Renske Wassenberg

Developmental changes in semantic verbal fluency: Analyses of word productivity as a function of time, clustering and switching

We investigated age-related improvement in semantic category verbal fluency (VF) in 309 Dutch schoolchildren attending first to ninth grade. Quantitative analyses of number of correct responses as a function of time as well as qualitative analyses of clustering and switching were conducted. Overall, Dutch VF task performance, i.e., number of correct responses over 60 seconds, was not established before mid-adolescence. This is in line with previously published studies, using VF number of correct responses over 60 seconds as the main outcome measure and examining VF task performance across other cultures and languages (e.g., Italian, French, Hebrew). Next, mean cluster size, a measure of lexico-semantic knowledge, was not established until at least grade 3. In contrast, performance on the VF outcome measures “number of switches/clusters” was established at least 4 years later. Qualitative and quantitative Design Fluency (DF) outcome measures support the notion that the numbers of switches/clusters are valid measures of higher order cognitive functions, such as strategy use and cognitive flexibility. In line of this, VF number of correct responses during 16–60 seconds, a measure of controlled information processing, is established at least 2 years later (i.e., grades 7–8) than number of correct responses during the first 15 seconds time slide, a measure of automatic processing. Finally, environment, i.e., the level of parental education, primarily affected automatic and lexico-semantic knowledge. No effects of sex on VF performance were found. These data suggest that the alternative scoring methods of VF tasks can be used to acquire knowledge on development of lower and higher order cognitive functions in healthy children and the influence of the environment on it.

Sustained attention in children and adolescents after traumatic brain injury: relation to severity of injury, adaptive functioning, ADHD and social background

Primary objective: To examine the relationship of child and family psychosocial variables and traumatic brain injury (TBI) severity as it relates to sustained attention (the Paediatric Assessment of Cognitive Efficiency, PACE). Research design: Forty-two children and adolescents were recruited and participated in a 2 year longitudinal study to evaluate sustained attention using the computerized testing metric, PACE. More specifically, errors of omission (inattention) and commission (impulsiveness) were measured. Main outcomes and results: Significant improvement on inattention and impulsiveness were observed over time. High pre-injury psychosocial adversity and low pre-injury adaptive functioning significantly predicted a greater number of inattention errors. Severity of injury predicted the reduction of impulsiveness. Moreover, omission errors immediately after TBI predicted later secondary attention-deficit/hyperactivity disorder (SADHD, ADHD that emerges after TBI). Conclusions: Based on these findings, it is important to consider pre-injury child and family psychosocial characteristics in addition to severity of injury when predicting outcome of TBI in children.

Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units

ContextIf delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required.ObjectiveRelating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm.ResultsDelirium-inducing factors, disturbance of consciousness and inattention are common in PICU patients: a pre-delirious state is present in most. An algorithm is introduced, containing (1) evaluation of the sedation-agitation level, (2) psychometric assessment of behavior and (3) opinion of the caregivers.DiscussionIt may be argued that the behavioral focus of the algorithm would benefit from the inclusion of neurocognitive measures.LimitationsNo sufficiently validated diagnostic instrument covering the entire algorithm is available yet.ConclusionThis is the first proposal for a PD diagnostic algorithm. Given the high prevalence of pre-delirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.

Subtypes of learning disabilities: neuropsychological and behavioural functioning of 495 children referred for multidisciplinary assessment

Aim of the present study was two fold: (1) to evaluate the course of referring and diagnosing Learning Disabilities (LD) and the contribution of multidisciplinary assessment and (2) to describe characteristics of three LD subtypes: Attention with or without Motor function Disabilities (AMD), Verbal Learning Disabilities (VLD) and Non-Verbal Learning Disabilities (NVLD). Diagnostics, behavioural and neuropsychological data from 495 children aged 6–17 years were described. First, AMD and VLD was the most frequent LD. Multidisciplinary assessment could contribute to the diagnostic process of LD, especially in diagnosing uncommon LD and comorbidities. Secondly, behavioural ratings, information processing, attention regularity and visual-motor integration proved to be most sensitive in discriminating between the three LD subtypes. However, diagnosing NVLD requires additional developmental information. Multiple discriminant function analysis correctly classified 61.7% of a selection of the present sample into LD subtypes as diagnosed by the multidisciplinary team. It is believed that the three subtypes are clinically relevant and suggestions are made to test the present classification functions in an independent sample, preferably diagnosed using a structured diagnostic interview.

Animal Verbal Fluency and Design Fluency in school-aged children: Effects of age, sex, and mean level of parental education, and regression-based normative data.

The Animal Verbal Fluency (AVF) and Design Fluency (DF) structured and unstructured test versions were administered to N = 294 healthy native Dutch-speaking children who were aged between 6.56 and 15.85 years. The AVF and DF structured test scores increased linearly as a function of age, whilst the relation between age and the DF unstructured test score was curvilinear (i.e., the improvement in test scores was much more pronounced for younger children than for older children). A higher mean level of parental education was associated with significantly higher AVF and DF structured test scores. Sex was not associated with any of the outcomes. Demographically corrected norms for the AVF and DF tests were established, and an automatic scoring program was provided.

Speed of language comprehension is impaired in ADHD

Objective: Children with ADHD have an increased risk of poor academic performance. It is important to identify cognitive processes that may be related to this academic failure. In Western schooling systems, especially language processing skills may be of relevance. The present study, therefore, compares the ability to comprehend complex sentences of individuals with and without ADHD. Method: Fifteen children (aged 8-11) and 15 adolescents (aged 12-16) with ADHD combined subtype are matched for age, gender, and parental level of education to 30 control subjects. Language comprehension is measured using the neuropsychological procedure proposed by Luria and an adapted version of the Token Test. Results: Compared with the control group, children and adolescents with ADHD perform significantly slower on language comprehension tasks. Differences in accuracy are limited. No interaction between age and ADHD is found. Conclusions: Children and adolescents with ADHD are slower and less efficient than matched control subjects with regard to complex sentence comprehension. (J. of Att. Dis. 2010; 13(4) 374-385)

Development of Inattention, Impulsivity, and Processing Speed as Measured by the d2 Test: Results of a Large Cross-sectional Study in Children Aged 7–13

The development of three aspects of selective attention was studied in 451 Dutch schoolchildren attending second to sixth grade. Selective attention was measured with the d2 Test of attention. The largest age differences were found for processing speed that continued to improve until the sixth grade. Impulsivity, as measured by the percentage of errors of commission, decreased until the fourth grade. Inattention, measured by the percentage of errors of omission, was stable in all grades. Processing speed and impulsivity were correlated with the score on the Attention Problems subscale of the Child Behavior Checklist. These results imply that selective attention continues to develop, at least, until the end of elementary school. The findings are support for a step-wise model of cognitive development (P. Anderson, 2002).

Age-related improvement in complex language comprehension: Results of a cross-sectional study with 361 children aged 5 to 15

We investigated age-related improvement in speed and accuracy of complex language comprehension with 361 children attending kindergarten and the 2nd, 4th, 6th, 7th, and 8th grades. Language comprehension was measured using both the neuropsychological procedure proposed by Luria (1966, 1980) and an adapted version of the Token Test. Levels of short-term memory and verbal intelligence were controlled for in the evaluation of language comprehension. The findings show that the accuracy of language comprehension continued to develop until the 6th grade, whereas the speed of language comprehension continued to improve up until the 7th grade. We thus conclude that the complex language comprehension of children is not fully developed until early adolescence. We further contend that the speed of complex language comprehension appears to be more sensitive than accuracy with respect to measuring developmental differences.

Classifying psychiatric disorders after traumatic brain injury and orthopaedic injury in children: adequacy of K-SADS versus CBCL

Primary objective: To evaluate the convergence between the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) for the diagnosis of psychiatric disorders and the Child Behavior Checklist (CBCL). Research design: Cross-sectional psychiatric study of 72 children with traumatic brain injuries or orthopaedic injuries aged 5–14. Methods and procedures: Sensitivity, specificity, total predictive value and odds ratio were calculated to evaluate the association between CBCL summary scores and K-SADS diagnosis of at least one psychiatric disorder (K-SADS-1), and of CBCL subscales and K-SADS diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD). Lowered cut-off scores of t ≥ 60 were used. Main outcomes and results: Convergence between the CBCL total problem scale and K-SADS-1 was poor. Convergence between ‘at least one elevated CBCL subscale’ and K-SADS-1, and between CBCL attention problems and social problems scales and K-SADS diagnosis of ADHD was excellent. Conclusions: Caution is needed when using the total problem scale of CBCL in predicting global psychological impairment because underestimation of problems is likely. The attention and social problems scales of CBCL can be used to estimate ADHD.

On the association between lateral preferences and pregnancy/birth stress events in a nonclinical sample of school-aged children

The pathological left-handedness theory claims that pregnancy and birth stress events (PBSEs) are important risk factors for sinistrality, but previous studies yielded inconclusive results. The aim of the present study was to further evaluate the effect of PBSEs on multiple indicators of lateral preference (i.e., hand, foot, eye, and ear preferences), strength of lateral preferences, and overall lateral consistency in a large nonclinical sample of school-aged children. Results showed that PBSEs occurred in about one third of the sample (mainly forceps use, cesarean section, and preterm birth). The occurrence of PBSEs did not significantly affect the lateral preference, strength of lateral preference, or the overall lateral consistency measures. On average, the PBSEs accounted for only 0.36% of the variance in the outcome measures. The validity of the pathological left-handedness theory could thus not be supported in the present study.