Principles of Integrated Cognitive Training for Executive Attention: Application to an Instrumental Skill.

One effective cognitive treatment is the rehabilitation of working memory (WM) using an integrated approach that targets the "executive attention" system. Recent neuroscientific literature has revealed that treatment efficacy depends on the presence of various features, such as adaptivity, empathy, customization, avoidance of automatism and stereotypies, and alertness activation. Over the last two decades, an Integrated Cognitive Training (ICT) protocol has been proposed and developed; ICT takes the above-mentioned features and existing literature into account, and has been used to promote the development of reading skills. ICT has been employed in several clinical settings and involves stimulation of a specific deteriorated system (e.g., reading) and the improvement of executive attention components, thus also increasing working memory capacity. In this context, we present two experiments. In Experiment 1, participants diagnosed with dyslexia (aged between 8 and 14 years) underwent two ICT sessions a week, with home supplements, for a duration of 7 months. The participants showed a significant improvement in the reading speed of text, words, and non-words, and in the reading accuracy of text and non-words. In Experiment 2, we replicated Experiment 1, but included a comparison between two groups (experimental group vs. control group) of young participants with diagnosis of dyslexia. The experimental group was subjected to 18 ICT sessions twice a week and with home supplements, using the same protocol as in Experiment 1. The control group was entrusted to the protocol of compensatory tools and dispense/helping procedures provided by the scholastic Personalized Educational Plan. After training, the experimental group gained about 0.5 syllables per second in text reading, and a marked decrease in error rate. The control group showed no significant improvement in reading skills after the same period. Moreover, the improvement observed in the experimental group remained stable 4 months after ICT had ended. The results of these two experiments support the efficacy of the integrated ICT protocol in improving reading skills in children with dyslexia and its sustained effect.

Time-frequency analyses of reaction times and theta/beta EEG ratio in pediatric patients with traumatic brain injury: A preliminary study.

PURPOSE: The literature on patients with attention deficit reports peculiar reaction time (RT) oscillation at very low frequencies (VLFO=0.06-0.2 Hz). The data were explained as default mode network (DMN) intrusion in goal-oriented activity. The present study investigates whether a pattern of recurrent lapses in attention can be detected in TBI patients and whether VLFO can be generalized to the sustained attention deficit, regardless of etiology. METHODS: Groups of pediatric TBIs and healthy controls performed four attentional tasks. RT and theta/beta timeseries were subjected to wavelet analyses. RESULTS: Significant high-power VLFOs were recorded in patient group performances but not in those of controls, both for RTs and theta/beta in all the tasks. CONCLUSION: This preliminary study suggests that central-midline theta/beta ratio could be considered a neurophysiological correlate of RT variability and that the general continuous goal-oriented activity can be cross-etiologically affected by recurrent lapses in attention regardless of the specific cognitive component involved.

Neuropsychological profile in new-onset benign epilepsy with centrotemporal spikes (BECTS): Focusing on executive functions.

PURPOSE: Increased evidence of subnormal neuropsychological functioning in new-onset childhood epilepsy has been obtained, although results are still rare and controversial. With a prospective study, we aimed to define the very early neuropsychological profile of children with benign epilepsy with centrotemporal spikes (BECTS), including executive functions (EF) because of their key role in learning. Additionally, we enrolled drug-naïve children, with a NREM sleep frequency of discharges <85% and with a Performance Intelligence Quotient equal or superior to 85, in order to exclude additional effects on the neuropsychological functioning. METHODS: Fifteen school-aged children with BECTS (mean age: 8.8years, standard deviation [SD]: 2.4years) and fifteen healthy children (mean age: 9.2years, [SD]: 2.5years) were enrolled and assessed with a comprehensive neuropsychological battery. The assessment included domain-specific standardized tests of language, EF, academic skills, visuomotor and visuospatial skills, and short-term memory. A p-value<0.05 was considered significant. RESULTS: Significant differences between patients and controls emerged with respect to 3 domains. Language was affected in color naming (p=.026), spoonerism (p=.003), and phonemic synthesis (p=.009). Executive functions appeared inadequate in the five point test with respect to the number of correct figures (p=.003) and errors (p=.008). In the domain of academic skills, significant differences between groups emerged regarding the number of mistakes in nonword writing (p=.001), nonword reading speed (p=.027), nonword reading number of mistakes (p=.019), and word reading errors (p=.023). DISCUSSION: Results showed that children with new-onset BECTS may demonstrate a range of neuropsychological dysfunctions, particularly affecting executive attention, despite a normal IQ, a low frequency of NREM sleep discharges, and the absence of drugs. These difficulties indicate a frontal dysfunction with cascading effects on language and academic skills. The inclusion of EF in the assessment battery and in the intervention since the very onset is warranted in order to avoid further and persistent academic difficulties.