Executive Function Problems Research Articles

Executive function mediates the link between externalizing behavior and HbA1c in children and adolescents with type 1 diabetes: A cross-national investigation.

Externalizing behavior (i.e., conduct problems, hyperactivity) and executive function (EF) problems in children and adolescents with type 1 diabetes (T1D) have been associated with worse diabetes-related and psychosocial outcomes but have not been examined in relationship to each other. We aimed to examine whether externalizing behavior is associated with HbA1c and whether this relationship is mediated by EF problems, specifically metacognition (i.e., ability to initiate, plan, organize and monitor behavior) and behavioral regulation (i.e., impulse control, regulation of emotion and behavior). Cohorts of Belgian and Dutch parents of children and adolescents (6-18 years) with T1D filled out questionnaires on externalizing behavior (Strengths and Difficulties Questionnaire; SDQ) and EF (Behavior Rating Inventory of Executive Function; BRIEF) composite scales. Treating physicians collected HbA1c values. Mediation analyses were performed separately for the BRIEF composite Metacognition and Behavior Regulation scales, correcting for age, sex and diabetes duration. The 335 parents of children and adolescents with T1D (mean age 12.3 ± 2.8 SD; mean HbA1c 7.6% ± 1.1 SD [60 mmol/mol ± 12.0 SD]; mean diabetes duration 5.3 ± 3.6 SD; 49.6% female) participated. Analyses showed that the association between externalizing behavior and HbA1c is mediated by metacognition (ab path Point estimate = 0.05 BCa CI 95% 0.02-0.08), and not behavioral regulation. Results uncovered the influence externalizing behavior may have on EF problems in the metacognition domain, which in turn seem to influence HbA1c. Clinicians should be mindful of these EF problems when working with children and adolescents displaying externalizing behavior, and not only target behavioral but also cognitive processes.

The contributions of intelligence and executive function to behaviour problems in school-age children born very preterm.

To examine the contributions of specific neurocognitive skills to behaviour problems in children born very preterm. We assessed children born <30weeks' gestation or <1500g at age 7years using subtests of the Wechsler Intelligence Scale for Children Fourth Edition, performance and questionnaire-based measures of executive function, and Child Behavior Checklist and Teacher Rating Form. We evaluated the contributions of IQ and executive function to behaviour problems and the moderating effect of sex using multiple regression. The 129 children (mean age=7.2years) had lower IQ, inferior executive function and increased internalising problems compared with normative samples. Verbal comprehension skills and working memory were associated with total, internalising and externalising problems at school. Performance-based and questionnaire-based executive function were associated with total and externalising behaviour problems both at home and school. Sex moderated the relationships between information processing and parent-reported total problems, and between teacher-rated executive function and total problems. Both IQ and executive function are related to behaviour problems in children born very preterm, but the relationships are different in boys and girls. Executive function may be a useful target for intervention.

Do ADHD Symptoms, Executive Function, and Study Strategies Predict Temporal Reward Discounting in College Students with Varying Levels of ADHD Symptoms? A Pilot Study.

The purpose of this study was to examine the relationship between temporal reward discounting and attention deficit hyperactivity disorder (ADHD) symptoms in college students. Additionally, we examined whether temporal reward discounting was associated with executive functioning in daily life and with learning and study strategies in this group. Thirty-nine college students (19 with ADHD and 20 controls) participated after meeting criteria for ADHD or non-ADHD based on standardized assessment. Strong preferences for small immediate rewards were specifically associated with the ADHD symptom domain hyperactivity–impulsivity. Additionally, these preferences were associated with daily life executive function problems and with weak learning and study strategies. This suggests that steep temporal discounting may be a key mechanism playing a role in the daily life challenges that college students with ADHD symptoms face. If these findings are replicated in larger samples, then intervention strategies may profitably be developed to counteract this strong preference for small immediate rewards in college students with ADHD symptoms.

Associations between frequent pain or headaches and neurobehavioral symptoms by gender and TBI severity

ABSTRACT Objective: To investigate differences in frequent pain or headaches and associated neurobehavioral symptoms among men, women, and transgender individuals with and without a history of traumatic brain injury (TBI). Setting: Community Participants: English and Spanish-speaking adults (n = 2,862) with and without self-reported TBI Design: Cross-sectional study Main Measures: Behavioral Assessment Screening Tool (BAST) subscales for Negative Affect, Substance Abuse, Executive Function, Fatigue, Impulsivity, and one item for experiencing “frequent pain or headache.” Results: Women reported more pain than men. Women with a mild TBI (mTBI) more often reported frequent headaches/pain than woman in general or those with mTBI alone. Women reporting frequent headache/pain reported more negative affect and fatigue than men with comparable TBI history. Individuals identifying as transgender/other without TBI had higher negative affect and fatigue than both men and women without TBI. Individuals with mTBI and frequent headache/pain reported more executive function problems than those with mTBI without headache/pain. Pain and moderate/severe TBI were associated with more executive function problems in men and women, but more so for women. Conclusion: Results suggest frequent headache/pain may differ between genders, particularly after mTBI. Pain, fatigue, executive function, and negative affect may be especially important in women’s recovery from TBI.

The role of executive functioning, healthcare management, and self-efficacy in college students’ health-related quality of life

Objective: Examine how executive functioning (EF), healthcare management, and self-efficacy relate to college students’ health-related quality of life (HRQOL). Participants: Undergraduates completed questionnaires at baseline (Time 1; n = 387) and 18–24 months later (Time 2; n = 102). Methods: Participants reported on their EF and healthcare management skills at Time 1 and self-efficacy and mental and physical HRQOL at Time 2. Results: Students with fewer EF problems reported higher mental and physical HRQOL at both timepoints and those with higher healthcare management skills had higher mental and physical HRQOL at Time 1. Higher self-efficacy mediated the relation between EF and mental HRQOL, and the relation between healthcare management and mental HRQOL. Conclusions: Findings illustrate two potential pathways by which self-management, in healthcare settings or daily living, contributes to mental HRQOL during emerging adulthood. Assessing EF and healthcare management could help identify those at risk of low HRQOL and provide information that can inform interventions in college settings.

Effectiveness of Motor Imagery Training for Children with Developmental Coordination Disorder Among Indian Children- A Pilot Study

Children with developmental coordination disorder (DCD) experiences difficulty in performing coordinated movement task as there is a defect in the internal of movements. The of DCD has been examined in several studies which reveal several viable hypotheses including reduced processing speed, problems in executive functioning, poor cross-model integration and low perceptual-motor coupling. Researchers well documented that the predictive control of movements is impaired in children with Developmental Coordination Disorder (DCD), it was examined that impaired control of movements was due to a deficit in the internal of movements. Motor imagery training has been used to test this internal deficit. Motor imagery training is useful for children with DCD as it focuses on internal of movements. The current study aims to examine the effectiveness of Motor imagery training focused on mental imagery task to enhance the movement coordination abilities of children with DCD. By random sampling, 20 children with DCD were randomly divided into two groups, Group A received MI training, and Group B received COOP- Cognitive orientation to daily occupational performance. Both groups received intervention for nine sessions of 45 minutes. The results provided by the current study will help to describe treatment protocol for children with DCD with evidence. Both children and therapist will be benefited from the study.

Prenatal exposure to organophosphate pesticides and longitudinally assessed executive function and attention in childhood and early adolescence

Background: Neurobehavioral functions governed by the prefrontal cortex, including executive function and attention, impact children’s academic and socioeconomic attainment into adulthood. Pesticide exposures may affect these functions. Objective: To investigate whether prenatal exposure to organophosphate (OP) pesticides is associated with children’s executive functioning and attention at ages 7 to 12 years. Methods: We measured dialkyl phosphates (DAPs), metabolites of OP pesticides, in urine samples collected from pregnant women participating in the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS), a population-based cohort study conducted in an agricultural region of California. We assessed executive functioning and attention via maternal report on behavior and standardized assessments of children. We estimated associations of prenatal OP exposure with these outcomes, longitudinally assessed at ages 7, 9, 10.5 and 12 years (n=310 to 341, depending on the time point), adjusting for sociodemographic factors, home learning environment, and maternal receptive language skills and depressive symptoms. Results: Higher prenatal total DAP concentrations (geometric mean (SD) = 130.3 (2.7)) were associated with more parent-reported executive function and attention problems and poorer performance on child assessment measures. For example, a 10-fold increase in prenatal DAP concentrations was associated with a 3.7 point (95% CI 1.8, 5.6) increase in Behavior Rating Inventory of Executive Function Global Executive Composite T-scores and a 3.9 point reduction (95% CI: -6.4, -1.3) in Weschler Intelligence Scales for Children-IV Working Memory scores. Associations were driven primarily by dimethyl phosphates, which are considerably higher than diethyl phosphates in CHAMACOS. In addition, DAP-related associations with parent-reported behavior were stronger in boys than in girls. Discussion: OP pesticide metabolite concentrations during pregnancy were associated with poorer executive functioning and attention at school age and into adolescence. Reducing prenatal exposure to OP pesticides through public health interventions and policy is an important goal.

Training effects of attention and EF strategy-based training “Nexxo” in school-age students

Given the importance of attention and executive functions in children's behavior, programs directed to improve these processes are of interest. Nexxo-training combines the use of the Nexxo touchscreen application (go/no-go and stop signal tasks) with procedural metacognitive strategies. The present paper reports a test of Nexxo's impact on children aged 6–7 and 8–9 years. We conducted a randomized active-controlled trial involving 108 typically-developing children: 1st grade (N = 61, M = 6.46 years, SD = 0.35) and 3rd grade (N = 47, M = 8.5 years, SD = 0.27), randomly assigned to: (1) experimental, (2) active-control, or (3) passive-control groups. A 2-month follow-up was carried out after the intervention. The 3rd grade experimental group displayed a significant reduction in attentional problems at follow-up compared to both control groups. Executive Function problems were also reduced at follow-up in the experimental group. Participants in this group improved in Supervision (self-monitoring) at post-intervention and follow-up compared to passive-controls. Although group effect was not significant at t1, it was significant at post measures in experimental group compared to passive-controls. Nexxo-training revealed a trend-level improvement in attention and executive functions for children in the 3rd grade.

Behavior Rating Inventory of Executive Function – adult version (BRIEF-A) in Iranian University students: Factor structure and relationship to depressive symptom severity

Major depressive disorder is the most common psychiatric illness in Iran, and depression is common among university students in the country. The presence of depression is frequently associated with problems in executive functioning. The Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) is a questionnaire measure designed to assess executive functioning in everyday life in clinical and non-clinical populations. Currently, there is limited empirical validation of the measure for use in Iran. This study evaluated the psychometric properties of a Persian-language BRIEF-A in a sample of Iranian university students (n = 300). The factor structure of the BRIEF-A was examined via a confirmatory factor analysis. We also evaluated whether BRIEF-A scores differed among university students varying in severity of depressive symptoms (Minimal, Mild, Moderate, Severe) as measured by the Beck Depression Inventory – II. Results indicated that a two-factor model structure best fit the data for the BRIEF-A. Acceptable internal consistency was also observed. Furthermore, poorer subjective executive functioning was endorsed by the three depressive subgroups relative to the Minimal symptoms group. Together, these findings support a two-factor model for the Persian translation of the BRIEF-A, and indicate that more severe depressive symptoms in Iranian university students is associated with worse subjective executive functioning.

Motor imagery and action observation for predictive control in developmental coordination disorder.

In 2019, international clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder (DCD) were published. Informing our understanding of mechanisms, recent systematic reviews have shown that children with DCD have difficulties with the predictive control of movements, including aspects of motor planning, which is expressed as the internal modeling deficit hypothesis. This motor control deficit is most evident when the spatial and temporal demands of a task increase. An increasing number of empirical studies suggest that motor planning problems can be remediated through training based on one or a combination of motor imagery and action observation. In this review, we show evidence of motor planning problems in children with DCD and show that task demands or complexity affects its appearance. Implications of these findings are treatments based on motor imagery and action observation to remediate motor planning issues. The article concludes with recommendations for future research.

Effects of a Cognitive-Functional Intervention Method on Improving Executive Function and Self-Directed Learning in School-Aged Children with Attention Deficit Hyperactivity Disorder: A Single-Subject Design Study.

Background School-aged children with attention deficit hyperactivity disorder (ADHD) face many difficulties with self-directed learning because of their poor executive function. This leads to secondary problems such as learning disabilities and depression, so the role of intervention to improve executive function in school-aged children with ADHD is important. Objective The present study is aimed to investigate how cognitive-functional (Cog-Fun) intervention affected executive function of school-aged children with ADHD and the sustainability of these effects. To investigate the effects of changes in the executive function of school-aged children with ADHD through Cog-Fun intervention in self-directed learning. Method A single-subject A-B-A research design was employed in this study. Three children aged 9-10 years who were diagnosed with ADHD were selected. A total of 17 experimental sessions were conducted. The Cog-Fun intervention program was implemented during the intervention phase. To measure dependent variables, Behavior Rating Inventory of Executive Function (BRIEF) and Homework Problems Checklist (HPC) were used. Significant changes in executive function assessed by the Children's Color Trails Test (CCTT) and Stroop test were analyzed through two-standard deviation band analysis. Additionally, video clips of task performance were analyzed to examine qualitative performance changes in self-directed learning. Result All three participants presented statistically significant changes with a number of near-misses of CCTT and color words score of Stroop test during the intervention. T-scores of the Global Executive Composite (GEC) decreased after the intervention, indicating improvement in executive function. The follow-up period revealed retention of the improved executive function. Additionally, self-directed learning improved in all participants after the implementation Cog-Fun intervention. Conclusion The study supports the effectiveness of Cog-Fun intervention in improving executive function in school-aged children with ADHD and confirmed that the improvement of executive function ultimately leads to the improvement of self-directed learning performance.

1313-P: Associations of Executive Function (EF) Problems with Demographic and Diabetes Factors in Teens with T1D from the EU and U.S.

Aim: EF (ability to initiate, plan, monitor behavior) impacts self-care and glycemic control in teens with T1D. We examined demographics, insulin therapy, A1c, and EF in 3 international cohorts of teens with T1D. Methods: Parents of 337 teens (13-18) with T1D from Belgium (BE), Netherlands (NL), and U.S. completed the BRIEF to assess teen EF. Parents/medical records provided demographic and diabetes data. BRIEF score ≥60 (composite score or either of 2 main indices) defined EF problems. Logistic regression determined associations of EF problems with A1c (&amp;lt;7.5 vs. ≥7.5%), controlling for country, sex, T1D duration, and pump use. Results: Teens (54% male; 27% BE, 24% NL, 49% U.S.) were 15.0±1.5 yrs old with T1D duration 7.4±4.0 years, A1c 8.1±1.2%, 61% pump. Teens from BE, NL, U.S. differed with respect to A1c (7.4±1.0, 8.1±1.3, 8.5±1.2%) and pump use (27%, 72%, 74%) (all p&amp;lt;.01). Overall, 30% had EF problems (26% BE, 32% NL, 32% U.S.). Generally, teens with EF problems had higher A1c vs. those without (Table). Pump use was less common in teens with EF problems in NL and U.S. and more common in BE. Odds of A1c ≥7.5% was 2.0 (95% CI 1.1, 3.6; p=.03) in teens with EF problems. Conclusion: In an international sample, teens with T1D and EF problems were twice as likely to have suboptimal A1c. Given country differences in pump use in teens with EF problems, future studies can assess potential benefit of technology in at-risk teens. Disclosure E.R. Goethals: None. M. de Wit: None. L.K. Volkening: None. K. Luyckx: None. K. Casteels: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US. Funding Iacocca Family Foundation; National Institutes of Health (P30DK036836, R01DK095273, K12DK094721); JDRF (2-SRA-2014-253-M-B)

Current survey of early childhood intervention services in infants and young children with sex chromosome aneuploidies.

Sex chromosome aneuploidies (SCAs) are the most commonly occurring aneuploidies in children with a collective prevalence rate of 1 in 500 live births. Prior research has documented SCAs are associated with an increased risk for early expressive language and gross motor delays, learning disorders, ADHD, autism spectrum disorder, anxiety, and executive function problems. Although SCAs have been historically underdiagnosed in young children, recent advances in noninvasive prenatal testing have resulted in an increasing nationwide cohort of infants with confirmed diagnoses. Consequently, early childhood support systems must prepare for an influx of children with known risks for associated developmental delays and potential school problems. This national survey aimed to update our understanding of current early childhood intervention services for young children with SCA in the United States and to describe parent perspectives and priorities. Descriptive statistics, chi-square tests, and logistic regression models controlling for parent education revealed a majority of respondents reported receiving public early childhood intervention services with speech therapy as the most common service. There were significant differences in early childhood intervention services by timing of diagnosis (prenatal vs. postnatal), number of sex chromosomes (trisomy vs. tetra/pentasomy), and geographic location. Parents described interventions as desirable and effective yet also difficult to obtain due to issues with the SCA phenotype, lack of provider knowledge, and challenges navigating the intervention systems. Results support the need for enhanced provider training in SCAs, policy change for early childhood intervention qualification criteria for SCA conditions, and collaboration between medical and early childhood settings.

SUN-072 Age of Critically Ill Children at Time of Exposure to Early Parenteral Nutrition Determines Its Impact on Long-Term Physical and Cognitive Development

BackgroundThe PEPaNIC RCT, which investigated critically ill children admitted to the pediatric intensive care unit, showed that early administration of parenteral nutrition (early PN) as compared with withholding PN for 1 week (late PN) negatively affected 6 neurocognitive functions assessed 2 years later (1). However, it is theoretically possible that age at time of exposure determines whether early PN has negative or positive impact on long-term physical and cognitive development, possibly resulting in a neutral outcome for the total study population. In this secondary analysis of the PEPaNIC RCT, we investigated whether age at exposure to early PN determined its 2 years developmental impact.MethodsThe 786 children who were evaluated 2 years after inclusion in the PEPaNIC RCT for health status, anthropometrics, executive functioning, emotional and behavioral problems, intelligence and visual motor integration were categorized for age at randomization (0–17 years). We defined 4 ±similarly sized age groups based on previously reported timing of cerebral maturation spurts: neonates ≤28 days old (n=121), infants 29 days to <11 months old (n=239), toddlers 11 months to <5 years old (n=223), children 5 years or older (n=203). For each outcome, interaction between the randomized intervention and age at randomization was assessed with a multivariable linear regression analysis adjusted for baseline risk factors. For the outcomes with an interaction p≤0.15, we subsequently compared the adjusted effect of early PN versus late PN within each age group.ResultsInteraction between randomization and age group was identified for weight, development of inhibitory control, flexibility, working memory, planning and organization, metacognition, total executive functioning and internalizing and total behavioral problems. In particular among infants 29 days to <11 months old, harm by early PN was observed for several neurocognitive functions [inhibitory control (p=0.008), flexibility (p=0.02), working memory (p=0.009), planning and organization (p=0.004), metacognition (p=0.008), total executive functioning (p=0.004), internalizing (p=0.005) and total behavioral problems (p=0.01)]. Among toddlers 11 months to <5 years old, neurocognitive harm by early PN was only observed for inhibitory control (p=0.003) and total executive functioning (p=0.02). In neonates ≤28 days old, early PN did not affect neurocognitive development whereas it increased weight (p=0.03) but not height. Among children 5 years or older, early PN only appeared to affect development of planning and organization in a positive manner (p=0.03).ConclusionCritically ill children who were exposed to early PN at an age between 29 days and 11 months were found to be most vulnerable for neurocognitive developmental harm evoked by early administration of PN, as assessed 2 years later.1 Verstraete et al. Lancet Respir Med 2018

The Effect of Perceptual-Motor Training on Executive Functions in Children with Non-Verbal Learning Disorder.

PurposeResearch shows an atypical cognitive process in children with nonverbal learning disorder (NLD) compared to typically developing children, but a wealth of information indicates that physical activity can influence cognitive processes. However, little is known about the effects of perceptual-motor training and its impact on the cognitive process of children with NLD. Thus, the major goals of this study are to compare the executive functions (EFs) in children with NLD with typically developing children and then to investigate the effect of perceptual-motor training on EFs of children with NLD.MethodsTo achieve the first goal, 400 typically developing (IQ >80) and NLD children (7–13 years old) were randomly selected in the city of Mashhad, Iran, during the period 2017–2018. As for the second goal, 50 children with NLD were randomly assigned to an experimental or control group. To evaluate executive functions, Delis–Kaplan executive function system test was used at the pretest, posttest, and 3-month follow-up. The experimental group received the Werner and Reini’s perceptual-motor training program in sixteen 45-min sessions (three sessions per week), but the control group did not receive any intervention.ResultsThe results showed that children with NLD were significantly weaker than typically developing children in London Tower Test (t (38) = −4.662, p <0.01), Trail Making Test (t (33.926) = −3.11, p <0.01), Card Sorting Test (t (38) = −3.427, p <0.01), and Stroop Color Test (t (30.035) = −5.876, p <0.01). The Pilates training had an obvious effect on enhancing the performance of participants in the experimental group (p<0.001), but similar results were not observed in the control group.ConclusionChildren with NLD have problems in EFs, but perceptual-motor training can be used as an effective intervention for these children.

Emotional, Behavioural and Executive Functioning Problems in Children in Residential Care.

This research analyses the emotional and behavioural problems, as well as the problems in the executive functions, of children in residential care under protective measures, between 8 and 12 years of age. We analyse the relationship between the problems with their executive functions and their emotional and behavioural problems, as well as the predictive value of the executive functions for the said emotional and behavioural problems. The instruments used were as follows: five digits test (FDT), behavioural assessment of the dysexecutive syndrome in children (BADS-C) and the system of evaluation for children and adolescents (SENA). The results indicate that the children have difficulties in their executive functions, with such problems as in attention control and regulation, impulsiveness, mental rigidity, behavioural organisation and planning and resolving problems. They also have internalising and externalising problems, as well as difficulties in controlling their emotional reactions and understanding the emotions of others. It becomes evident that the difficulties in their executive functions are related to and predict their emotional and behavioural problems. The research demonstrates the need to intervene in the problems detected through the design of therapeutic programmes and interventions in the residential context.

Executive and non-executive functions in low birthweight/preterm adolescents with differing temporal patterns of inattention.

ObjectiveThis study assesses whether low birthweight/preterm (LBW/PT) adolescents with persistent inattention (PIA) have neuropsychological deficits that distinguish them from adolescents with school age limited inattention (SAL) and those largely unaffected (UA).MethodThree latent classes (PIA, SAL, UA), derived from an earlier analysis of a LBW/PT birth cohort were compared on non-executive and executive functioning measures assessed at age 16.ResultsThe PIA class displayed the poorest performance on executive functioning, which was exaggerated in the context of lower IQ. The PIA and the SAL classes had poorer performance on non-executive functioning relative to the UA class. Both types of functioning mediated the relationship of class to school service use and grade retention.ConclusionNeuropsychological impairment characterizes children and adolescents with inattention problems. Problems in executive functioning characterize the subset whose inattention persists through adolescence. Subsequent research can examine the potential for remediating these deficits to address academic and social problems.

Caregivers' Grit Moderates the Relationship Between Children's Executive Function and Aggression.

ObjectivePrevious studies have shown that the impairment of executive function is positively related to aggression in children and adolescents. What is worth investigating is the moderator of such a relationship so that aggressive behavior can be reduced effectively in those who have executive function problems. The present study examined the association between executive function and two major subtypes of aggression (proactive and reactive aggression) and whether their caregivers’ grit (perseverance) moderated such relationship.MethodExecutive function and reactive and proactive aggression were assessed in 254 children and adolescents aged 8–19 years old, and their caregivers’ grit was measured.ResultsResults show that caregivers’ grit plays a significant role in moderating the relationship between children’s executive function and proactive aggression after controlling for the covariates including the children’s age, gender, and family income. Specifically, children’s executive function became more negatively associated with proactive aggression when caregivers’ grit was high while the association was positive when it was low. On the other hand, the association between children’s executive function and reactive aggression did not vary across different levels of caregivers’ grit.ConclusionThese findings suggest that proactive aggression may be reduced in those who have better executive function by enhancing their caregivers’ grit, which inform the design of interventions in adjunct with the current approach (e.g., executive function training) to reduce aggression in children and adolescents in the community.

The Effectiveness of Training Neuropsychological Skills on Executive Function in Deaf Students with Cochlear Implants: A Single-Subject Research

Introduction: Children with cochlear implants, due to previous hearing deprivation, have damages in the areas of neuropsychological skills, including their executive functions. Since the executive functions are linked with a range of skills such as speech, language, communication, and education, this research aimed to investigate the effectiveness of training neuropsychological skills on executive function problems in deaf students with cochlear implants. Materials and Methods: This study was a single-subject research with A-B design. The study population consisted of all deaf children with cochlear implants at the age of 6 to 12 years in Isfahan City, Iran. Among them, 5 were selected using purposive sampling method. The research instrument was the Connors Neuropsychological Questioner. To analyze the obtained data, after drawing the diagrams, we used visual analyses, trending, and stability, as well as percentages of non-overlapping and overlapping data. Results: The mean scores of 5 subjects decreased from 62.47, 58.12, 61.19, 61.46, and 59.61 at the baseline to 48.22, 51.21, 49.30, 49.74, and 50.94 at the end of intervention, respectively. According to the visual analyses of the data diagrams, the intervention was effective on the studied subjects. The percentage of non-overlapping data in the two baseline and intervention situations for the subjects was 90%, 70%, 90%, 100%, and 80%. This effectiveness was observable in the follow-up stage. Conclusion: According to the results of this study, we can judge that training neuropsychological skills reduce executive function problems in deaf students with cochlear implans, and this approach can be used in the training and rehabilitation centers of children with cochlear implants.

The feasibility and acceptability of goal management training of executive functions in children with spina bifida and acquired brain injury

ABSTRACT Executive dysfunction causes significant real-life disability for children with spina bifida (SB) and acquired brain injury (ABI), and efficient interventions are needed. Goal Management Training (GMT) is a cognitive rehabilitation intervention for improving executive function (EF) that has received empirical support in studies of adults with SB and ABI. The purpose of this study was to determine the feasibility and acceptability of a newly developed pediatric GMT protocol (pGMT). Thirteen children (7 boys, 10–16 years) with SB (n = 4), traumatic brain injury (n = 8), and encephalitis (n = 1) were included, based upon the presence of EF problems as described by parents. The participants received 21 h of pGMT, using inpatient intervention periods, followed by 4 h of pGMT outpatient guidance over 8 weeks. Notably, pGMT was found to be both feasible and acceptable, with satisfactory compliance for the children, parents and teachers, in addition to being considered acceptable by all participants. Furthermore, a reliable change in daily life EF was reported by the parents for 2 children. And, some children obtained scores below clinical cut-off on a measure of parent reported real-life EF after intervention. Hence, findings suggest that a randomized controlled trial of pGMT, with a larger sample size, should be conducted.