Kathleen M. Jenks

Perceptions of cardiovascular risk among patients with hypertension or diabetes

We aimed to examine risk perceptions among patients at moderate to high cardiovascular risk. A questionnaire about perceived absolute risk of myocardial infarction and stroke was sent to 2424 patients with hypertension or diabetes. Response rate was 86.3% and 1557 patients without atherosclerotic disease were included. Actual cardiovascular risk was calculated by using Framingham risk functions. A total of 363 (23.3%) of the 1557 patients did not provide any risk estimates and these were particularly older patients, patients with a lower educational level, and patients reporting no alcohol consumption. The remaining 1194 patients tended to overestimate their risk. In 42.3% (497/1174) and 46.8% (541/1155) of the cases, patients overestimated their actual 10-year risk for myocardial infarction and stroke, respectively, by more than 20%. Older age, smoking, familial history of cardiovascular disease (CVD), and actual absolute risk predicted higher levels of perceived absolute risk. Male sex, higher scores for an internal health locus of control, lower scores for a physician locus of control, and self-rated excellent or (very) good health were positively related to higher accuracy. In conclusion, patients showed inadequate perceptions of their absolute risk of cardiovascular events and physicians should thus provide greater information about absolute risk when offering preventive therapy.

Arithmetic difficulties in children with cerebral palsy are related to executive function and working memory

BACKGROUND Although it is believed that children with cerebral palsy are at high risk for learning difficulties and arithmetic difficulties in particular, few studies have investigated this issue. METHODS Arithmetic ability was longitudinally assessed in children with cerebral palsy in special (n = 41) and mainstream education (n = 16) and controls in mainstream education (n = 16). Second grade executive function and working memory scores were used to predict third grade arithmetic accuracy and response time. RESULTS Children with cerebral palsy in special education were less accurate and slower than their peers on all arithmetic tests, even after controlling for IQ, whereas children with cerebral palsy in mainstream education performed as well as controls. Although the performance gap became smaller over time, it did not disappear. Children with cerebral palsy in special education showed evidence of executive function and working memory deficits in shifting, updating, visuospatial sketchpad and phonological loop (for digits, not words) whereas children with cerebral palsy in mainstream education only had a deficit in visuospatial sketchpad. Hierarchical regression revealed that, after controlling for intelligence, components of executive function and working memory explained large proportions of unique variance in arithmetic accuracy and response time and these variables were sufficient to explain group differences in simple, but not complex, arithmetic. CONCLUSIONS Children with cerebral palsy are at risk for specific executive function and working memory deficits that, when present, increase the risk for arithmetic difficulties in these children.

The Effect of Cerebral Palsy on Arithmetic Accuracy is Mediated by Working Memory, Intelligence, Early Numeracy, and Instruction Time

The development of addition and subtraction accuracy was assessed in first graders with cerebral palsy (CP) in both mainstream (16) and special education (41) and a control group of first graders in mainstream education (16). The control group out-performed the CP groups in addition and subtraction accuracy and this difference could not be fully explained by differences in intelligence. Both CP groups showed evidence of working memory deficits. The three groups exhibited different developmental patterns in the area of early numeracy skills. Children with CP in special education were found to receive less arithmetic instruction and instruction time was positively related to arithmetic accuracy. Structural equation modeling revealed that the effect of CP on arithmetic accuracy is mediated by intelligence, working memory, early numeracy, and instruction time.

The relationship between medical impairments and arithmetic development in children with cerebral palsy.

Arithmetic ability was tested in children with cerebral palsy without severe intellectual impairment (verbal IQ ≥ 70) attending special (n = 41) or mainstream education (n = 16) as well as control children in mainstream education (n = 16) throughout first and second grade. Children with cerebral palsy in special education did not appear to have fully automatized arithmetic facts by the end of second grade. Their lower accuracy and consistently slower (verbal) response times raise important concerns for their future arithmetic development. Differences in arithmetic performance between children with cerebral palsy in special or mainstream education were not related to localization of cerebral palsy or to gross motor impairment. Rather, lower accuracy and slower verbal responses were related to differences in nonverbal intelligence and the presence of epilepsy. Left-hand impairment was related to slower verbal responses but not to lower accuracy.

Affective Processes in Learning

In the last decade the role of emotions in education seems to have been rediscovered (Maehr, 2001). Affective processes are now recognised as playing an important role in learning. Students’ emotions, such as, enjoyment, boredom, pride, and anxiety are seen to affect achievement by influencing the student’s involvement and attitude towards learning and learning environments, which also affects how (intensively) students process and/or interpret information (for a discussion see e.g., Boekaerts, 2003; Boekaerts & Simons, 1995; Pekrun, 2005; Pekrun, Goetz, Titz, & Perry, 2002). This (renewed) attention for affect is the result of several developments. A first development is the change from teacher-directed to learner-centred approaches in education, which often involve giving more responsibility for and control over the learning process to the learners.

Issues from Neuroscience

The present volume takes educational issues as a starting point and looks at possible contributions which could be given from the point of view of cognitive neuroscience. Issues that directly arise from the neurosciences which might be of relevance for education are only described in relation to educational issues. The interested reader is referred to recent reviews and ‘opinion’ articles which take a more cognitive neuroscience stance (e.g., Ansari & Coch, 2006; Casey, Getz, & Galvan, 2008; Jolles, 2007a,b; OECD, 2002, 2007; Steinberg, 2008) and other papers, mentioned in the Introduction. Yet, two issues deserve a short elaboration, because they are pertinent to the scientific findings and directions described in earlier sections. This concerns the issues of ‘plasticity’ and ‘maturation’.

Second) Language Learning and Literacy

Literacy is incredibly complex, and a full report on the links between neuroscience and language instruction would be an undertaking all on its own. In this chapter we therefore focus on a number of focal questions: What is the neurological basis of development of literacy? Can cognitive neuroscience help to distinguish between competing models discussed in educational research? What is the role of age of acquisition in second language (L2) learning? Does early L2 learning have a negative impact on acquisition of literacy in the native language? Can late L2 learners process an L2 in a native-like way? First, we give a brief overview of educational research developments in these areas, followed by an overview of neurocognitive contributions.

Numeracy and Mathematics Learning

Because numeracy, like literacy, results from the interplay of biology and experience it is the natural domain of both cognitive neuroscience and educational science. Although there is no single agreed upon definition, numeracy implies an understanding of the concept of number and the ability to reason quantitatively. As such, it is considered the basis of both simple and complex mathematics.