Autism is a neurodevelopmental disorder that has been associated with atypical brain functioning. Functional connectivity MRI (fcMRI) studies examining neural networks in autism have seen an ...exponential rise over the last decade. Such investigations have led to the characterization of autism as a distributed neural systems disorder. Studies have found widespread cortical underconnectivity, local overconnectivity, and mixed results suggesting disrupted brain connectivity as a potential neural signature of autism. In this review, we summarize the findings of previous fcMRI studies in autism with a detailed examination of their methodology, in order to better understand its potential and to delineate the pitfalls. We also address how a multimodal neuroimaging approach (incorporating different measures of brain connectivity) may help characterize the complex neurobiology of autism at a global level. Finally, we also address the potential of neuroimaging-based markers in assisting neuropsychological assessment of autism. The quest for a neural marker for autism is still ongoing, yet new findings suggest that aberrant brain connectivity may be a promising candidate.
Conventional meta-analytic procedures assume that effect sizes are independent. When effect sizes are not independent, conclusions based on these conventional procedures can be misleading or even ...wrong. Traditional approaches, such as averaging the effect sizes and selecting one effect size per study, are usually used to avoid the dependence of the effect sizes. These ad-hoc approaches, however, may lead to missed opportunities to utilize all available data to address the relevant research questions. Both multivariate meta-analysis and three-level meta-analysis have been proposed to handle non-independent effect sizes. This paper gives a brief introduction to these new techniques for applied researchers. The first objective is to highlight the benefits of using these methods to address non-independent effect sizes. The second objective is to illustrate how to apply these techniques with real data in R and Mplus. Researchers may modify the sample R and Mplus code to fit their data.
Several studies have found that maltreated children show neuropsychological deficits in various cognitive domains such as memory and attention, language, visuospatial skills, emotional regulation, ...social cognition, and executive functioning. In terms of functional connectivity, abused children show an increased connectivity in the salience network (SN) as opposed to a decreased connectivity within the default (DMN) and executive networks (CEN). Children who suffer maltreatment may develop post-traumatic stress disorder (PTSD), which in turn, can increase psychological and cognitive sequelae. The present study examined the relation between resting state functional connectivity (RSFC), PTSD symptoms and neuropsychological profiles in abused children before and after following a psychological therapy named Trauma Focused Cognitive Behavioral therapy (TF-CBT). Resting state functional magnetic resonance imaging, neuropsychological (attention, memory and executive functions) and clinical evaluations were performed in 13 abused children with PTSD (mean age=8.77 years old, S.D.=1.83) recruited from a non-governmental shelter in Mexico and in a control group of 10 children from the general population (mean age = 9.57 years old, S.D. = 1.91). Both groups were matched according to age and gender. Changes in PTSD symptoms correlated with changes in the left insula node. Additionally, significant correlations were identified between changes in the average connectivity of the DMN, intra-nodal connectivity of lateral parietal and medial prefrontal regions, and performance in attention and memory tasks.
Repeated assessments are a relatively common occurrence in clinical neuropsychology. The current paper will review some of the relevant concepts (e.g., reliability, practice effects, alternate forms) ...and methods (e.g., reliable change index, standardized based regression) that are used in repeated neuropsychological evaluations. The focus will be on the understanding and application of these concepts and methods in the evaluation of the individual patient through examples. Finally, some future directions for assessing change will be described.
Forensic neuropsychology derived from clinical neuropsychology. This area not only relies on neuropsychological approach and practice and principals of brain structure and functions, but also on the ...contribution of diagnostic methods of brain visualization (neuroimaging). In the last decade, large number of books that deal with this topic has been published, mostly by American authors, just as a Journal of Forensic Neuropsychology dedicated to this field has started issuing. There are more and more demands in the world from judges and lawyers that neuropsychologists should provide services of quantifying and evaluating the severity of cognitive deficits of respondents. In most cases, it is being asked of neuropsychologist to provide expertise based on clinical observation and results of neuropsychological examinations about the connection of individual cognitive functioning and behavior and special brain localization, as well as to provide the evaluation of the level of cognitive impairments. Unfortunately, official educational and training program in this field doesn’t exist in Serbia, so a specific license is not required. Also, there is a lack of professional organization that would gather forensic neuropsychologists. Practitioners that firstly obtained the status of graduated psychologists and then were educated in the field of clinical neuropsychology are the ones who deal with this area. In our country the role of forensic neuropsychologist is still not recognised enough, just as the possible significance these experts might have in judicial processes isn’t. Topics that are being most focused on in the scope of forensic neuropsychology are ethical questions, the evaluation of validity of symptoms with special emphasis on evaluating effort that is being put on examination and the presence of potential malingering, There are significant differences between clinical and forensic neuropsychology. Clinical neuropsychology determines the presence of impairment in cognitive functioning, while the main goal of forensic neuropsychology is to provide answers to the legal questions. That key difference between goals leads to different presumptions, roles, alliances and methods. The results of clinical and forensic examinations are demanded and used by different scientists. Clinical evaluation is mostly demanded by experts who deal with treating and rehabilitating people with neuropsychological impairments or brain injuries, while forensic evaluation is being demanded and used by legal institutions. Efficient use of neuropsychological principles as an answer on forensic questions requires clinical skills, critical thinking and close connection to the scientific principles. With double focus on clinical psychology and neurology, neuropsychologists can contribute to the legal system not only by their understanding of neuro-anatomy and neuropathology, but also with their capability to objectively document how neuropathological conditions affect thinking, memory and decision making process, which is, by far, the most important.
Objective: As the coronavirus pandemic extends across the globe, the impacts have been felt across domains of industry. Neuropsychology services are no exception. Methods for neuropsychological ...assessments, which typically require an in-person visit, must be modified in order to adhere to social distancing and isolation standards enacted in an effort to slow the pandemic. How can providers continue to meet the needs of patients referred for neuropsychology evaluations, while respecting federal and state guidelines for safety and ethical mandates? We offer a novel, tiered model of care, successfully implemented in response to mandated social distancing, in a large, pediatric neuropsychology program.
Method: We describe the considerations and challenges to be addressed in transitioning a large neuropsychology department to a new model of care, including triaging referrals, developing -or rediscovering - types of services to meet the needs of a virtual patient population, and helping patients, parents, and providers to adjust to these new models.
Conclusions: Lessons learned as a function of rapid changes in care models have implications for the field of neuropsychology as a whole as well as for future flexibility in meeting the needs of pediatric patients and their families.
Abstract
BACKGROUND: Due to regular hospital check-ups, inpatient treatments, or a weakened immune system, children with brain tumors experience frequent and long absences from school and social ...activities. Returning to school presents a challenge for these patients, as they experience reduced health-related quality of life (HRQOL), decreased sense of belonging and a lack of social inclusion in class. To prevent social and emotional problems, telepresence systems such as the Avatar AV1 are described as promising approach for pediatric patients. OBJECTIVES: To sustainably improve social inclusion in times of illness-related absence for these patients, the first study in Austria investigating effects of the use of the Avatar is pursuing both, a qualitative and quantitative approach. METHODS: To examine effects on social inclusion, sense of belonging and HRQOL in pediatric patients, interviews were conducted with patients, their parents, teachers and classmates within the qualitative approach and questionnaires were administered at three times (before -, after 6 months Avatar-use and 3 months after returning the Avatar) within the quantitative approach. The sample consists of pediatric patients (6 to 18 years). RESULTS: Categories from n=24 interviews indicate that a positive attitude towards and identification with the Avatar as well as the patients’ psychological condition and social inclusion into class before the illness play major roles. Preliminary findings from the ongoing longitudinal quantitative survey indicate that the Avatar has significant positive and stabilizing effects on HRQOL, sense of belonging and social inclusion of pediatric patients. CONCLUSION: This study is the first to describe the impact of Avatar use on social inclusion in children with brain tumors. To strengthen the sense of belonging in these children, the pedagogical-interactional component needs to be brought in focus. Through pedagogical-didactical adaptions, a routine handling of and a positive attitude towards the telepresence system, pediatric patients highly benefit from the Avatar.
Abstract
PURPOSE: Children treated for medulloblastoma (MB) undergo intensive multimodality treatment compromising surgery, irradiation, and chemotherapy, which is associated with a significant risk ...of neurocognitive deficits. Successive multicenter frontline treatment protocols have introduced reduced posterior fossa boost margins for cranial irradiation for sparing collateral tissue and preserving function. This study examines neurocognitive outcomes in the setting of reduced primary site target volume margins in children treated for MB. PATIENTS & METHODS: Prospective longitudinal neurocognitive data were collected from newly diagnosed patients with MB (n = 372, ages 3-21 years) enrolled on one of two sequential multicenter clinical protocols between 1996 and 2012. The treatment regimen included surgery, risk-adapted craniospinal irradiation with a posterior fossa boost with restricted clinical target volume (CTV) margins (2 cm and 1 cm), and dose-intensive chemotherapy. Comparative analysis of neurocognitive outcomes was performed using linear mixed-effects models. RESULTS: Intelligence quotient (IQ) scores were better preserved in average-risk patients who received treatment using a clinical target volume with a lesser margin of 1 cm (p < 0.0099). Findings were consistent with prior studies on measures of academics including reading performance, mathematical reasoning, and spelling across both risk groups regardless of CTV. CONCLUSION: This study presents compelling evidence in favor of restricted CTVs for preserving IQ without sacrificing treatment efficacy in average childhood MBs.
Abstract
INTRODUCTION: Procedural memory (PM) is a skill learning system that allows, through training, the automatization of procedures and progressive improvement of performances. The aim of this ...work was to explore the impact of a posterior fossa tumor (PFT) on PM. We hypothesized that motor adaptation, depending on cortico-cerebellar system, was impaired in PFT survivors treated with and without radiotherapy, and motor sequence learning, depending on cortico-striatal system, was only impaired in PFT treated with radiotherapy. METHODS: We investigated PM in 60 participants from the IMPALA study (NCT04324450) divided into three groups: 39 cured from a PFT in childhood (22 irradiated (PFT+RT group) and 17 non-irradiated (PFT group)) and 21 healthy volunteers (Control group) matched on age, sex and handedness with the PFT+RT group. We used a visuo-motor learning test, the Serial Reaction Time task (SRTT) and a motor adaptation task (MAT) of backwards handwriting. ANOVA and mixed models were used for statistical analysis. RESULTS: SRTT performance analysis showed an effect of Block in specific sequence learning (F(1)48.70,p<0.001) with a preserved specific learning in the three groups. However individual differences were observed with 7/22 patients in PFT+RT group and 4/17 in PFT group who did not have specific learning. MAT performance analysis showed an effect of interaction between Orientation (forward or backward) and Group for speed (F(2)15.58,p<0.001), linearity (F(2)8.39,p<0.001) and amplitude standard deviation (F(2)15.70,p<0.001) traducing an impairment both in PFT+RT and PFT groups, more marked in the PFT+RT group. CONCLUSION: We showed impairment, predominantly on motor adaptation but also, at individual level, in motor sequence learning whose origin requires additional work. This study brings new insights on the long-term impact of a PFT in childhood on a rarely investigated part of memory that is PM.
Abstract
BACKGROUND AND AIMS: Pediatric brain tumors are the second most common type of pediatric cancer, and these patients face the worst health related quality of life (HRQOL) outcomes. Adult ...studies show increased inflammation association with lower HRQOL in adult brain tumor survivors. This relationship has not been explored in pediatric brain tumor survivors (PBTS). We conducted a case-control study to explore the relationship between inflammatory biomarkers and psychological sequela (i.e., sleep disturbance, fatigue, pain, negative affect) in PBTS. METHODS: Survivors aged 7-14 years with a primary brain tumor diagnosis were recruited from UMMC (N=29) and UAB (N=4) between 2016-2019. A control group (N=12) was recruited from UMMC well-child appointments. Parents and children completed self-reported surveys of pain, sleep, fatigue, and mood. The primary aims were to: (1) examine levels of C-reactive protein (CRP) inflammation in PBTS compared to controls (2) examine if higher CRP and SOX2 (from tumor tissue) were associated with psychological sequela. Independent samples T-Tests and spearman correlations evaluated aims. RESULTS: The final sample included 33 PBTS: median age=12.42 years; sex=51.5% female; race=63.6% Caucasian, 33.3% African American; pathologic diagnoses=67% astrocytoma/glioma, 11% medulloblastoma, 6% ependymoma, 12% other. Twelve controls had a median age=11.98 years; sex=41.7% female; race=16.7% Caucasian, 83.8% African American. There were marginal elevations in CRP for PBTS (44%, n=13) compared to controls (13%, n=1) (p=0.06). In PBTS, higher CRP levels were associated with greater parent-reported fatigue (p=0.035), sleep-wake disorders (p=0.017), excessive somnolence (p=0.042) and longer pain duration (p=0.037). From 13 tumor samples, positive SOX2 (69% of samples) was associated with increased parent-reported sleep-wake disorders (p=0.016), excessive somnolence (p=0.036), and both child and parent-reported sleep disturbance (child: p=0.014; parent: p=0.034). CONCLUSIONS: Elevated inflammation in PBTS, up to 9 years post-treatment, is consistently associated with increased sleep disturbance and fatigue. These relationships warrant further investigation in PBTS.
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