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Journal: Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence

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Recent attempts to identify a neurocognitive profile of children with prenatal alcohol exposure (PAE) have led to an emerging “generalized deficit” conceptualization marked by diffuse information processing and integration difficulties as opposed to a specific profile. This study examines whether this conceptualization can be extended to higher functioning children with PAE who are without intellectual disability and addresses several limitations of previous research. One hundred twenty-five children aged 6-12 years with social skills deficits, 97 of whom met diagnostic criteria for a Fetal Alcohol Spectrum Disorder (FASD), underwent a comprehensive, multi-informant assessment of neurocognitive, emotional, social, behavioral, and adaptive functioning. Multivariate analyses of variance examined differences in functioning between the PAE group and a nonexposed comparison group with and without controlling for child IQ. Results indicated that the PAE group returned significantly poorer scores than the nonexposed group on every construct assessed, including executive functioning, attention, working/visuospatial memory, linguistic abstraction, adaptive behavior, emotional/behavioral functioning, and social cognition. These differences largely maintained after controlling for IQ and were similar regardless of informant, although teachers reported somewhat fewer group differences. Within the PAE group, no differences were found across FASD subtypes. These results provide evidence extending the emerging generalized deficit conceptualization of children with PAE to those higher functioning individuals without global intellectual disability.

Concepts: Psychology, Alcohol, Pregnancy, Prenatal development, Cognition, Mental retardation, Disability, Fetal alcohol syndrome

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Background: Children with fetal alcohol spectrum disorders (FASD) exhibit difficulties in many cognitive and behavioral domains and also have high comorbidity with other disorders such as attention deficit/hyperactivity disorder (ADHD) and conduct disorder as well as autism. Although the FASD profile is shown to be distinct from ADHD and conduct disorder, far less is known about the commonalities with autism. The current study used a parent-rated questionnaire containing an autism subscale to explore the autistic-like features that children with FASD exhibit. Methods: Studied were 25 children with FASD (age: M = 10.3 years) and 17 normal controls (NCs; age: M = 10.2 years). As part of a larger study, all parents/caregivers completed the Social Skills Improvement System (SSIS; Gresham & Elliot, 2008), which in addition to evaluating social skills and behavior problems globally, includes an Autism subscale. Results: Between-group comparisons showed the FASD group not only scored significantly lower in social skills and significantly higher in behavior problems than the NC group but children with FASD also scored significantly higher on the Autism subscale. Item analysis revealed they showed the most difficulty in terms of social and communicative functioning and the least in repetitive and restrictive behaviors. Conclusion: Current findings signify that FASD and autism share similarities with regard to social and communicative functioning. These findings, which further our knowledge of the FASD phenotype, may be useful in specifying the particular interventions these children need.

Concepts: Psychology, Attention, Attention-deficit hyperactivity disorder, Mental disorder, Behavior, Human behavior, Mental retardation, Childhood psychiatric disorders

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It is widely known that humans have a tendency to imitate each other and that appropriate modulation of automatic imitative behaviors has a crucial function in social interactions. Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterized by motor and phonic tics. Apart from tics, patients with GTS are often reported to show an abnormal tendency to automatically imitate others' behaviors (i.e., echophenomena), which may be related to a failure in top-down inhibition of imitative response tendencies. The aim of the current study is to explore the top-down inhibitory mechanisms on automatic imitative behaviors in youngsters with GTS. Error rates and reaction times from 32 participants with GTS and 32 controls were collected in response to an automatic imitation task assessing the influence of observed movements displayed in the first-person perspective on congruent and incongruent motor responses. Results showed that participants with GTS had higher error rates than controls, and their responses were faster than those of controls in incompatible stimuli. Our findings provide novel evidence of a key difference between youngsters with GTS and typically developing participants in the ability to effectively control the production of own motor responses to sensory inputs deriving from observed actions.

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Memory disturbances are common in children with neurological and developmental conditions. One way to measure memory disturbances and their functional implications is via a memory questionnaire. Several pediatric memory questionnaires have been published but no systematic review has been conducted to establish their psychometric properties. This review evaluated currently available pediatric memory questionnaires using the Evidence-Based Assessment (EBA) criteria developed by the American Psychological Association Task force. A systematic search of CINAHL, EMBASE, Medline, and PsychINFO was completed on June 2019. The selection process was guided by pre-defined inclusion and exclusion criteria, followed by full manuscript reviews, and hand-search of reference lists of relevant papers. Selected questionnaires were evaluated by two independent raters against the EBA criteria and classified into “well established”, “approaching well-established”, and “promising” categories. The electronic searches yielded 9888 articles, 24 of which met the inclusion criteria. Hand searches identified additional 21 studies. The 45 identified studies reported on 24 versions of 10 memory questionnaires assessed working memory, everyday memory, prospective and retrospective memory, and self-awareness of memory functions. Based on EBA criteria, only one memory questionnaire (The Working Memory Rating Scale - 20 item version) was classified as “well-established”, 3 as “approaching well-established”, and 20 as “promising”. Most (n = 19) had good reliability but lacked concurrent validity; had low or no correlations with objective memory tests, and low predictive power. In conclusion, this review highlights an urgent need for the development and validation of pediatric memory questionnaires to increase the evidence base and improve questionnaires' clinical utility.

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Objective. The current study examined the effects of clinical factors (i.e., treatment type, history of cerebellar mutism) as well as environmental factors (i.e., family environment) as predictors of cognitive and psychosocial outcomes in children treated for posterior fossa tumors. Method. Twenty-seven children/adolescents treated for posterior fossa tumors (treatment type: radiation [n = 12], surgery [n = 15]; history of mutism: yes [n = 7], no [n = 20]) and n = 13 healthy controls, aged 8-17 years, and their caregivers completed measures assessing cognitive and psychosocial functioning, as well as the family environment (i.e., parental education, family functioning, family psychiatric history). Hierarchical linear regression analyses were conducted to examine the role of clinical factors and the family environment as predictors of cognitive and psychosocial outcomes. Family environment was also examined as a moderator of clinical factor group differences in outcomes. Results. Regression analyses revealed lower intelligence scores among the radiation group compared to the control group, lower verbal memory scores among both treatment groups compared to the control group, and a significant positive effect of parental education on verbal memory scores. Further, history of cerebellar mutism predicted poorer performance on a speeded naming task, and this relationship was moderated by family functioning, with a greater effect of mutism present among those with poorer family functioning. Conclusions. Interventions aimed at improving the family environment may help to mitigate negative cognitive effects of pediatric brain tumors, particularly among those most at-risk for poor outcomes.

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The relationship between phonological knowledge and reading is consistent both in typically developing children and in children with dyslexia. However, children with dyslexia usually show lower phonological skills. In a group of children with dyslexia 8- to 12-year-old we investigated how different long-term memory phonological associations are updated in memory, that is how are kept in mind and replaced when no longer relevant. Response times (RTs) and accuracy rates were collected. Typically, long-term memory associations are dismantled and updated with greater difficulty (longer RTs). We did not replicate these findings in children with dyslexia thus demonstrating the effects of phonological disruption during updating, a mechanism that is preserved overall. In summary, our work advances literature about how phonological knowledge impacts verbal working memory updating.

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It is now established that socioeconomic variables are associated with cognitive, academic achievement, and psychiatric outcomes. Recent years have shown the advance in our understanding of how socioeconomic status (SES) relates to brain development in the first years of life (ages 0-5 years). However, it remains unknown which neural structures and functions are most sensitive to the environmental experiences associated with SES. Pubmed, PsycInfo, and Google Scholar databases from January 1, 2000, to December 31, 2019, were systematically searched using terms “Neural” OR “Neuroimaging” OR “Brain” OR “Brain development,” AND “Socioeconomic” OR “SES” OR “Income” OR “Disadvantage” OR “Education,” AND “Early childhood” OR “Early development”. Nineteen studies were included in the full review after applying all exclusion criteria. Studies revealed associations between socioeconomic and neural measures and indicated that, in the first years of life, certain neural functions and structures (e.g., those implicated in language and executive function) may be more sensitive to socioeconomic context than others. Findings broadly support the hypothesis that SES associations with neural structure and function operate on a gradient. Socioeconomic status is reflected in neural architecture and function of very young children, as early as shortly after birth, with its effects possibly growing throughout early childhood as a result of postnatal experiences. Although socioeconomic associations with neural measures were relatively consistent across studies, results from this review are not conclusive enough to supply a neural phenotype of low SES. Further work is necessary to understand causal mechanisms underlying SES-brain associations.

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Background: The purpose of this study was to evaluate brain structure and function in participants with iCL/P and unaffected controls. Effects of cleft presence and reading status (average vs impaired) were evaluated. Methods: Males, ages 8-11 years old, including 26 with iCL/P and 57 unaffected peers were recruited and coded for reading status (average vs impaired). All participants underwent a volumetric and task-based functional MRI. Volumes and significant regions of activation during the decoding task were obtained. Main effects of cleft and reading status, and their interaction were evaluated. Results: Participants with iCL/P had significantly increased frontal gray matter volume (associated with average reading) and occipital gray and white matter volume (associated with impaired reading). Impaired readers with iCL/P had a distinctive activation pattern in visual association and motor regions relative to other groups. Conclusions: Findings suggest that increases in frontal gray matter volume may be associated with effective compensation during reading, while posterior increases in occipital volume may be associated with ineffective compensation for participants with iCL/P. These patterns were different from idiopathic dyslexia. Further work in a larger sample is needed to determine if these differences are associated with cleft type and with sex. Abbreviations: iCL/P (isolated cleft lip and/or palate); iCL (isolated cleft lip only); iCLP (isolated cleft lip and palate); iCP (isolated cleft palate only); uAR (unaffected average reader); uIR (unaffected impaired reader); cAR (average reader with iCL/P); cIR (impaired reader with iCL/P).

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Congenital hypothyroidism (CH) is an important cause of preventable intellectual disability. Implementation of CH neonatal screening programs leading to early treatment has improved cognitive outcome. However, more subtle cognitive impairments are still reported, and there is lack of clarity regarding factors that impact long-term cognitive outcome. Research to better understand these factors can lead to further improvements in the cognitive prognosis for these patients. The current study aimed to evaluate the cognitive performance of adolescents who were early-treated for primary permanent CH and possible associated variables. Neurocognitive evaluation was carried out in 66 adolescents, 11 to 16 years old: 34 with CH and 29 paired controls. Intellectual quotient (IQ), verbal fluency, processing speed, executive functions, and memory were investigated. CH patients and control subjects were comparable regarding sex, age, schooling, family’s socioeconomic status and caregiver’s educational level. Both groups presented not only similar IQ scores but also equivalent performances regarding Perceptual Reasoning, Working Memory and Processing Speed index scores. Patients presenting different CH etiologies (dysgenesis and dyshormonogenesis) showed similar cognitive performance. Socioeconomic aspects along with the initial levothyroxine dose were the main variables to positively influence the cognitive performance, the family’s socioeconomic status having the strongest association with patients' cognitive skills.

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The relation between sustained attention in the laboratory and behaviors exhibited in naturalistic settings among children with Attention Deficit/Hyperactivity Disorder (ADHD) remains unclear. Additionally, research on stimulant medication effects in these areas and their association with one another remains scarce. Twenty-one children with ADHD and 21 children without ADHD completed a novel continuous performance test (CPT) involving high cognitive demands (e.g., visual search). Participants with ADHD also attended a Summer Treatment Program and received three doses of stimulant medication (placebo, low, and high). Their behavior in classroom and peer settings was observed and recorded, and they completed the CPT in each medication condition. The CPT measures of bias and sensitivity were used in analyses. Results indicated that children with ADHD had impaired overall performance and worse bias during the second half of the task compared to controls. Methylphenidate improved both naturalistic behavior and overall CPT performance but did not specifically improve the sustained attention deficit. Despite improvements in overall CPT performance, medication-related improvement in CPT performance did not mediate medication-related improvement in observed behavior in classroom or recreational settings. As such, our findings suggest that although children with ADHD do demonstrate a sustained attention deficit, salutary psychostimulant effects on CPT performance are not indicative of, or causally linked to, psychostimulant effects on presenting problems in naturalistic settings.