standardization sample of the NEPSY: A Developmental Neuropsychological Assessment, a relatively new neuropsychologic testing instrument. Nineteen children with a confirmed diagnosis of epilepsy (11 boys, 8 girls), aged 3-12 years, participated. Attention/executive function, language, sensorimotor, visuospatial, and learning/memory domain scores were examined, as well as individual subtest scores. The mean scores on the attention/executive function, language, and sensorimotor domains were >1.5 standard deviations below the normative mean, and significantly lower than the mean visuospatial domain score (P < 0.05). The mean language domain score was also significantly lower than the learning/memory score (P < 0.05). Mean subdomain scores varied, with impairment on two tasks measuring rapid automatic processing and graphomotor precision, respectively. On the majority of subtests, 15% or more of the sample scored in the impaired range. Associations between patient age, seizure onset age, seizure frequency, and antiepileptic medication status were not associated with outcome, perhaps due in part to the small sample size. The strengths and weaknesses of the NEPSY as a measure of neuropsychologic functioning in children with epilepsy, and its utility in highlighting risks to academic achievement are discussed.

Neuropsychological Correlates of Vocabulary, Reading, and Working Memory in Deaf Children With Cochlear Implants

The performance of deaf children with cochlear implants was assessed using measures standardized on hearing children. To investigate nonverbal cognitive and sensorimotor processes associated with postimplant variability, five selected sensorimotor and visuospatial subtests from A Developmental Neuropsychological Assessment (NEPSY) were compared with standardized vocabulary, reading, and digit span measures. Participants were 26 deaf children, ages 6-14 years, who received a cochlear implant between ages 1 and 6 years; duration of implant use ranged from 3 to 11 years. Results indicated significant correlations between standard scores on the Design Copying subtest of the NEPSY and standard scores on vocabulary comprehension, reading, and digit span measures. The results contribute to our understanding of the benefits of cochlear implantation and cognitive processes that may support postimplant language and academic functioning.

Cognitive Functions in Children at Risk for Congenital Adrenal Hyperplasia Treated Prenatally with Dexamethasone

In Sweden, from 1985 through 1995, 40 fetuses at risk for congenital adrenal hyperplasia (CAH) were treated with dexamethasone (DEX) to prevent virilization of affected females. We report long-term effects on neuropsychological functions and scholastic performance of this controversial treatment. Prenatally treated children, 7 to 17 yr old, were assessed with standardized neuropsychological tests (A Developmental Neuropsychological Assessment and Wechsler Intelligence Scales for Children) and child-completed questionnaires measuring self-perceived scholastic competence (Self-Perception Profile for Children). A parent-completed questionnaire (Child Behavior Checklist/4-18 School Scale) was used to evaluate whether the treatment had any impact on the children's school performance. In addition, a child-completed questionnaire measuring social anxiety (The Social Anxiety Scale for Children-Revised) was completed by the prenatally treated children aged 8 to 17 yr (n = 21) and age- and sex-matched controls (n = 26). Of 40 DEX-treated children, 26 (median age, 11 yr) participated in the study. Thirty-five sex- and age-matched healthy children were controls. There were no between-group differences concerning psychometric intelligence, measures of cerebral lateralization, memory encoding, and long-term memory. Short-term treated, CAH-unaffected children performed poorer than the control group on a test assessing verbal working memory (P = 0.003), and they rated lower on a questionnaire assessing self-perception of scholastic competence (P = 0.003). This group also showed increased self-rated social anxiety assessed by The Social Anxiety Scale for Children-Revised (P = 0.026). Prenatally treated, CAH-affected children performed poorer than controls on tests measuring verbal processing speed, although this difference disappeared when controlling for the child's full-scale IQ. This study indicates that prenatal DEX treatment is associated with previously not described long-term effects on verbal working memory and on certain aspects of self-perception that could be related to poorer verbal working memory. These findings may thus question future DEX treatment of congenital adrenal hyperplasia. Therefore, we encourage additional retrospective studies of larger cohorts to either confirm or challenge the present findings.

The Relationship Between Executive Attention and Dissociation in Children

SUMMARY Dissociation involves disruption in the usually integrated functions of consciousness, memory, identity, and perception. Recent research with adults suggests that dissociation is associated with alterations in attention. Little work, however, has examined the attentional correlates of dissociation in childhood. This study is the first to investigate the specificity of cognitive functions related to dissociation in children. Twenty-four 5- to 8-year-old foster children completed several subtests of the NEPSY: A Developmental Neuropsychological Assessment (Korkman, Kirk, & Kemp, 1998) in the Executive Functioning/ Attention domain. Foster caregivers completed the Child Dissociative Checklist (Bernstein & Putnam, 1986). Consistent with the adult literature, higher levels of childhood dissociation were associated with deficits in tasks requiring inhibition, but not with tasks requiring primarily planning, strategy, or multiple rule sets.