Jane Holmes Bernstein

Processing Speed in Children With Attention Deficit/Hyperactivity Disorder, Inattentive Type

Attention Deficit/Hyperactivity Disorder (ADHD) is among the most common and most often reconceptualized neurobehavioral disorders of childhood. In the most recent DSM-IV, a primarily inattentive subtype of ADHD (AD) has again been identified. This study explores the neuropsychological profile of this group of children. Eighty-two children referred for school-related problems participated. Twenty-five met criteria for AD; 52 met criteria for reading disability (RD); 9 were comorbid for RD and AD. AD children performed poorly on measures of information processing speed. Children with comorbid AD/RD were distinguishable from those with RD on speed of processing measures only. Vulnerability to information processing load may be at the root of many of the behavioral manifestations of AD.

Neurobehavioral and Neurologic Outcome in Long-Term Survivors of Posterior Fossa Brain Tumors: Role of Age and Perioperative Factors

We evaluated the neuropsychological and neurologic outcome of 15 long-term survivors of posterior fossa tumors who were treated between 1970 and 1984 with cranial irradiation (n = 15) and surgery (n = 14). The interval between diagnosis and evaluation ranged from 4 to 20 years (median = 10 years). Earlier age at diagnosis (< 6 years) was associated with an increased incidence of severe neurologic and neuropsychological sequelae. Hydrocephalus, obtundation, and tumor extension outside the vermis also were more prevalent in the younger group. Poor neurobehavioral outcomes in young children with posterior fossa tumors may be related to more aggressive tumor growth or complications of the initial therapy and not solely due to toxicity from craniospinal irradiation. (J Child Neurol 1995;10:209-212).

Visual-spatial skills in children after open-heart surgery

ABSTRACT. This study was part of a randomized clinical trial comparing the central nervous system effects of the two vital organ‐support methods used in infant cardiac surgery: total circulatory arrest and low‐flow cardiopulmonary bypass. The extent to which visual‐spatial deficits are (1) associated with surgical and perioperative variables, (2) attributable to visual‐perceptual, motor control, or metacognitive deficits, and (3) associated with adaptive difficulties at home or school was evaluated. The subjects were 155 8‐year‐old children with D‐transposition of the great arteries who underwent the arterial switch operation before 3 months of age. As part of a comprehensive evaluation, the Rey‐Osterrieth Complex Figure (ROCF) was administered. ROCF copy productions were classified as having a Basal Organization Level of 1 (low) or 2 or greater. A five‐category clinical rating was also assigned. More than half of the children in the cohort (52%) had copy productions scored at Level 1, more than twice the expected frequency. The risk of having a low score was not associated with vital organ support method or other surgical variables. On the basis of comparisons of the relative fits of nested logistic regression models, poor visual‐perceptual abilities were more predictive of having a Level 1 score than either motor control or metacognitive deficits. Children with poor copy production scores had lower mathematics scores, but not lower reading scores or poorer parent and teacher ratings of adaptive competence. The percentage of children receiving remedial school services was associated with ROCF clinical rating, ranging from 58% in the worst category to 8% in the best category. Visual‐spatial deficits are common among children after infant heart surgery and seem to reflect visual‐perceptual rather than motor control or metacognitive deficits. In addition, these deficits do not seem to be clearly associated with the intraoperative methods or postoperative events evaluated. J Dev Behav Pediatr 24:169‐179, 2003. Index terms: congenital heart disease, visual‐spatial skills, transposition of the great arteries, Rey‐Osterrieth Complex Figure.

Effects of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) at Age 8 Years: Preliminary Data

The current study reports the effects of NIDCAP (Newborn Individualized Developmental Care and Assessment Program) at 8 years of age for a randomized controlled trial of 38 very early born (≤29 weeks postmenstrual age), high-risk preterm infants. It was hypothesized that the experimental group at school age in comparison with the control group would perform significantly better neuropsychologically and neuroelectrophysiologically. Twenty-two (11 control, 11 experimental) children of the original 38 (18 control, 20 experimental) participants were studied at school age with a detailed neuropsychological battery and with EEG spectral coherence measures. Results indicated significantly better right hemisphere and frontal lobe function in the experimental group than the control group, both neuropsychologically and neurophysiologically. Neurobehavioral and physiological results in the newborn period successfully predicted the beneficial brain function effects at age 8 years. Results support the conclusion that the NIDCAP intervention has lasting effects into school age.

Information Processing Deficits in Children with Attention-Deficit/Hyperactivity Disorder, Inattentive Type, and Children with Reading Disability

We examined the information processing capabilities of children diagnosed with the inattentive subtype of attention-deficit/hyperactivity disorder (ADHD) who had been characterized as having a sluggish cognitive tempo. Children referred for school-related problems (n = 81) and nonreferred community controls (n = 149) participated. Of the referred children, 24 met criteria for ADHD, 42 met criteria for reading disability (RD), and 9 of these were comorbid for RD and ADHD. Children with ADHD differed from those without ADHD on a visual search task but not on an auditory processing task; the reverse was true for children with RD. Decomposition of the visual search task into component operations demonstrated that children in the ADHD group had a slow processing rate that was not attributable to inattention. The children with ADHD were not globally poor at information processing or inattentive, but they demonstrated diminished speed of visual processing.

Sources of poor performance on the Rey-Osterrieth Complex Figure Test among children with learning difficulties: a dynamic assessment approach.

A dynamic assessment approach was used to examine the source of poor performance on the Rey–Osterrieth Complex Figure Test (ROCF) among 202 school-age children referred for learning difficulties. The ROCF was administered in the standard format and then in a structured format that highlighted the designs organizational framework. Manipulating encoding in this way improved recall to at least age-level for the majority of children. Those children who did not benefit from the structured format had relatively poor visual organizational skills. For most children with learning problems, poor ROCF performance stems from metacognitive difficulties; for a minority, the source appears to be more perceptual. A dynamic assessment procedure can enhance the diagnostic utility of the ROCF for children.

Performance of learning‐disabled and non‐learning‐disabled children on the Rey‐Osterrieth Complex Figure: Validation of the developmental scoring system

We evaluated performance on the Rey‐Osterrieth Complex Figure (ROCF) test of 323 children between 7 and 14 years old who were referred for evaluation as learning disabled (LD) as well as 353 non‐LD controls. The Waber‐Holmes developmental scoring system (Waber & Holmes, 1985, 1986), which quantifies organization, style, accuracy (organizational scheme [OS], incidental feature [IF]), and errors, was employed. There were reliable group differences for all outcomes, the magnitude of which was age related. Children in the non‐LD group showed marked improvement between 8 and 9 years old in organization, style (more configurational), and the number of organizational‐structure components reproduced, with steady but more gradual improvement at older ages. Frequency of errors among non‐LD children declined with age. There were no age‐related effects for any outcome for the LD group, whose performance remained at the normative 8‐year level through age 14. For LD children, the ROCF is sensitive to metacognitive skil...

Neuropsychological diagnostic profiles of children who received CNS treatment for acute lymphoblastic leukemia: The systemic approach to assessment

A systemic developmental neuropsychological approach (Bernstein & Waber, 1990) was applied in a controlled fashion to evaluate its reliability and validity. Specifically, we examined the impact of central nervous system (CNS) treatment on behavioral development of children treated for acute lymphoblastic leukemia (ALL). A blind structured clinical rating procedure yielded severity ratings and neuropsychological diagnoses for 49 ALL patients and 15 Wilms tumor (WT) patients. The ALL patients were more severely affected than the WT patients and females more affected than males. Neuropsychological diagnostic profiles were systematically related to age at CNS treatment: Children treated before 36 months of age exhibited inefficiencies of right‐hemisphere brain systems; those treated at older ages showed left‐hemisphere related inefficiencies. The findings are discussed in relation to processes of human postnatal neurobehavioral development, as well as to the status of the systemic approach.

Neurobehavioral test strategies for environmental exposures in pediatric populations

The Agency for Toxic Substances and Disease Registry convened a workshop in Atlanta, GA, that evaluated approaches and methods to ascertain whether there are neurobehavioral sequelae to children and adults exposed to hazardous substances in the environment. This article, developed from that workshop, addresses the feasibility of employing extant neurobehavioral tests to screen pediatric populations. A matrix lists basic functions to be assessed during eight developmental periods ranging from birth to high school. The best of these neurobehavioral tests for pediatric populations and the types of assessment tools that are still needed are discussed. We make 10 specific recommendations to establish a hazardous substances neurobehavioral screen for pediatric populations, including appointing a review panel, developing a structured questionnaire, convening a conference on design and analysis, addressing minority and socially disadvantaged populations, coordinating adult and child assessment methods, information sharing among Federal agencies, baseline data, methodology research, research associated with hazardous worksites, and establishment of a pediatric databank.

Mind, brain, and education in reading disorders

Part I. What is Reading, and What are Reading Disorders? Looking to Neuroscience, Evolution and Genetics: 1. Towards a grounded synthesis of mind, brain and education for reading disorders: an introduction to the field and this book Kurt W. Fischer, Mary Helen Immordino-Yang and Deborah Waber 2. An evolutionary perspective on reading and reading disorders Mary Helen Immordino-Yang and Terrence W. Deacon Essay: brain volume and the acquisition of adaptive capacities Verne S. Caviness 3. The genetics of dyslexia: what is the phenotype? Albert M. Galaburda and Gordon F. Sherman Part II. Reading and the Growing Brain: Methodology and History: 4. A brief history of time, phonology, and other explanations of developmental dyslexia Maryanne Wolf and Jane Ashby 5. Approaches to behavioural and neurological research on learning disabilities: in search of a deeper synthesis Robbie Case 6. Growth cycles of mind and brain: analyzing developmental pathways of learning disorders Kurt W. Fischer, L. Todd Rose and Samuel P. Rose Essay: cycles and gradients in development of the cortex Robert W. Thatcher 7. Brain bases of reading disabilities Francine Benes and Juliana Pare-Blagoev 8. The neural correlates of reading disorder: functional magnetic resonance imaging Juliana Pare-Blagoev 9. Patterns of cortical connection in children with learning problems Frank H. Duffy Essay: the role of experience in brain development: adverse effects of childhood maltreatment Martin H. Teicher Part III. Watching Children Read: 10. Finding common ground to promote dialogue and collaboration: using case material to jointly observe childrens behaviour Jane Holmes Bernstein 11. Analyzing the reading abilities of four boys: educational implications Susan Brady 12. First impressions: what four readers can teach us Benita A. Blachman 13. Analysis of reading disorders from a neuropsychological perspective H. Gerry Taylor 14. An education/psychological perspective on the behaviors of three children with reading disabilities Joseph K. Torgesen Part IV. Reading Skills in the Long Term: 15. The importance of comprehension in reading problems and instruction Joseph C. Campione Essay: bringing reading research to the trenches Sandra Priest Rose 16. What successful adults with dyslexia teach educators about children Rosalie Fink 17. Is a synthesis possible? Making doubly sure in research and application David Rose.