Autism Spectrum Disorder in Children with an Early History of Paediatric Acquired Brain Injury.

Autism spectrum disorder (ASD) is a neurodevelopmental condition that arises from a combination of both genetic and environmental risk factors. There is a lack of research investigating whether early acquired brain injury (ABI) may be a risk factor for ASD. The current study comprehensively reviewed all hospital records at The Brain Injury Service, Kids Rehab at the Children's Hospital at Westmead (Australia) from January 2000 to January 2020. Of the approximately 528 cases, 14 children with paediatric ABI were subsequently given an ASD diagnosis (2.7%). For this ASD sample, the mean age at the time of the ABI was 1.55 years, indicating a high prevalence of early ABI in this diagnostic group. The mean age of ASD diagnosis was, on average, 5 years later than the average ASD diagnosis in the general population. Furthermore, 100% of children had at least one medical comorbidity and 73% had three or more co-occurring DSM-5 diagnoses. Although based on a small data set, results highlight early paediatric ABI as a potential risk factor for ASD and the potential for a delayed ASD diagnosis following early ABI, with comorbidities possibly masking symptoms. This study was limited by its exploratory case series design and small sample size. Nonetheless, this study highlights the need for longitudinal investigation into the efficacy of early screening for ASD symptomatology in children who have sustained an early ABI to maximise potential intervention.

A randomized controlled trial of cognitive behavioural therapy for managing anxiety in adolescents with acquired brain injury.

The aim of this randomized controlled trial was to evaluate an adapted cognitive behavioural therapy (CBT) programme for treating anxiety in adolescents with acquired brain injury (ABI). Participants with ABI (12-19 years, N = 36) recruited from two sites were randomly allocated into either the intervention receiving 11 sessions of CBT (n = 19) or a wait-list control group (n = 17). The primary outcome was participants' anxiety and secondary outcomes were participants' depression, self-perception, and participation in daily activities, and parental stress, measured at (i) pre-intervention, (ii) immediately post-intervention, (iii) 2 months post-intervention and (iv) 6 months post-intervention. Repeated measures ANOVAs revealed significant treatment effects with the intervention group demonstrating greater improvements in self-reported anxiety, as well as self- and parent-reported depression from pre- to immediately post-treatment, compared to wait-list controls. Little evidence of treatment effects was found for the remaining outcomes (parent-reported anxiety, self-perception, daily participation, and parental stress). Significant improvement in self-reported anxiety found immediately post-treatment was maintained at two- and six-month follow-up. Findings provide support for adapted CBT as an effective means of reducing anxious and depressive symptomatology in adolescents with ABI compared to waitlist controls, and offer support for the use of these techniques to manage anxiety in this population..

Time-based prospective memory in children and adolescents with traumatic brain injury: Impact of working memory demands.

OBJECTIVE: Difficulties with prospective memory are frequently reported following pediatric traumatic brain injury (TBI), but rarely researched. We aimed to (i) investigate time-based prospective memory post-pediatric TBI; (ii) examine whether time-based prospective memory is differentially impacted by the demand placed on working memory; and (iii) explore which components of working memory (viz., central executive, phonological loop, and visuospatial sketchpad) are involved in time-based prospective memory under low and high cognitive load following pediatric TBI. METHOD: Thirty-nine children and adolescents (20 survivors of moderate-severe TBI and 19 healthy controls) completed (i) a newly developed time-based prospective memory task (TBPMT), embedded in an ongoing lexical-decision task, with two conditions: low and high working memory load; and (ii) tests of working memory components from the Automated Working Memory Assessment. RESULTS: Compared to controls, participants with TBI had significantly lower prospective memory accuracy on the TBPMT across working memory loads (low, high). In contrast, the groups did not differ in time monitoring or accuracy on the ongoing task. In the TBI group, higher scores on tests of the central executive (but not phonological loop or visuospatial sketchpad) were associated with higher prospective memory accuracy and time monitoring (controlling for age). CONCLUSIONS: Time-based prospective memory is impaired following moderate-severe pediatric TBI, irrespective of the level of working memory demand. Our findings suggest that children and adolescents with TBI may be at risk of failing to perform future intentions at the right time in daily life, especially for individuals identified as having deficits in central executive functioning. (PsycINFO Database Record

The neuropsychological function of children with achondroplasia.

The current observational study had three specific objectives: (i) to document any neuropsychological impairment in a sample of children with achondroplasia; (ii) to explore individual variability; and (iii) to determine the functional impact of any impairments. Fourteen children aged between 6 and 15 years with a medically confirmed diagnosis of achondroplasia (FGFR 3 mutation positive) underwent a comprehensive standardized neuropsychological evaluation. On average, while generally still within normal limits, significantly lower scores compared to standardized means were identified on: Full-scale IQ, verbal IQ, working memory, arithmetic, attention, executive functioning and aspects of day-to-day emotional, social, and behavioral functioning. Clinically significant levels of impairment at a group level were identified on measures of: arithmetic, attention, and executive functioning. There was variability among the group and for most measures scores ranged from impaired to within normal limits. A high percentage of children were impaired on measures of: verbal IQ, attention and executive functioning. Results of this study suggest a need for individual neuropsychological evaluation and monitoring of children with achondroplasia and suggest verbal IQ, arithmetic, attention, and executive functioning are particularly common areas of impairment. © 2016 Wiley Periodicals, Inc.

Computerized Working Memory Training for Children with Moderate to Severe Traumatic Brain Injury: A Double-Blind, Randomized, Placebo-Controlled Trial.

Pediatric traumatic brain injury (TBI) places children at risk for deficits in working memory (WM; comprising a central executive [CE], and two storage systems: phonological loop [PL] and visuospatial sketchpad [VSSP]), which is strongly related to attention and academic skills in childhood. This study aimed to examine whether different components of WM can be improved following adaptive WM training (Cogmed) and whether improvements in WM generalize to other cognitive (attention) and academic skills (reading and mathematics) in children with TBI. Twenty-seven children with moderate to severe TBI were randomized to adaptive (Cogmed; n = 13) or non-adaptive training (active placebo; n = 14) and evaluated at baseline, post-training, and 3-months follow-up. Three children in the adaptive group and one child in the non-adaptive group withdrew from the study before completion of training. Complete case (CC) and intention-to-treat (ITT) analyses were conducted. Children in the adaptive group demonstrated significantly greater gains on select WM tasks (VSSP, but not PL or CE) from pre- to post-training (pre-post) and pre-training to follow-up (pre-follow-up; CC and ITT analyses). No gains were found on tests of attention. Adaptive training resulted in significantly greater gains on select academic skills (reading, but not mathematics): reading comprehension pre-post-training (ITT analyses) and reading accuracy pre-follow-up (CC and ITT analyses). This first, to our knowledge, study to examine the efficacy of adaptive WM training for children with TBI provides preliminary evidence of near and far transfer of training to WM and academic skills, respectively.

Understanding and motivating health care employees: integrating Maslow's hierarchy of needs, training and technology.

AIM: This paper applies Maslow's Hierarchy of Needs Model to the challenges of understanding and motivating employees in a rapidly changing health care industry. BACKGROUND: The perspective that Maslow's Model brings is an essential element that should be considered as the health care arena is faced with reorganization, re-engineering, mergers, acquisitions, increases in learning demands, and the escalating role of technology in training. EVALUATION: This paper offers a new perspective related to how Maslow's Model, as used in business/organizational settings, can be directly related to current workforce concerns: the need for security and freedom from stress, social belongingness, self-esteem, self-actualization, altered work/social environments, and new opportunities for learning and self-definition. KEY ISSUES: Changes in health care will continue at an accelerated pace and with these changes will come the need for more and more training. The use of technology in training has heightened access, faster distribution, innovation and increased collaboration. However, with this technology come attendant challenges including keeping up with the technology, the increased pace of training, depersonalization, and fear of the unknown. The Maslow model provides a means for understanding these challenges in terms of universal individual needs. CONCLUSION: How does one motivate employees in the face of increased demands, particularly when they are being asked to meet these demands with fewer resources? The answer is, in large part, to make the employee feel secure, needed, and appreciated. This is not at all easy, but if leaders take into consideration the needs of the individual, the new technology that provides challenges and opportunities for meeting those needs, and provides the training to meet both sets of needs, enhanced employee motivation and commitment is possible.