Persistent Difficulties Research Articles

Outcome measures for children with speech sound disorder: an umbrella review

ObjectiveSpeech sound disorder (SSD) describes a ‘persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication’. There is a need to establish which care pathways...

The Impact of Demographic Factors on Financial Literacy among Farmers: Insights from Rural Tamil Nadu

Financial literacy is becoming more widely acknowledged as an essential skill for navigating the intricacies of the financial world. Governments globally are proactively working to improve financial literacy among their populations, understanding that a lack of proficiency in this domain can result in persistent difficulties that greatly affect a person’s financial health. In our country, the convergence of limited literacy and restricted access to financial services poses a barrier for smallholders in acquiring these essential skills. Given the diverse needs within different demographic groups, tailored financial education becomes imperative. This research, focusing on the specific demographic of “farmers,” serves as valuable insight for the government to customize financial literacy content. The study employs the Chi-square test to analyze the association between literacy levels and demographic variables, offering a comprehensive understanding of the dynamics at play.

A systematic review of transcranial magnetic and direct current stimulation application on the improvement of reading ability of developmental dyslexia

Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), two non-invasive brain stimulation techniques (NIBS), are modulatory tools to probe into a possible causal and interaction relationship between brain structure and function. Developmental dyslexia (DD) is a neurodevelopmental disorder, which is characterized by significant and persistent difficulty in learning and reading-related skills. Previous studies have shown that TMS and tDCS play an important role in reading ability and neurocognitive plasticity, such as visuospatial working memory, attention, speech recognition, and motor perception. However, research on the effectiveness of TMS/tDCS in treating DD is still limited. The current study aimed to systematically review the broadly application of TMS/tDCS in the treatment of dyslexic children and adolescents as well as adults. Twelve studies involving 128 dyslexic subjects (199 children/adolescents and 29 adults) were included in this systematic review. Overall, TMS/tDCS appeared to be an effective technique for treating dyslexia. However, further future studies with larger sample sizes as well as more different languages are essential to demonstrate its potential for successful intervention in DD. This systematic review suggested that the combination of tDCS and cognitive training was effective. Moreover, the treatment with multiple sessions and coupled with behavioral training appeared to result in greater efficacy than stand-alone NIBS treatment.

Parallels between clinical and genetic characteristics in children with primary ciliary dyskinesia

Primary ciliary dyskinesia (PCD) is a rare genetic disorder that leads to chronic inflammatory damage to the airways and auditory organs. This article presents current information and a study aimed at investigating parallels between the course of PCD and clinical and genetic variant of the disease, which contributes to a timely diagnosis and enables personalized treatment approach.The aim of the study was to identify phenotypic characteristics and chronological patterns of PCD course depending on the genotype.Methods. The study was conducted at the Veltischev Research Clinical Institute of Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University (Pirogov Medical University), Ministry of Health of Russia. The study included children with PCD who underwent next generation sequencing (NGS) of the exome.Results. Significant differences were found in the course of PCD based on clinical and genetic characteristics. Children with defects in the genes encoding central pair proteins are characterized by an earlier onset of daily productive cough and recurrent respiratory infections. A similar pattern is typical for patients with defects in the genes encoding the cilia assembly proteins. The first episode of respiratory infection occurs later in patients with defects in the genes encoding dynein handle proteins. Patients who do not have defects in PCD-associated genes are characterized by a late onset of persistent difficulty in nasal breathing, productive cough and respiratory diseases.Conclusion. Identification of clinical and genetic variants of PCD allows prediction of chronological features of the course of the disease.

Excitatory and inhibitory neurochemical markers of anxiety in young females

Between the ages of 10–25 years the maturing brain is sensitive to a multitude of changes, including neurochemical variations in metabolites. Of the different metabolites, gamma-aminobutyric acid (GABA) has long been linked neurobiologically to anxiety symptomology, which begins to manifest in adolescence. To prevent persistent anxiety difficulties into adulthood, we need to understand the maturational trajectories of neurochemicals and how these relate to anxiety levels during this sensitive period. We used magnetic resonance spectroscopy in a sample of younger (aged 10–11) and older (aged 18–25) females to estimate GABA and glutamate levels in brain regions linked to emotion regulation processing, as well as a conceptually distinct control region. Within the Bayesian framework, we found that GABA increased and glutamate decreased with age, negative associations between anxiety and glutamate and GABA ratios in the dorsolateral prefrontal cortex, and a positive relationship of GABA with anxiety levels. The results support the neural over-inhibition hypothesis of anxiety based on GABAergic activity.

Stability of executive function in children born at risk of neonatal hypoglycemia

ABSTRACT Executive function plays an important role in promoting learning and social-emotional development in children. Neonatal hypoglycemia associates with executive function difficulties at 4.5 years, but little is known about the development of executive function over time in children born at risk of neonatal hypoglycemia. We aimed to describe the stability of executive function from early to mid-childhood in children born at risk of neonatal hypoglycemia and its association with neonatal hypoglycemia. Participants in a prospective cohort study of infants born at risk for neonatal hypoglycemia were assessed at ages 2, 4.5, and 9–10 years. We assessed executive function with batteries of performance-based and questionnaire-based measures, and classified children into one of four stability groups (persistent typical, intermittent typical, intermittent difficulty, and persistent difficulty) based on dichotomized scores (typical versus low at each age). Multinomial logistic regression was used to determine the associations between neonatal hypoglycemia and executive function stability groups. Three hundred and nine children, of whom 197 (64%) experienced neonatal hypoglycemia were assessed. The majority of children had stable and typical performance-based (63%) and questionnaire-based (68%) executive function across all three ages. Around one-third (30–36%) of children had transient difficulties, and only a few (0.3–1.9%) showed persistent difficulties in executive function at all ages. There was no consistent evidence of an association between neonatal hypoglycemia and the stability of executive function. Neonatal hypoglycemia does not appear to predict a specific pattern of development of executive function in children born at risk.

Differences in Cortical Surface Area in Developmental Language Disorder.

Approximately 7% of children have developmental language disorder (DLD), a neurodevelopmental condition associated with persistent language learning difficulties without a known cause. Our understanding of the neurobiological basis of DLD is limited. Here, we used FreeSurfer to investigate cortical surface area and thickness in a large cohort of 156 children and adolescents aged 10-16 years with a range of language abilities, including 54 with DLD, 28 with a history of speech-language difficulties who did not meet criteria for DLD, and 74 age-matched controls with typical language development (TD). We also examined cortical asymmetries in DLD using an automated surface-based technique. Relative to the TD group, those with DLD showed smaller surface area bilaterally in the inferior frontal gyrus extending to the anterior insula, in the posterior temporal and ventral occipito-temporal cortex, and in portions of the anterior cingulate and superior frontal cortex. Analysis of the whole cohort using a language proficiency factor revealed that language ability correlated positively with surface area in similar regions. There were no differences in cortical thickness, nor in asymmetry of these cortical metrics between TD and DLD. This study highlights the importance of distinguishing between surface area and cortical thickness in investigating the brain basis of neurodevelopmental disorders and suggests the development of cortical surface area to be of importance to DLD. Future longitudinal studies are required to understand the developmental trajectory of these cortical differences in DLD and how they relate to language maturation.

Speed of processing in Developmental Language Disorder (DLD): The case of real-time grammatical processing.

Developmental Language Disorder (DLD) impacts various aspects of children's language abilities, including the processing of inflectional morphology. Prior research suggests that children with DLD exhibit deficits in processing speed and sensitivity to grammatical inflections, yet the relationship between these deficits remains unclear. This study aimed to investigate the relationship between processing speed and sensitivity to inflectional morphology in children with DLD, focusing on their real-time processing abilities in response to regular past tense, third person singular, and regular plural inflections at different rates of sentence articulation. Eighteen children with DLD and 18 age-matched controls underwent word monitoring tasks that assessed sensitivity to grammaticality of inflections in sentences presented at normal and slow rates of articulation. At a normal rate of articulation, children with DLD demonstrated slower response times and reduced sensitivity to grammaticality across all inflections compared to controls. When the articulation rate was slowed, children with DLD showed improved sensitivity, particularly to regular plural and third person singular inflections, although deficits in processing the regular past tense persisted. The findings suggest a significant relationship between processing speed and inflectional morphology sensitivity in children with DLD. Slower articulation rates improved grammatical sensitivity for certain inflections, highlighting the potential of tailored interventions that consider processing speed limitations. Persistent difficulties with the regular past tense inflection indicate the need for targeted support for children with DLD in this area. What is already known on this subject Children with Developmental Language Disorder (DLD) have a wide range of language difficulties, but deficits in inflectional morphology are regarded as a 'hallmark' of the disorder. Children with DLD are also very likely to show deficits in speed of processing, although it is not known if a 'slowness to process' can causally explain the language difficulties these children experience. What this study adds to existing knowledge When grammatical sensitivity was measured using an online real-time task, children with DLD showed widespread inflectional deficits when sentences were spoken at a normal conversational rate. When sentence articulation rate was slowed down, children with DLD were faster, more accurate and more sensitive to the grammaticality of constructions. However, deficits in the regular past tense remained persistent, even in this slow-rate condition. What are the clinical implications of this work? This study has implications for clinical and educational practices that work with children with DLD to improve their language skills. The findings of this study show that when children with DLD are given more time to process incoming information, their grammatical skills significantly improve. This study also shows that deficits in the regular past tense are persistent, and children are likely need extensive and intensive support with this particular grammatical feature.

Undergraduate students’ models of single- and multi-electron atoms

ABSTRACT Quantum physics forms the basis for exciting new technologies, including quantum computers, quantum encryption, and quantum entanglement. The advancement of science and technology highlights the importance of mastering quantum physics and its applications, not only at the college level but also as early as high school. In this multiple case study, we investigated first- and second-year undergraduate college students’ models of single and multi-electron atoms after completing a modern mechanics course, which addressed basic QM topics. The students’ models were categorised into four primary categories: the discrete entity (particle) model, hybrid model, quantum-like model, and quantum model, and subcategories for atom structure and electron attribution and motion. Despite being introduced to quantum concepts in high school and first-year undergraduate calculus-based physics classes, many students constructed incomplete, inaccurate, or incoherent models. Seven of eight students’ atomic structure models and six of eight students’ electron attribution and motion models were classified as discrete entity and hybrid models. The findings of this study reveal students’ conceptual challenges in explaining the structure of single and multiple-electron atoms and shed light on the factors contributing to the persistent difficulties in their understanding of atomic structure in the realm of quantum mechanics.

Autism spectrum disorder detection using facial images: A performance comparison of pretrained convolutional neural networks.

Autism spectrum disorder (ASD) is a complex psychological syndrome characterized by persistent difficulties in social interaction, restricted behaviours, speech, and nonverbal communication. The impacts of this disorder and the severity of symptoms vary from person to person. In most cases, symptoms of ASD appear at the age of 2 to 5 and continue throughout adolescence and into adulthood. While this disorder cannot be cured completely, studies have shown that early detection of this syndrome can assist in maintaining the behavioural and psychological development of children. Experts are currently studying various machine learning methods, particularly convolutional neural networks, to expedite the screening process. Convolutional neural networks are considered promising frameworks for the diagnosis of ASD. This study employs different pre-trained convolutional neural networks such as ResNet34, ResNet50, AlexNet, MobileNetV2, VGG16, and VGG19 to diagnose ASD and compared their performance. Transfer learning was applied to every model included in the study to achieve higher results than the initial models. The proposed ResNet50 model achieved the highest accuracy, 92%, compared to other transfer learning models. The proposed method also outperformed the state-of-the-art models in terms of accuracy and computational cost.

Efeito da remediação fonológica em criança com altas habilidades/superdotação e dislexia do desenvolvimento

ABSTRACT Twice-exceptionality is characterized as the presence of high performance concomitantly with deficiencies or incompatible conditions. An example is when giftedness manifest associated with neurodevelopmental disorders. This study is a clinical case report referring to the evaluative and interventional process of a 9- year-old child with the paradoxical combination of giftedness associated with dyslexia. It aims to compare the performance in phonological processing, reading and writing before and after phonological remediation. In the first assessment, the child demonstrated alphabetic level in reading, a transition phase between syllabic-alphabetic and alphabetical writing levels, and below-expected performance in phonological processing skills. After intervention, the results showed consistent improvements in phonological processing, the consolidation of alphabetical writing and orthographic reading level. In general, children with isolated dyslexia have persistent difficulties in several skills after intervention. The evolution shown after phonological remediation, especially at reading level, shows different characteristics than expected. Thus, it can be concluded that twice-exceptionality may have favored the overcoming of some of the shown difficulties more successfully. Studies on these combined conditions can contribute to a better understanding of this framework during the development of learning and to formulate specialized interventions.

Management of Paraneoplastic Syndromes in the Era of Immune Checkpoint Inhibitors.

Our understanding of paraneoplastic neurologic syndromes (PNS) has blossomed over the past few decades. Clinicians have access to more robust diagnostic criteria and have a heightened index of suspicion for these disorders. Nonetheless, treatment, which typically includes immunosuppression, and response to treatment, varies. Due to persistent difficulty in making a definitive diagnosis, we favor empiric treatment when a possible diagnosis of PNS is suspected, and other alternative causes have substantially been excluded (e.g., infections, toxic-metabolic derangements, metastasis, or leptomeningeal disease). Treatment of the underlying cancer, if identified, is the first therapeutic step and can prevent disease worsening and in rare cases, can reverse neurologic symptoms. In addition to anti-cancer treatment, first line immunotherapies, which include corticosteroids, intravenous immunoglobulins (IVIG), or plasma exchange (PLEX) are typically used. If partial or no benefit is seen, second line immunotherapeutic agents such as rituximab are considered. Additionally, the severity of the initial presentation and possible risk for relapse influences the use of the latter agents. Symptomatic management is also an important component in our practice and will depend on the syndrome being treated. One of the more novel entities we are facing currently is the management of immune checkpoint (ICI)-induced PNS. In those cases, current American Society of Clinical Oncology (ASCO) guidelines are followed.

Efficient-VGG16: A Novel Ensemble Method for the Classification of COVID-19 X-ray Images in Contrast to Machine and Transfer Learning

Corona Virus Disease 2019 (COVID-19) is a contagious respiratory disease characterized by its high transmissibility and exponential spread, presenting persistent difficulties. This investigation sought to incorporate machine learning (ML) and transfer learning (TL) and introduced Efficient-VGG16, a novel ensemble approach that integrated the EfficientNet-B0 and VGG16 architectures to classify chest X-ray images as either COVID-19 positive or non-COVID. The COVID-Xray-5k dataset used in the research was split into different training and testing sets (with ratios of 80:20, 75:25, and 70:30), preprocessed, and then used to evaluate the approach’s effectiveness. Throughout the investigation, all procedures operated effectively at the same selected image size, 224*224. Preprocessing included Gaussian blur to remove noise and relics, while Contrast Limited Adaptive Histogram Equalization (CLAHE) adjusted contrast. Among the employed ML classifiers, XgBoost attained the highest accuracy, with F1 scores of 95.78% and 71.56%, respectively. In addition, the research investigated the effectiveness of TL using pre-trained convolutional neural networks (CNNs) such as VGG16, MobileNetV3, ResNet101, Densenet201, and EfficientNet-B0. EfficientNet-B0 achieved the highest levels of accuracy and F1 score, 99.31% and 93.72%, respectively. Furthermore, the proposed Efficient-VGG16 achieved accuracy and an F1 score of 99.46% and 98.41%, respectively, and outperformed TL with EfficientNet-B0 and XgBoost. The investigation demonstrated the effectiveness of the Efficient-VGG16 for accurately classifying COVID-19.

Pak-US Relations: An Overview in Historical Perspective (1947-2021)

This comprehensive analysis explores the history of relations between the United States and Pakistan from the country's founding in 1947 to the year 2021, providing valuable context for understanding the complex nature of this diplomatic alliance. Through the use of a historical lens, the study investigates the major occasions, turning moments, and thematic developments that have influenced the bilateral relations between Pakistan and the US over time. Starting with the early years of diplomatic engagement, the examination looks at how Cold War dynamics affected Pakistan and the United States' alignment of interests in the early post-independence era. It explores the significance of Pakistan's role in enabling the U.S. and China to establish diplomatic relations in the 1970s and how it affected world geopolitics. The research also examines times of conflict and divergence, such as the 1960s military aid embargo, the 1980s nuclear proliferation worries, and the difficulties brought on by regional conflicts. A particular focus is placed on the period following 9/11, elucidating the intricacies of the strategic alliance established within the framework of the fight against terrorism and the consequent realignment of objectives. In addition, the abstract evaluates the relationship's economic aspects by looking at trade agreements, foreign aid, and how economic assistance shapes bilateral ties. It also takes into account how the internal political climates of both nations affect the ebb and flow of their interactions. This overview attempts to offer a comprehensive understanding of the persistent trends, difficulties, and opportunities that have shaped Pakistan-U.S. relations by utilizing a historical perspective. The study adds to a thorough examination of the diplomatic, geopolitical, economic, and sociocultural factors that have influenced the development of this important relationship over more than seven decades by using a multidimensional analysis.

The psychometric properties and treatment outcomes associated with two measures of the adult therapeutic alliance using naturalistic data

AbstractPurposeThis is the first of two articles that examine the psychometric properties and treatment outcomes associated with measures of the therapeutic alliance collected in naturalistic settings rather than clinical trials. These articles break new ground in understanding the relationship between measures of alliance and treatment outcome by performing detailed item analyses in order to assess the psychometric properties of each individual item, its propensity to change from session to session and its utility in predicting change in the outcome measure.MethodsData were taken from the ACORN database for adults attending for psychotherapy treatment in naturalistic settings (N = 147,399). The sample, the largest to date, included only those completing both an alliance measure and an outcome measure at every session. Two sets of three different alliance items are used across three different treatment populations: general outpatient, substance use, and severe and persistent mental health difficulties. To investigate this possibility, the psychometric properties of each item were evaluated, including factor analysis, likelihood of change over time in treatment and correlations between changes in alliance and magnitude of client‐reported improvement in therapy. The predictive validity of each individual item is compared with the predictive validity of their respective three‐item measures. The problem of alliance scores being heavily skewed in a positive direction and the resulting lack of variability from session to session is addressed by categorising change in alliance as same, better or worse, regardless of the magnitude of change.ResultsFindings tended to differ from those in clinical trials, with the last alliance score being most predictive of outcome. In this data set, the alliance accounted for, at most, 2% of the variance in outcomes. Measures of the therapeutic alliance demonstrate ceiling effects, and the alliance–outcome correlation is far from linear. Change in alliance score, rather than a single assessment, is more predictive of outcome, regardless of the magnitude of change in the alliance measure, with effect sizes of up to 50% more for those who rated the alliance as worse than for those rating it as no change or better.ConclusionTherapists using therapeutic alliance questionnaires will benefit from being aware of how the psychometric properties of alliance measures impact outcomes. Even the smallest drop in alliance is predictive of significant clinically meaningful differences. Implications for practice, training and research are considered.

The Decision Dilemma: Disinvestment or Turnaround?

The case describes the journey of one of the most ambitious public sector undertakings, Heavy Engineering Corporation Limited (HECL), in the earlier unified state of Bihar, India. Despite being a leading manufacturer and supplier of capital equipment and experiencing growth in the initial years, the company incurred losses for over 17 consecutive years. In the year 2006–2007, the company briefly bounced back to profits, but those revival hopes faded within five years, leaving the company in dire need of an immediate strategic rethink and a complete overhaul. This case specifically focuses on the problems and challenges faced by the cash-strapped public sector enterprise, HECL. It addresses issues such as its negative net worth, the rising wage and incentive bills of its employees, declining product competitiveness at the global level and other persistent financial difficulties and bureaucratic hurdles that created inflexibilities in decision-making. The need for agile and lean management approaches that could increase overall organizational performance, efficiency and value deliverables was also explored.

Developmental profiles of arithmetic fluency skills from grades 1 to 9 and their early identification.

The aim of the present study was to examine the kinds of developmental profiles of arithmetic fluency skills that can be identified across Grades 1-9 (ages 7-16) in a large Finnish sample (n = 2,518). The study also examined whether membership in the developmental profiles could be predicted using a comprehensive set of kindergarten-age factors, including information on cognitive skills; motivational, parental, and home environment factors; and gender. Four profiles of arithmetic fluency skills development were identified using a factor mixture model: persistent arithmetic difficulties (12.23%), precocious onset (50.24%), delayed onset (36.96%), and precocious onset with a Grade 7 drop (.06%). The Cholesky models predicting membership in the three largest profiles suggested that overall, the strongest kindergarten-age predictors were cognitive skills (especially counting, number concepts, spatial relations, rapid automatized naming [RAN], phonological awareness, and letter knowledge), but motivational, parental, and home environment factors were also significant. Membership in the profile with precocious onset was predicted by most of the kindergarten-age measures, suggesting that the strengths in early skills, as well as motivational, parental, and home environment factors, are reflected in the advanced start in arithmetic development at school. The profiles with delayed onset and persistent difficulties were similar in most kindergarten-age measures but differed in task avoidance and four cognitive skills (letter knowledge, counting, number concepts, and RAN), suggesting that these factors predict differential development over the longer term. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Study on the correlation between dietary structure and sleep in patients with insomnia disorder.

Insomnia disorder (ID) is a persistent difficulty sleeping, often accompanied by anxiety and depression, which seriously reduces a person's quality of life. Dietary changes in insomnia patients have been a concern. To explore the rationality of diet in patients with ID and its correlation with insomnia in ID patients. This study included 216 patients diagnosed with ID and 197 individuals as the healthy control (HC) group who attended the neurology outpatient clinic or sleep clinic at Henan Provincial People's Hospital between September 2018 and November 2019. Through the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD), sleep and mental conditions were assessed in the ID and HC groups. The dietary intake structure of both groups was observed using the food frequency table. Meanwhile, the relationship between dietary intake and sleep quality was analyzed based on the logistics regression. Individuals in the ID group had significantly higher age, weight, and body mass index compared to the HC group (p<0.01). Individuals within the ID category demonstrated a heightened daily consumption of carbohydrates, grains, tubers, and legumes relative to the healthy control group. In contrast, the intake levels of vegetables, fruits, and nuts were diminished compared to the HC group, with this difference being statistically significant (p<0.01). A positive correlation was observed between the daily consumption of grains, tubers, and legumes and PSQI scores. Conversely, a negative association was found between daily consumption of vegetables and fruits. ID patients exhibit an elevated intake of carbohydrates, whereas the consumption of vegetables, fruits, and nuts is deficient in comparison to the healthy cohort, implying that a distorted dietary structure might be a contributing factor to ID onset. Sensible and scientific dietary guidance is of considerable significance in preventing the onset of ID and facilitating its management. However, the derived conclusions warrant further extensive research.

A Case of Oropharyngeal Teratoma Associated with Subluxation of Temporomandibular Joint: A Case Report

Teratomas are the most common congenital tumors and contain cells from the ectoderm, mesoderm, and endoderm. They are mainly located in the central axis of the body. The tumors are most commonly found in the sacrococcygeal region, followed by the gonadal site and mediastinum, and rarely in the head and neck. Teratomas can cause various clinical symptoms depending on the location of the mass and may result in feeding difficulties or respiratory distress. We present a case of oropharyngeal teratoma accompanied by respiratory distress and persistent feeding difficulties, leading to compression of the temporomandibular joint, which in turn caused subluxation.

Cognitive Remediation in Bipolar (CRiB2): study protocol for a randomised controlled trial assessing efficacy and mechanisms of cognitive remediation therapy compared to treatment as usual

BackgroundA substantial proportion of people with bipolar disorder (BD) experience persistent cognitive difficulties associated with impairments in psychosocial functioning and a poorer disorder course. Emerging evidence suggests that cognitive remediation (CR), a psychological intervention with established efficacy in people with schizophrenia, can also benefit people with BD. Following a proof-of-concept trial showing that CR is feasible and potentially beneficial for people with BD, we are conducting an adequately powered trial in euthymic people with BD to 1) determine whether an individual, therapist-supported, computerised CR can reduce cognitive difficulties and improve functional outcomes; and 2) explore how CR exerts its effects.MethodsCRiB2 is a two-arm, assessor-blind, multi-site, randomised controlled trial (RCT) comparing CR to treatment-as-usual (TAU). Participants are people with a diagnosis of BD, aged between 18 and 65, with no neurological or current substance use disorder, and currently euthymic. 250 participants will be recruited through primary, secondary, tertiary care, and the community. Participants will be block-randomised (1:1 ratio, stratified by site) to continue with their usual care (TAU) or receive a 12-week course of therapy and usual care (CR + TAU). The intervention comprises one-on-one CR sessions with a therapist supplemented with independent cognitive training for 30–40 h in total. Outcomes will be assessed at 13- and 25-weeks post-randomisation. Efficacy will be examined by intention-to-treat analyses estimating between-group differences in primary (i.e., psychosocial functioning at week 25 measured with the Functional Assessment Short Test) and secondary outcomes (i.e., measures of cognition, mood, patient-defined goals, and quality of life). Global cognition, metacognitive skills, affect fluctuation, and salivary cortisol levels will be evaluated as putative mechanisms of CR through mediation models.DiscussionThis study will provide a robust evaluation of efficacy of CR in people with BD and examine the putative mechanisms by which this therapy works. The findings will contribute to determining the clinical utility of CR and potential mechanisms of action.Trial registrationCognitive Remediation in Bipolar 2 (CRiB2): ISRCTN registry: https://www.isrctn.com/ISRCTN10362331. Registered 04 May 2022. Overall trial status: Ongoing; Recruitment status: Recruiting.