Status of Clinical Neuropsychology Training in Finland.

This paper provides information on different training models within clinical neuropsychology in Finland. Systematic specialization training program began in Finland in 1983. It was first organized mainly by the Finnish Neuropsychological Society and since 1997 by the Finnish universities. At present, close to 400 clinical neuropsychologists have completed the training. The number of professionals still does not cover the needs of the country (population 5.5 million, area 338,440 km2), and geographical disparities are a constant concern. The training models in Finland have changed over the years and will continue to evolve. Specialization training can be organized by national societies or by universities. It can lead to an academic degree or a diploma. It can be linked to doctoral studies or form a parallel track. Financial model can involve student fees or be governed by ministries (such as the Ministry of Education or Ministry of Health). This paper describes and compares different strategies in education that have impact on the output of professionals. One model does not fit all, or even one country at all times. The strategies of the stakeholder ministries can change over time. The experiences from Finland can be useful for other countries that are developing their models. The estimated need of practitioners and the educational resources including the available financial models for training differ between countries. The guiding principles in specialist training should focus on the advanced competencies expected from the neuropsychologist when entering the profession.

Finnish diabetes-related quality of life questionnaire for children and adolescents: Reliability and validity.

AIM: To study the psychometric properties, reliability and validity of the FinDiab quality-of-life questionnaire (FDQL), a strength-oriented quality-of-life (QOL) questionnaire for children and adolescents with type 1 diabetes (T1D). METHODS: Participants were 215 youths with T1D (aged 10-17 years). They completed FDQL and comparison questionnaires (KINDL-R and SDQ). Demographic and disease measures were collected from the participants' medical records. The questionnaire's psychometric properties were investigated. Construct validity was studied through principal component analysis using Promax rotation, reliability with alphas, and criterion and convergent validity with correlations between sum scale, subscales, demographic and disease factors, and comparison measures. RESULTS: FDQL demonstrated an adequate range of measurement and feasibility. The four-factor solution was found to be optimal, resulting in the subscales of flexibility with diabetes, well-being, social relations and health behaviour. The sum scale correlated significantly with glycaemic control and the psychosocial and QOL comparison measures. Construct, criterion and convergent validity of the subscales was also good. Children under 14 years of age reported better QOL than older adolescents. CONCLUSION: FDQL is a practical QOL assessment method focusing on strengths. The questionnaire has good validity and reliability and is easy to use as a clinical tool.

Social competence group intervention (SOCO) for children with autism spectrum disorder: A pilot study.

This study aimed to describe concept of social competence as a theoretical background for social skills group intervention for children with autism spectrum disorder (ASD). A model of social competence comprised of three components: social skills, social performance, and social adjustment. We also examined the feasibility and preliminary efficacy of the manualized Social Competence group intervention for children with autism spectrum disorder (SOCO) using a variety of outcome measures. The nine-month intervention included children groups, parental support groups and co-operation with teachers. A pilot study involved 23 children aged 7 to 12 years (n = 16 intervention, n = 7 control) and intervention outcomes were measured with questionnaires for parents and teachers, neuropsychological tests, and observations. The parents of the intervention group reported improvements in social skills and social adjustment, whereas the teachers reported increases in social performance. Findings also indicated that affect recognition skills, social overtures, and reactions to peers were improved in the intervention group. Although the evidence of the pilot study should be considered as preliminary, it gives some indication of the feasibility of the SOCO group intervention and supports the usability of the theoretical background and approach for multiple outcome measures.

Neurobehavioral Outcomes in School-Aged Children with Primary Snoring.

OBJECTIVE: We assess behavioral and attentional problems and neurocognitive functioning in school-aged children with primary snoring (PS). METHODS: Seventeen children with PS and 27 non-snoring peers aged 6-10 years took part in the study. All children underwent a polysomnography (PSG) at the Sleep Laboratory. Snoring was defined by parents and with PSG. Children with obstructive sleep apnea were excluded. The parents completed the Sleep Disturbance Scale for Children. Parents and teachers assessed behavioral and attentional problems with the Child Behavior Checklist and the Conners' Rating Scale-Revised. Neuropsychological assessment included the Wechsler Intelligence Scale for Children and the Developmental Neuropsychological Assessment (NEPSY test). RESULTS: The PS group had significantly more parent-reported internalizing, total, and attentional problems than the control group. Teachers did not report behavioral problems in the PS group. The PS and control groups had equal IQ scores and similar core neurocognitive functions, except for one visuospatial subtest. The PS group had significantly more inspiratory flow limitation and increased diaphragmatic electromyography compared with the controls. Parents reported significantly more daytime sleepiness in the PS group. Daytime sleepiness and snoring time were consistently associated with more behavioral and attentional problems. Flow limitation and more oxygen saturation values under 90% were associated with attentional problems, higher oxygen desaturation index, and lower mean oxygen saturation percentage with reduced language functions. CONCLUSIONS: Snoring with an increase in respiratory effort without apneas and hypopneas and parent-reported daytime sleepiness may be linked to daytime symptoms. School-aged children with PS are at risk for behavioral and attentional problems, but not cognitive impairments.

Neuropsychological group rehabilitation on neurobehavioral comorbidities in children with epilepsy.

Neurobehavioral comorbidities, particularly attention-deficits, are common in children with epilepsy (CWE). Neurobehavioral problems are manifested in school performance, peer relations, and social competence. Although the high prevalence of these comorbid behavioral problems is fully recognized, there remains to be a lack of studies on the interventions targeted for CWE. A manualized neuropsychological group intervention, Rehabilitation of EXecutive Function and ATtention (EXAT) has been developed for school-aged children (aged 6-12 years) with executive function (EF) and attention-deficits. This study aimed to explore the effects of EXAT on parent- and teacher-rated attention and behavior problems in CWE compared with children with the diagnosis of attention-deficit hyperactivity disorder (ADHD) and children with no formal diagnosis but prominent deficits in EF and attention. Forty-two children attending in neuropsychological group rehabilitation EXAT between the years 2006 and 2017 participated in this retrospective registry study. The CWE group consisted of 11 children, the ADHD group with 16 children, and EF/attention group consisted of 15 children with EF attention and/or problems without diagnosis of ADHD. The CWE group did not differ from the other two study groups (ADHD and no formal diagnosis) before the EXAT intervention. This indicates that attention problems in CWE are similar to those with diagnosed ADHD. The results were promising for applying structured multilevel intervention for CWE and neurobehavioral comorbidities. Lack of group differences between the groups participating EXAT suggests similar intervention effects between CWE, ADHD, and those with less severe EF and attention problems. In parent ratings, intervention effects were higher in hyperactivity and oppositional behavior for children with attention problems and without epilepsy. Parents in the CWE group reported no effects except for one subscale related to hyperactivity. However, teachers reported consistently positive intervention effects for both inattention and hyperactivity-impulsivity along with anxiety and emotional lability. The results suggest that neurobehavioral comorbidities in CWE could be targeted in neuropsychological group intervention. In conclusion, CWE seem to benefit from interventions and behavior modification techniques first developed for children with ADHD.

Effects of the EXAT neuropsychological multilevel intervention on behavior problems in children with executive function deficits.

This is a clinical intervention study of children with executive function (EF) deficits. A neuropsychological multimodal group intervention called EXAT (rehabilitation of EXecutive function and ATtention) was developed at the Psychology Clinic of the University of Tampere. Based on the principles of neuropsychological rehabilitation and behavioral modification, EXAT combines child group training, parent training, and teacher consultations. The aims of this study were to investigate behavior problems before and after the intervention in children attending EXAT and in controls, and to compare intervention effects in hyperactive, inattentive, and EF subgroups based on the primary deficit described in the referral. The participants were 86 children (6-12 years) with a mean IQ of 91.4 attending EXAT and 45 controls. The participants' parents and teachers completed the Conners' Rating Scales-Revised. In addition, the Strengths and Difficulties Questionnaire was completed by the parents attending EXAT. The parents reported statistically significant decreases with medium effect sizes for the CPRS-R subscales for impulsivity, hyperactivity, and oppositional behavior. In the controls within the same time interval, there was increase in restless and impulsive behavior, and a decrease in total problems. The teachers reported positive changes after the intervention in ADHD symptoms and anxiousness/shyness, but the effects sizes were small. The intervention effects were larger in the hyperactive subgroup. Positive intervention effects were related to a younger age, lower IQ, and simultaneous learning support. In conclusion, EXAT - a structured multilevel group intervention - has positive effects on children's behavior regulation skills by decreasing impulsivity and restless behavior.

Cognitive impairment in preschool children with epilepsy.

PURPOSE: Studies have shown that underlying pathology and early onset of seizures are both significant factors contributing to cognitive impairment in children with epilepsy. However, there are only few studies focusing on cognitive impairment in preschool children with epilepsy. The purpose of this study was to describe the cognitive performance in a population-based cohort of preschool children with epilepsy. The aims of the study were to determine frequency of cognitive impairment, level of cognitive functions, and epilepsy-related factors correlating with cognitive impairment. METHODS: The study group consisted of a population-based cohort (N = 64) of preschool children (3-6 years 11 months) with active epilepsy. Medical data and results from previous psychological evaluations were reviewed retrospectively from the medical records. A logistic regression model was used for the prediction of cognitive impairment. KEY FINDINGS: Prevalence of epilepsy was 3.2 per 1,000 children. Cognitive function was considered to be within normal or borderline range for 50%, mildly retarded for 22%, and moderately to severely retarded for 28%. Cognitive impairment was related to complicated epilepsy, age at onset of epilepsy, abnormal magnetic resonance imaging (MRI), and additional neurologic problems. Age at the onset of seizures was the only significant predictor of cognitive impairment. SIGNIFICANCE: The results concur with those of earlier studies on cognitive impairment in childhood epilepsy. Age at onset of epilepsy is also an important factor for cognitive impairment on young children with epilepsy. The results suggest that cognitive impairment is evident early in the course of epilepsy.

Executive functions in youth with spastic cerebral palsy.

Dependent on criteria used, between 35% and 53% of the participants with cerebral palsy fulfilled the criteria of clinically relevant executive function problems as defined by Conners' (1994) Continuous Performance Test. Executive function problems were noticed mainly in participants with bilateral brain lesions and who had been born preterm. Findings highlight the need to check for attention problems in children with cerebral palsy.

Neurocognitive functioning of preschool children with uncomplicated epilepsy.

Only few studies are available on the cognitive functioning of preschool children with uncomplicated epilepsy. The aim of this study was to describe the neurocognitive functioning of 3-6-year-old children with uncomplicated epilepsy. A subgroup of children with uncomplicated epilepsy from a population based cohort of preschool children with active epilepsy (N=64) participated in the study. The neurocognitive functioning of these children (N=13) was compared to that of matched healthy controls (N=13). The Wechsler's Primary and Preschool Scale of Intelligence - Revised and the Developmental Neuropsychological Assessment were administered. The intellectual functioning of the children with uncomplicated epilepsy was within normal range, but differed significantly from that of healthy controls, which was contrary to expectations. Statistically significant differences emerged between the study and the control group in Verbal IQ and Full Scale IQ, but no differences were found in Performance IQ. The children with uncomplicated epilepsy also had minor neurocognitive difficulties in verbal short-term memory (p<.01) compared to healthy children. The result suggests that uncomplicated epilepsy in preschool children may interfere with language and verbal short-term memory functions. Further studies with detailed neuropsychological assessments and follow-up time are needed to gain more insight into the developmental course of children with uncomplicated epilepsy. Also, because of the developmental risks reported in this study, psychological screening and detailed neuropsychological assessment are recommended in clinical practice.