Language Subscales Research Articles

Feasibility of a Home-Based Developmental Behavioral Intervention for Children With Autism Spectrum Disorder in Underserved Taiwanese Families

Purpose: This study aims to investigate the feasibility of the home-based parent- mediated intervention Naturalistic developmental behavioral intervention (HB-NDBI) in underserved Taiwanese families of children with Autism spectrum disorder (ASD) and explore its effects on children’s developmental skills and parents’ parenting stress. Method: 24 underserved Taiwanese families of children with ASD (mean age = 46.5 months) received 12-week HB-NDBI programs. Social Responsiveness Scale, Second Edition (SRS-2), Mullen Scales of Early Learning (MSEL), Child Behavior Checklist (CBCL/1.5-5), and Parenting Stress Index (PSI) were administered before and after the HB-NDBI programs. Results: Following the HB-NDBI programs, significant improvements in social cognition, social communication subscales, receptive language subscale, internalizing, externalizing, and total behavioral problems scales of children, and release of parenting stress were observed. Conclusion: This study demonstrated the feasibility of home-based parent-mediated intervention for underserved families in Taiwan. These promising results might facilitate the development of such interventions for underserved families.

Recurrent acute kidney injury is associated with delayed language development in infants with Congenital Heart Disease.

Neurodevelopmental delay is common in children who undergo surgery for Congenital Heart Disease (CHD) in infancy. Cardiac surgery associated acute kidney injury (CS-AKI) occurs frequently in the paediatric cardiac Intensive care unit (ICU). Cardiac surgery associated acute kidney injury (CS-AKI) is associated with worse neurodevelopmental scores and delay in cognitive, language, and motor domains in children with CHD. No known data exist regarding the association of CS-AKI and motor and language subscales. In this study, we explored the relationship between CS-AKI and receptive and expressive language, as well as gross and fine motor delay. This was a single centre retrospective observational cohort study. Children who underwent surgery for CHD and developed recurrent CS-AKI in the first year of life who had follow-up neurodevelopmental testing using the Bayley Scale of Infant Development Version III were included. Neurodevelopmental delay subscales assessed included: receptive and expressive language, fine and motor skills. The study cohort included 203 children. Recurrent CS-AKI was significantly associated with lower scores in receptive and expressive language, as well as fine and gross motor on unadjusted analyses. On adjusted analyses, recurrent CS-AKI was significantly associated with severe receptive language delay. The independent association of recurrent CS-AKI with severe language delay in children who undergo surgery for CHD in infancy is novel. Our findings may contribute to the understanding of language impairment in this population. Further studies are required to better understand this relationship and any potentially modifiable factors.

The Influence of Structural Brain Changes on Cognition in the Context of Healthy Aging: Exploring Mediation Effects Through gBAT-The Graphical Brain Association Tool.

The contribution of age-related structural brain changes to the well-established link between aging and cognitive decline is not fully defined. While both age-related regional brain atrophy and cognitive decline have been extensively studied, the specific mediating role of age-related regional brain atrophy on cognitive functions is unclear. This study introduces an open-source software tool with a graphical user interface that streamlines advanced whole-brain mediation analyses, enabling researchers to systematically explore how the brain acts as a mediator in relationships between various behavioral and health outcomes. The tool is showcased by investigating regional brain volume as a mediator to determine the contribution of age-related brain volume loss toward cognition in healthy aging. We analyzed regional brain volumes and cognitive testing data (Montreal Cognitive Assessment [MoCA]) from a cohort of 131 neurologically healthy adult participants (mean age 50 ± 20.8 years, range 20-79, 73% females) drawn from the Aging Brain Cohort Study at the University of South Carolina. Using our open-source tool developed for evaluating brain-behavior associations across the brain and optimized for exploring mediation effects, we conducted a series of mediation analyses using participant age as the predictor variable, total MoCA and MoCA subtest scores as the outcome variables, and regional brain volume as potential mediators. Age-related atrophy within specific anatomical networks was found to mediate the relationship between age and cognition across multiple cognitive domains. Specifically, atrophy in bilateral frontal, parietal, and occipital areas, along with widespread subcortical regions mediated the effect of age on total MoCA scores. Various MoCA subscores were influenced by age through atrophy in distinct brain regions. These involved prefrontal regions, sensorimotor cortex, and parieto-occipital areas for executive function subscores, prefrontal and temporo-occipital regions, along with the caudate nucleus for attention and concentration subscores, frontal and parieto-occipital areas, alongside connecting subcortical areas such as the optic tract for visuospatial subscores and frontoparietal areas for language subscores. Brain-based mediation analysis offers a causal framework for evaluating the mediating role of brain structure on the relationship between age and cognition and provides a more nuanced understanding of cognitive aging than previously possible. By validating the applicability and effectiveness of this approach and making it openly available to the scientific community, we facilitate the exploration of causal mechanisms between variables mediated by the brain.

The cognitive and language development of young Flemish foster children

Foster children often experienced adversities, putting them at risk for problematic outcomes ( Dozier & Rutter, 2016 ). To our knowledge, there is no research regarding the cognitive and language development of young Flemish foster children. In this study, we describe a study conducted longitudinal research over a one year period into the development of 53 young foster children (12–20 months old at T1). The cognitive and language development of the children was measured using the Bayley Scales of Infant and Toddler Development-Third-Edition (Bayley-III-NL). First, scaled scores of the Bayley subscales cognitive functioning, receptive language and expressive language, both at T1 and T2, were compared to the mean norm-scores. Second, the associated variables with the children’s functioning on cognitive and language scales were explored using Multilevel Modelling. For all subscales except receptive language at T2, the results did not significantly differ from the mean normative scores. The scores of the foster children in this study were significantly lower on receptive language at T2. When we looked at individual scores, most children (66%–83%) had scores that did not differ more than one standard deviation from the normative mean. Children in kinship foster care had lower scores in multiple developmental domains. There were also negative associations between both language subscales and insecure attachment behavior. For most subscales, the results did not significantly differ from the mean normative scores, which is promising.

A - 46 Relationship between Working Memory and Externalizing Behaviors in Children from a Clinical Population: an Exploration of the Role of Expressive Language

Abstract Objective Externalizing behaviors affect children’s functioning in different domains. Previous studies revealed the impact of working memory, mainly through its role in goal keeping, goal-related search, and response selection. This study explored the role of expressive language in the relationship between working memory and externalizing behaviors in children. Method The data were collected from 50 children at a private practice agency (male: 76%; Age M = 4.16, SD = 1.13). All participants were diagnosed with at least one neurodevelopmental disorder. Their index score on the Externalizing Problems from Behavior Assessment System for Children, 3rd Edition, index score on the Working Memory from Stanford-Binet Intelligence Scales, 5th Edition, and expressive language subscale score from Vineland Adaptive Behavior Scales, 3rd Edition were collected. A mediation analysis was performed. Results The mediation analysis results showed a significant indirect effect (B = −0.081, 95% CI [−0.172, −0.015]) of working memory on externalizing behaviors through expressive language. It suggested that poorer working memory was associated with less expressive language, which then resulted in more externalizing behaviors. The direct effect between working memory and externalizing behavior was statistically significant (B = −0.331, p < 0.001), indicating that expressive language only partially mediated the relationship between working memory and externalizing behaviors. Conclusions The study provided empirical support for the mediating effect of expresive langaguge on the relationship between working memory and externaizing behaviors in children from a clinical population. It informs that the use of evidence-based interventions on expressive langauge skills might potentially help address externalizing behaviors in children.

The utility of the child development review in Suriname: Validating a neurodevelopmental screener for use in a low- to middle- income Country

BackgroundAccess to efficient, culturally relevant, and validated measures of neurodevelopment in Low- and Middle-Income Countries (LMICs) remains a critical need. This study describes the validation and reliability of the Child Development Review (CDR), a parent report neurodevelopmental screening tool, for use in a cohort of Surinamese children aged 2–4 years. SubjectsComplete data from 355 Surinamese children through the Caribbean Consortium for Research in Environmental and Occupational Health were utilized for validation. Convergent validity was assessed using a subset of 31 children with concurrently administered CDRs and Bayley Scales of Infant and Child Development Third Edition (BSID-III). MethodsCronbach's alpha was used to assess subscale reliability. Cluster analyses were used to assess internal factor structure. Measures of convergent validity used Cohen's Kappa statistic and partial correlations between comparative CDR and BSID-III subscales. ResultsCronbach's Alpha values were acceptable for all CDR subscales (range 0.63 - 0.79). CDR subscale responses clustered into two distinct groups, representing milestones that were or were not achieved. Patterns of change indicate increased milestone achievement with increased age. Partial correlations indicated that the social, fine motor, and language subscales of the CDR and BSID-III subscales were significantly correlated. However, Cohen's Kappa was only significant for the gross motor CDR and BSID-III subscales. ConclusionsThe CDR has acceptable reliability, internal validity, and convergent validity. Use of the CDR should be considered as a screening tool for neurodevelopment in Suriname and may provide an efficient initial assessment of developmental delay in LMIC.

Pre-pregnancy maternal obesity and infant neurodevelopmental outcomes in Latino infants.

This study explores the impact of maternal pre-pregnancy BMI on infant neurodevelopment at 24 months in low-income Latino families. It also investigates whether infant diet mediates this relationship. Latino mother-infant pairs (n = 163) were enrolled at 1 month post partum and were followed for 2 years, with assessments at 6-month intervals. Maternal pre-pregnancy anthropometrics were self-reported at baseline, and child neurodevelopment was assessed at 24 months using the Bayley Scales of Infant Development. Diet quality of infants was measured using the Healthy Eating Index (HEI)-2015 and HEI-Toddlers-2020 scores at multiple time points. Mediation and regression models that adjust for maternal factors were used to examine the associations. Pre-pregnancy BMI showed significant negative associations with child cognitive scores (β = -0.1, 95% CI: -0.2 to -0.06, p < 0.001) and language scores (β = -0.1, 95% CI: -0.2 to -0.03, p = 0.01) at 24 months. Infant HEI-2015 scores at 24 months partly mediated these associations, explaining 23% and 30% of the total effect on cognitive and language subscales, respectively. No specific dietary components in infants mediated the relationship, except for the total HEI-2015 score. Managing maternal obesity pre-pregnancy is crucial for improving infant neurodevelopmental outcomes, especially in low-income Latino families. Promoting healthy weight and enhancing infant diet quality can enhance neurodevelopment in these populations.

Overt hypothyroidism in pregnancy and language development in offspring: is there an association?

PurposeOvert hypothyroidism during pregnancy is linked to various obstetric complications, such as premature birth and fetal death. While some studies have shown that maternal hypothyroidism can impact a child's Intelligence Quotient (IQ) and language development, findings are controversial. The aim of this study was to explore the connection between treated maternal hypothyroidism during pregnancy and offspring neurodevelopment, focusing on learning and language and examining related maternal obstetric complications.MethodsGroup 1 included 31 hypothyroid women with elevated thyroid stimulating hormone (TSH) (> 10 mU/L, > 10 µIU/mL) during pregnancy, and Group 2 had 21 euthyroid women with normal TSH levels (0.5–2.5 mU/L, 0.5–2.5 µIU/mL). Children underwent neuropsycological assessments using the Griffiths-II scale.ResultsPregnancy outcome showed an average gestational age at delivery of 38.2 weeks for hypothyroid women, compared to 40 weeks for controls, and average birth weight of 2855.6 g versus 3285 g for controls, with hypothyroid women having children with higher intrauterine growth restriction (IUGR) prevalence and more caesarean sections. The 1-min APGAR score was lower for the hypothyroid group's children, at 8.85 versus 9.52. Neuropsychological outcomes showed children of hypothyroid mothers scored lower in neurocognitive development, particularly in the learning and language subscale (subscale C), with a notable correlation between higher maternal TSH levels and lower subscale scores.ConclusionFetuses born to hypothyroid mothers appeared to be at higher risk of IUGR and reduced APGAR score at birth. Neurocognitive development seemed to affect language performance more than the developmental quotient. This alteration appeared to correlate with the severity of hypothyroidism and its duration.

Type 2 Diabetes Moderates the Association Between Amyloid and 1-Year Change in Everyday Functioning in Older Veterans.

Type 2 diabetes mellitus (T2DM) affects ∼25% of Veterans, a prevalence rate double that of the general population. T2DM is associated with greater dementia risk and has been shown to exacerbate the impact of Alzheimer's disease (AD) risk factors on declines in daily functioning; however, there are few studies that investigate these patterns in older Veterans. This study sought to determine whether T2DM moderates the association between amyloid-β (Aβ) positron emission tomography (PET) and 1-year change in everyday functioning in older Veterans. One-hundred-ninety-eight predominately male Vietnam-Era Veterans without dementia from the Department of Defense-Alzheimer's Disease Neuroimaging Initiative (DoD-ADNI) with (n = 74) and without (n = 124) T2DM completed Aβ PET imaging and everyday functioning measures, including the Clinical Dementia Rating-Sum of Boxes (CDR-SB) and Everyday Cognition (ECog). Linear mixed effects models tested the moderating role of T2DM on the association between Aβ PET and 1-year change in everyday functioning. The 3-way T2DM×Aβ PET×time interaction was significant for CDR-SB (p < 0.001) as well as the Memory (p = 0.007) and Language (p = 0.011) subscales from the ECog. Greater amyloid burden was associated with greater increases in functional difficulties, but only in Veterans with T2DM. Higher Aβ was only associated with declines in everyday functioning over 1 year in Veterans with T2DM. Given that people with T2DM are more likely to have co-occurring cerebrovascular disease, the combination of multiple neuropathologies may result in faster declines. Future studies should examine how diabetes duration, severity, and medications impact these associations.

A community-based child health and parenting intervention to improve child HIV testing, health, and development in rural Lesotho (Early Morning Star): a cluster-randomised, controlled trial

When caregivers live in remote settings characterised by extreme poverty, poor access to health services, and high rates of HIV/AIDS, their caregiving ability and children's development might be compromised. We aimed to test the effectiveness of a community-based child health and parenting intervention to improve child HIV testing, health, and development in rural Lesotho. We implemented a matched cluster-randomised, controlled trial in the Mokhotlong district in northeastern Lesotho with 34 community clusters randomly assigned to intervention or wait-list control groups within a pair. Eligible clusters were villages with non-governmental organisation partner presence and an active preschool. Participants were caregiver-child dyads, where the child was 12-60 months old at baseline. The intervention consisted of eight group sessions delivered at informal preschools to all children in each village. Mobile health events were hosted for all intervention (n=17) and control (n=17) clusters, offering HIV testing and other health services to all community members. Primary outcomes were caregiver-reported child HIV testing, child language development, and child attention. Assessments were done at baseline, immediately post-intervention (3 months post-baseline), and 12 months post-intervention. We assessed child language by means of one caregiver-report measure (MacArthur-Bates Communicative Development Inventory [CDI]) and used two observational assessments of receptive language (the Mullen Scales of Early Learning receptive language subscale, and the Peabody Picture Vocabulary Test 4th edn). Child attention was assessed by means of the Early Childhood Vigilance Task. Assessors were masked to group assignment. Analysis was by intention to treat. This trial was registered with ISRCTN.com, ISRCTN16654287 and is completed. Between Aug 8, 2015, and Dec 10, 2017, 1040 children (531 intervention; 509 control) and their caregivers were enrolled in 34 clusters (17 intervention; 17 control). Compared with controls, the intervention group reported significantly higher child HIV testing at the 12-month follow-up (relative risk [RR] 1·46, 95% CI 1·29 to 1·65, p<0·0001), but not immediately post-intervention. The intervention group showed significantly higher child receptive language on the caregiver report (CDI) at immediate (effect size 3·79, 95% CI 0·78 to 6·79, p=0·028) but not at 12-month follow-up (effect size 2·96, 95% CI -0·10 to 5·98, p=0·056). There were no significant group differences for the direct assessments of receptive language. Child expressive language and child attention did not differ significantly between groups. Integrated child health and parenting interventions, delivered by trained and supervised lay health workers, can improve both child HIV testing and child development. United States Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR).

Comparison of Children’s Communication Checklist Between Deaf and Hard of Hearing, and Hearing Adolescents

Background and Objectives: The present research compared pragmatic abilities between deaf and hard-of-hearing (DHH), and hearing adolescents using the children’s communication checklist (CCC). Methods: In this study, 16 hearing adolescents aged 11–16 and 16 deaf and DHH adolescents with similar chronological ages participated. The CCC was completed with parents of DHH and hearing adolescents. Results: The study’s results revealed that DHH and hearing adolescents had a significant difference in pragmatic composite scores (PCS) and the score of all CCC subscales. The results showed that in all subscales of the CCC, DHH adolescents received lower scores from their parents than hearing adolescents. The inappropriate initiation and stereotyped language subscales of the CCC had the highest correlation rates. Also, the pragmatic composite score showed the highest correlation with the stereotyped language subscale. Conclusion: DHH adolescents showed weaker performance in pragmatic skills than hearing adolescents.

Subjective language difficulties are associated with tau and objective verbal memory in older women with increased AD risk

AbstractBackgroundEarly cognitive changes in preclinical Alzheimer’s Disease (AD) include memory problems and language difficulties. Subjective cognitive complaints (SCC) are an AD risk factor and are associated with AD pathologies. Women have higher tau levels over men, despite demonstrating a life‐long “verbal memory advantage.” Therefore, SCC may be a stronger indicator of early tau accumulation than objective cognitive changes. Here, we examined the relationships among tau, subjective cognitive function, and objective cognitive function in older women at higher AD risk.Method16 older women (age: 72.3±3.1years) participated in Women Inflammation and Tau Study (WITS). The inclusion criteria are: 65+ years old, AD polygenic hazard score &gt;50th percentile, and a telephone Montreal Cognitive Assessment score suggestive of mild cognitive impairment (MCI; range 16‐20). Tau was measured with cerebrospinal fluid (CSF) ptau181 and 18F‐MK6240 positron emission tomography (PET) with standardized uptake value ratio (SUVR) calculated in Braak1, correlating with MCI stage. Objective memory and language performance were assessed with the Rey Auditory Verbal Learning Test (RAVLT; immediate and delayed recall) and the Multilingual Naming Test (MINT), respectively. Subjective cognition was measured approximately one year later with the self‐reported Everyday Cognition Scale (ECog) memory and language subscales (higher score indicate more complaints). Spearman partial correlations analyzed the associations among tau, objective cognition, and subjective cognition while controlling for age.ResultGreater CSF ptau181 was significantly associated with higher ECog‐Language (rho = 0.62, p = 0.02), higher ECog‐Memory (rho = 0.53, p = 0.51), and lower RAVLT immediate recall (rho = ‐0.54, p = 0.046; Figure 1). More tau in Braak1 was associated with lower RAVLT immediate recall (rho = ‐0.58, p = 0.03) and higher ECog‐Language (rho = 0.45, p = 0.09), but not ECog‐Memory (p = 0.26; Figure 2). Higher ECog‐Language was significantly associated with lower RAVLT immediate (rho = ‐0.59, p = 0.02) and delayed recall (rho = ‐0.69, p&lt;0.01; Figure 3). MINT correct responses were not related to tau and ECog (p’s&gt;0.28).ConclusionOur preliminary results suggest that, in older women with elevated AD risk, language concerns with memory features (e.g., word finding and forgetting object names) may track with early increases in CSF ptau181 and entorhinal cortex tau‐PET. Self‐reported language decline may be predictive of tau accumulation and worsening objective verbal memory, which could be clinically important for older women.

The Telephone Language Screener (TLS): standardization of a novel telephone-based screening test for language impairment.

This study aimed at developing and standardizing the Telephone Language Screener (TLS), a novel, disease-nonspecific, telephone-based screening test for language disorders. The TLS was developed in strict pursuance to the current psycholinguistic standards. It comprises nine tasks assessing phonological, lexical-semantic and morpho-syntactic components, as well as an extra Backward Digit Span task. The TLS was administered to 480 healthy participants (HPs), along with the Telephone-based Semantic Verbal Fluency (t-SVF) test and a Telephone-based Composite Language Index (TBCLI), as well as to 37 cerebrovascular/neurodegenerative patients-who also underwent the language subscale of the Telephone Interview for Cognitive Status (TICS-L). An HP subsample was also administered an in-person language battery. Construct validity, factorial structure, internal consistency, test-retest and inter-rater reliability were tested. Norms were derived via Equivalent Scores. The capability of the TLS to discriminate patients from HPs and to identify, among the patient cohort, those with a defective TICS-L, was also examined. The TLS was underpinned by a mono-component structure and converged with the t-SVF (p < .001), the TBCLI (p < .001) and the in-person language battery (p = .002). It was internally consistent (McDonald's ω = 0.67) and reliable between raters (ICC = 0.99) and at retest (ICC = 0.83). Age and education, but not sex, were predictors of TLS scores. The TLS optimally discriminated patients from HPs (AUC = 0.80) and successfully identified patients with an impaired TICS-L (AUC = 0.92). In patients, the TLS converged with TICS-L scores (p = 0.016). The TLS is a valid, reliable, normed and clinically feasible telephone-based screener for language impairment.

A Reliability Generalization Meta‐Analysis of the Kaufman Domains of Creativity Scale

ABSTRACTThe Kaufman Domains of Creativity Scale (K‐DOCS) is a self‐reported rating scale that measures creative behaviors in five areas. Despite the vast amount of research on the scale, the internal consistency reliability of K‐DOCS scores have not been examined. Specifically, there is no study on the overall reliability coefficients, the variation in the reliability of scores, and reliability induction. In the present study, reliability generalization meta‐analyses were conducted to address these issues. The sample consisted of 56 studies that produced 60 Cronbach's alpha coefficients in total. The pooled alpha values were estimated to be .904 (total scale), .825 (Self/Everyday subscale), .858 (Scholarly subscale), .887 (Performance subscale), .867 (Scientific subscale), and .861 (Artistic subscale). The moderator analyses showed that the reliability estimates of K‐DOCS total scores and Self/Everyday subscale scores did not differ with respect to any of the moderator variables. On the other hand, certain variables affected the alpha coefficients for Scholarly (educational level, SD of the age, and mean age), Performance (continent, educational level, ethnicity, Caucasian percentage, SD of the age, and mean age), Scientific (language, test version, continent, country, ethnicity, SD of the age, and mean age), and Artistic (continent, language, country, mean age, and total mean score) subscale scores. Finally, the reliability induction rate was 39.62%, and there were no statistically significant differences between the inducing and reporting studies with respect to the continuous variables (mean of the total score, means and SDs of the sample age, and percentages of female and Caucasian). Our findings indicate that the K‐DOCS provides highly reliable scores. However, certain variables contribute to systematic errors in Scholarly, Performance, Scientific, and Artistic subscale scores. Hence, scores on these subscales should be interpreted with caution. Due to a high amount of variation in the reliability coefficients, reliability induction is not advised for the K‐DOCS.

Program de intervenție logopedică pentru dezvoltarea limbajului la preșcolarii din grupa mare

This paper aims to identify the developmental characteristics of language in preschool children, capturing the impact of the speech therapy program on language development, and utilizing the principles of the TALK program in speech therapy intervention. The study sample consisted of 22 preschoolers, aged between 5-6 years, from a kindergarten in Cluj-Napoca. After dividing the participants into two groups, control and experimental, the evaluation was performed using three assessment tools: the Curriculum TALK, Portage (Language subscale), and the Logopedic Album. A speech therapy intervention program was implemented for the experimental group, followed by a final evaluation conducted using the same assessment tools. After collecting the results from pre and post-tests, all data were centralized in an SPSS database for processing. Thus, by using the paired samples t-test (hypothesis 1), the independent samples t-test (hypothesis 2), and Pearson’s bivariate correlation (hypothesis 3), it was found that all research hypotheses were confirmed.

Effects of Cooperative, Competitive, and Solitary Exergames on Cognition and Anxiety Levels in Children with Developmental Disabilities.

Objective: Exergames are playing an important role in person-centered therapy, health care services, and in the rehabilitation field. This study aimed to compare the effects of cooperative, competitive, and solitary exergames on cognition and anxiety levels in children with developmental disabilities (DD). Materials and Methods: This study was a randomized controlled trial pretest-posttest including 36 children with DD who were allocated to the cooperative exergame group (CGG), competitive exergame group (CmGG), and solitary exergame group (SGG). The exergame program was performed two times a week for 8 weeks and the outcome measurements were conducted before and after the program. A paired sample t-test and one-way analysis of variance (ANOVA) were used to analyze the changes within and between the groups. Results: The result indicated a significant improvement in memory, attention, and visual perception in all groups; the CGG and CmGG showed a high increase in attention compared with the SGG. However, only the CGG presented a significant improvement in the language subscale. In terms of anxiety, only the CGG presented substantial improvements in all anxiety subscales. The CmGG showed improvement in social phobia and the SGG in physical injury fears, social phobia, and general anxiety fears. Conclusion: The findings suggest that cooperative and competitive exergames may be used to effectively improve cognitive functions; cooperative exergames can be applied as the most effective method to reduce anxiety compared with the other game types for children with DD.

Research Letter: TBI Severity Moderates the Association Between Subjective and Objective Attention in Older Veterans.

This study examined the moderating effect of traumatic brain injury (TBI) history on subjective and objective cognition across multiple cognitive domains. Participants included 242 Vietnam-era veterans with a history of no TBI (n = 86), mild TBI (n = 74), or moderate-to-severe TBI (n = 82) from the observational Department of Defense-Alzheimer's Disease Neuroimaging Initiative (DoD-ADNI) study. Objective cognition was the outcome and was measured using neuropsychological measures in the domains of memory, attention/executive functioning, and language. Subjective cognition was measured using the memory, divided attention, and language subscales from the Everyday Cognition (ECog) measure. TBI severity status was the moderating variable. Veterans with a history of moderate-to-severe TBI had a stronger negative association between subjective and objective attention relative to participants without a TBI ( P = .002). Although this association did not differ between mild TBI and no TBI history groups ( P = .100), the association between subjective and objective attention for the mild TBI group was intermediate to the no TBI and moderate-to-severe TBI history groups. TBI status did not moderate associations between subjective and objective memory or language. Results highlight the importance of assessing subjective and objective cognition in older veterans and the relevance of attention in the context of TBI history. More work is needed to better understand the intersection of TBI and aging and how these factors may be used to guide individualized assessment and treatment approaches for older veterans.

Potential barriers to early diagnosis of autism in Turkey: an evaluative study

ABSTRACT Our objective was to evaluate pathways between initial concerns of parents regarding atypical development of their children and autism spectrum disorder (ASD) diagnosis in Turkey. The study included 199 children aged 18–97 months and diagnosed with ASD. The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were used along with information obtained from parents and direct observation of the child. The Childhood Autism Rating Scale (CARS) was used as a diagnostic tool. A 45-minute semi-structured interview was conducted with parents to evaluate the time until their child was diagnosed with ASD. A period longer than 1 year (mean: 13.69 ± 10.80 months) had passed from the first concern of parents until their children were diagnosed with ASD. Further, 53.8% of parents consulted a healthcare professional a few months after their initial concern and 46.2% did not for a longer time (9.34 ± 8.36 months). Maternal education level, socioeconomic status, and higher Autism Behavior Checklist (ABC) relating subscale scores predicted an earlier age for a diagnosis of ASD, while higher ABC language subscale scores predicted ASD diagnosis at older ages. Based on our results, it appears that factors such as spoken language and socioeconomic level may be related to significant delays in ASD diagnoses in Turkey.

Regulatory T cells mediate insomnia-related psychotic symptoms and cognitive impairment in chronic schizophrenia patients

Insomnia occurs frequently in schizophrenia patients and is often accompanied with severe psychotic symptoms and cognition impairment. Moreover, chronic insomnia is associated with immune alterations. This study explored the correlations between insomnia and clinical manifestations of schizophrenia and analyzed mediation effects of regulatory T cells (Tregs) on these correlations. In a total of 655 chronic schizophrenia patients, 70 persons (10.69%) had an ISI (Insomnia Severity Index) score >7 and were referred to as Insomnia group. Compared to non-Insomnia group, Insomnia group presented more severe psychotic symptoms (assessed by PANSS) and cognitive impairment (assessed by RBANS). The total effect of ISI on PANSS/RBANS total score was not significant due to the mediation effects by Tregs, in which Tregs strongly mediated the effect of ISI on PANSS total score in negative direction but mediated the effect of ISI on RBANS total score in positive direction. Pearson Correlation Coefficient revealed negative correlations between Tregs and PANSS total score or disorganization subscale of PANSS. Positive correlations existed between Tregs and RBANS total score, between Tregs and the subscales of attention, delayed memory, or language of RBANS. These mediation effects of Tregs on insomnia-related psychotic symptoms and cognitive impairment in chronic schizophrenia patients point to a potential therapeutic strategy of modulating Tregs for the patients.

ASQ-3 and BSID-III’s concurrent validity and predictive ability of cognitive outcome at 5 years

BackgroundEarly detection of cognitive disability is challenging. We assessed the domain-specific, concurrent validity of the ages and stages questionnaire (ASQ-3) and the Bayley Scales of Infant and Toddler Development (BSID-III), and their ability to predict cognitive delay at school age.MethodsWithin a longitudinal birth cohort study, a nested cohort of children was assessed using ASQ-3 and BSID-III at 24 months, and at 5 years using the Kaufmann brief IQ test (KBIT).Results278 children were assessed using BSID-III and ASQ-3 at 24-months; mean(SD) BW = 3445(506) grams, M:F ratio=52:48. ASQ-3 had reasonable predictive ability (AUROC, p value, sensitivity:specificity) of same domain delay for motor (0.630, p = 0.008, 50%:76.1%) and language (0.623, p = 0.010, 25%:99.5%) at 2 years, but poor ability to detect cognitive delay compared to BSID-III (0.587, p = 0.124, 20.7%/96.8%;). 204/278 children were assessed at 5 years. BSID-III language and cognition domains showed better correlation with verbal and nonverbal IQ (R = 0.435, p < 0.001 and 0.388, p < 0.001 respectively). Both assessments showed high specificity and low sensitivity for predicting delay at 5 years.ConclusionsThe ASQ-3 cognitive domain showed poor concurrent validity with BSID-III cognitive score. Both ASQ-3 and BSID-III at 2 years poorly predict cognitive delay at 5 years.ImpactThe ASQ-3 does not adequately detect cognitive delay or predict cognitive delay at 5 years, particularly for children with mild to moderate delay.The ASQ-3 shows reasonable concurrent validity with the motor and language subscales of the BSID-III. Neither early screening nor formal developmental testing demonstrated significant predictive validity to screen for cognitive delay at school age.This article highlights the need to analyse our existing model of using the ASQ-3 to screen for cognitive delay in children aged 2 years.