National Guidelines for Cognitive Assessment and Rehabilitation of Iranian Traumatic Brain Injury Patients.

BACKGROUND: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran. METHODS: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients' conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2). RESULTS: A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation. CONCLUSION: Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system.

Is Emotion Recognition Related to Core Symptoms of Childhood ADHD?

OBJECTIVE: Children with attention deficit/hyperactivity disorder (ADHD) have some problems in social relationships which may be related to their deficit in recognizing emotional expressions. It is not clear if the deficit in emotion recognition is secondary to core symptoms of ADHD or can be considered as an independent symptom. This study aimed to evaluate the ability of detecting emotional faces and its relation to inattention and hyperactivity-impulsivity in children with ADHD compared to a typically developing (TD) group. METHODS: Twenty-eight boys diagnosed as having ADHD, aged from seven to 12 years old were compared to 27 TD boys using a computerized Facial Emotion Recognition Task (FERT). Conners' Parent Rating Scale (CPRS) and Continuous Performance Test II (CPT II) were also administered to assess the severity of inattention and impulsivity. RESULTS: The percentages of angry, happy and sad faces detected by children with ADHD were significantly lower (p<0.05) compared to the control group. The time spent in recognizing happy faces was higher in the ADHD group (p=0.04). The sequential regression analyses showed a significant association between angry and sad targets recognition and inattention (P<0.05), as well as between oppositionality and angry faces detection (P<0.05) when hyperactivity-impulsivity was added to the model. CONCLUSION: It can be concluded that children with ADHD suffer from some impairments in recognizing angry, happy and sad faces. This deficit may be related to inattention and hyperactivity-impulsivity.

OBJECTIF: Les enfants souffrant du trouble de déficit de l'attention avec hyperactivité (TDAH) ont des problèmes de relations sociales qui peuvent être liés à leur déficit de reconnaître les expressions émotionnelles. Il n'est pas déterminé si le déficit de reconnaissance des émotions est secondaire aux symptômes de base du TDAH ou s'il peut être considéré comme étant un symptôme indépendant. Cette étude visait à évaluer la capacité de détecter les expressions émotionnelles faciales et sa relation à l'inattention et à l'hyperactivité-impulsivité chez les enfants souffrant du TDAH comparativement à un groupe au développement typique (DT). MÉTHODES: Vingt-huit garçons de 7 à 12 ans ayant reçu un diagnostic de TDAH ont été comparés avec 27 garçons au DT à l'aide du test informatisé de reconnaissance des émotions faciales (FERT). L'échelle d'évaluation des parents (CPRS) et le test de performance continu II (CPT II) de Conners ont aussi été administrés pour évaluer la gravité de l'inattention et l'impulsivité. RÉSULTATS: Les pourcentages de visages fâchés, heureux et tristes détectés par les enfants souffrant du TDAH étaient significativement plus faibles (p < 0,05) que ceux du groupe témoin. Le temps passé à reconnaître les visages heureux était plus élevé dans le groupe du TDAH (p = 0,04). Les analyses de régression séquentielle indiquaient une association significative entre la reconnaissance des visages fâchés et tristes et l'inattention (P < 0,05), ainsi qu'entre l'oppositionnalité et la détection des visages fâchés (P < 0,05) quand l'hyperactivité-impulsivité était ajoutée au modèle. CONCLUSION: Il est possible de conclure que les enfants souffrant du TDAH présentent un déficit de reconnaissance des visages fâchés, heureux et tristes. Ce déficit peut être lié à l'inattention et à l'hyperactivité-impulsivité.

Understanding intentionality in children with attention-deficit/hyperactivity disorder.

One of the main aspects of theory of mind is intentionality which refers to recognizing other people's intentions in their behaviors. The aim of this study was to investigate intentionality in children with attention-deficit/hyperactivity disorder (ADHD). Thirty children with ADHD were compared to thirty age- and IQ-matched normal children. All participants were assessed using the moving shapes paradigm task which contains one large red and one small blue triangle moving around a black screen. They were asked to describe what the movements mean and how the triangles interact with each other. The answers were rated based on the accuracy, type of descriptions applied, mental states, and length of phrases. With regard to intentionality score, children with ADHD performed significantly worse than normal children (P < .05). Based on appropriateness score, the accuracy of patients' answers was lower in comparison with the control group. Children with ADHD used longer phrases as compared to controls. Children with ADHD can have problems with comprehending others' intentionality. This leads to impairment in social relationship.